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Allergic Rhinitis – Causes, Symptoms & Treatment

Allergic rhinitis is an inflammatory condition of the nasal mucosa triggered by allergens such as pollen or house dust. It causes sneezing, a runny nose, and itching.

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Things worth knowing about "Allergic Rhinitis"

Allergic rhinitis is an inflammatory condition of the nasal mucosa triggered by allergens such as pollen or house dust. It causes sneezing, a runny nose, and itching.

What is Allergic Rhinitis?

Allergic rhinitis is an inflammatory condition of the nasal mucosa caused by an overreaction of the immune system to otherwise harmless substances known as allergens. It is one of the most common allergic disorders worldwide, affecting both children and adults. When triggered by pollen, it is commonly referred to as hay fever.

Causes

Allergic rhinitis is based on an IgE-mediated hypersensitivity reaction (Type I allergy). The immune system produces antibodies against specific allergens, leading to an exaggerated inflammatory response upon subsequent exposure.

Seasonal allergic rhinitis: Triggered by pollen from grasses, trees, or weeds – typically occurring in spring and summer.
Perennial allergic rhinitis: Caused year-round by house dust mites, pet dander, mold spores, or cockroaches.
Occupational allergic rhinitis: Triggered by workplace allergens such as flour dust or latex particles.

Genetic predisposition, environmental factors, and an altered immune environment (e.g., due to reduced microbial exposure in childhood) are recognized risk factors.

Symptoms

Symptoms typically appear immediately after allergen exposure and can significantly impact quality of life:

Frequent sneezing
Runny or blocked nose (rhinorrhoea or nasal congestion)
Itching of the nose, eyes, throat, or ears
Watery, red eyes (allergic conjunctivitis)
Mouth breathing, sleep disturbances, and difficulty concentrating in prolonged cases

Diagnosis

Diagnosis is based on medical history, physical examination, and specific allergy tests:

Skin prick test: The most common skin test, in which small amounts of allergen extracts are applied to the skin to assess for a reaction.
Specific IgE blood test (RAST): A laboratory test to detect allergen-specific antibodies in the blood.
Nasal provocation test: Controlled application of an allergen directly into the nose under medical supervision.

Treatment

Allergen Avoidance

Where possible, exposure to the triggering allergen should be avoided or reduced. This may include keeping windows closed during high pollen seasons or using allergen-proof covers on bedding to reduce house dust mite exposure.

Pharmacological Treatment

Antihistamines: Block the effects of histamine and relieve sneezing, itching, and runny nose. Available as tablets, nasal sprays, or eye drops.
Nasal corticosteroids: Anti-inflammatory nasal sprays are considered the most effective pharmacological treatment for allergic rhinitis.
Decongestants: Used for short-term relief of nasal congestion.
Leukotriene receptor antagonists: Used particularly in patients with concurrent asthma.

Allergen Immunotherapy (Desensitization)

Allergen immunotherapy (AIT) – also known as desensitization – is the only disease-modifying treatment for allergic rhinitis. It gradually accustoms the immune system to the triggering allergen. It is available as subcutaneous injections (SCIT) or sublingual tablets or drops (SLIT) and is typically carried out over several years.

Complications

Untreated or poorly controlled allergic rhinitis can lead to asthma, chronic sinusitis, middle ear infections, or sleep apnea. Persistent symptoms may also impair academic and professional performance.

References

Bousquet J. et al. - Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines 2020 Revision. Journal of Allergy and Clinical Immunology, 2020.
World Health Organization (WHO) - Allergic Rhinitis: A Global Problem. WHO White Book on Allergy, 2011-2012.
Klimek L. et al. - Guidelines for the Diagnosis and Treatment of Allergic Rhinoconjunctivitis. Allergo Journal International, 2019.

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