Question 1 of 10

    Allergic Rhinitis

    Misc pollen[1]

    Allergic rhinitis is an inflammation of the nasal membranes that presents with any of nasal congestion, itching, sneezing and rhinorrhea or a combination of any or all of them.

    This disorder is the consequence of the following process: auto-immune.

    Presentation

    • Symptoms associated with this condition include pruritus of the nose or palate, rhinorrhea, sneezing, postnasal drip, nasal congestion, anosmia, headache, tearing, eye swelling, red eyes, earache, fatigue, drowsiness and a general feeling of malaise.
    • At presentation, history taking should also involve questions to determine trigger factors, familial history, and comorbid conditions.
    • Physical examination will reveal allergic shiners and nasal crease. The nasal turbinates may be enlarged and there may be erythema of the mucosa. The ears, eyes and neck as well as skin and lungs should be examined.

    Jaw & Teeth
    Halitosis
    • Hoarseness, coughing Runny nose, congestion Decreased sense of smell Sneezing Sore throat, post nasal drip Serous otitis media and hearing loss Snoring and/or worsening of sleep apnea Watery, itchy, or red eyes Coughing, shortness of breath, wheezing Halitosis[theasthmacenter.org]
    • Look for signs suggestive of chronic nasal congestion - mouth breathing, cough, halitosis.[patient.info]
    Mouth Breathing
    • New York, American College of Allergy, Asthma and Immunology, 1990 evidence of allergies such as eczema Mouth breathing Skin testing-pretest probability of allergic rhinitis exceeds treatment threshold for most patients, so treatment without diagnositc[pedclerk.bsd.uchicago.edu]
    • breathing • Snoring • Sinus involvement • Otitis media • Nasal polyps • Conjunctivitis Response to previous medications • Second-generation oral antihistamines • Intranasal corticosteroids Outward signs • Mouth breathing • Rubbing the nose/transverse[aacijournal.biomedcentral.com]
    • It is common to have asthma as well, but the nasal problems often cause more disturbance to the quality of life than the asthma by causing nasal blockage, tendency to sinus infections, snoring, mouth breathing, glue ears from blockage of the Eustachian[allergiesexplained.com]
    • Look for signs suggestive of chronic nasal congestion - mouth breathing, cough, halitosis.[patient.info]
    • Along with a runny nose and reddened eyes, other symptoms may include dark circles under the eyes caused by nasal congestion, the "alleric salute" in which a child rubs a hand along the side of the nose, mouth breathing, sleepiness during the day, and[encyclopedia.com]
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  • Entire body system
    Fatigue
    • These symptoms can lead to poor sleep, which can result in significant daytime sleepiness and fatigue.[sleepfoundation.org]
    • Systemic effects, including fatigue, sleepiness, and malaise, can occur from the inflammatory response.[emedicine.medscape.com]
    • […] or any area Decreased sense of smell Runny nose Sneezing Watery eyes If you have continued exposure to the allergen, other symptoms may also develop, including: Stuffy nose Coughing Clogged ears Sore throat Puffy eyes or dark circles under the eyes Fatigue[medicine.yale.edu]
    • Allergic rhinitis can negatively impact an individual’s quality of life by impairing concentration and causing fatigue and sleep disturbances.[pharmacytimes.com]
    • Poor quality sleep causes daytime sleepiness, fatigue and significant impairment in learning, cognition and professional performance.[scielo.br]
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  • Face, Head & Neck
    Facial Pain
    • If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.[entnet.org]
    • High fever, significantly swollen glands, severe facial pain in the sinuses, and a cough that produces mucus, may indicate a complication or more serious illness requiring a doctor's attention.[nicklauschildrens.org]
    • Common symptoms include: sneezing watery eyes itchy throat itchy nose blocked or runny nose Severe symptoms may include: sweats headaches loss of smell and taste facial pain caused by blocked sinuses itchiness spreading from the throat to the nose and[medicalnewstoday.com]
    • ‘Do you have the following symptoms: one-sided nasal complaints; thick, green or yellow nasal discharge; postnasal drip; facial pain; recurrent nose bleeds; loss of smell?’[mci-forum.com]
    • Signs and Symptoms Allergic rhinitis can cause many symptoms, including: Stuffy or runny nose Sneezing Post-nasal drip Red, itchy, watery eyes Swollen eyelids Itchy mouth, throat, ears, and face Sore throat Dry cough Headaches Facial pain or pressure[umm.edu]
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  • neurologic
    Insomnia
    • It is not uncommon for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening.[acaai.org]
    • Except for cromolyn sodium, which is one of the more expensive treatments on the market, most of these drugs display adverse effects such as dizziness, drowsiness, insomnia, nervousness, and gastro-intestinal disorders.[acupuncture.com]
    • […] blocked or runny nose Severe symptoms may include: sweats headaches loss of smell and taste facial pain caused by blocked sinuses itchiness spreading from the throat to the nose and ears Some people may experience tiredness or fatigue, irritability, and insomnia[medicalnewstoday.com]
    • Side-effects include sedation, dizziness, fatigue, insomnia, nervousness, and gastro-intestinal disturbances.[maciociaonline.blogspot.com]
    • Side effects may include nervousness, racing heart, elevated blood pressure, and insomnia.[health.harvard.edu]
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  • respiratoric
    Anosmia
    • Clinical findings Paroxysms of sneezing, nasal congestion, nasal and ocular pruritus, tearing, rhinorrhoea, anosmia, ageusia, postnasal drip (which may cause coughing), partial or total obstruction of airflow, throat clearing, and allergic periorbital[medical-dictionary.thefreedictionary.com]
    Common Cold
    • *NO TITLE Each year, millions of Americans suffer from one or more episodes of the common cold, flu (influenza), allergic rhinitis , and sinusitis .[nicklauschildrens.org]
    • Blocked sinuses can be caused by the common cold, hay fever or nasal polyps (small lumps inside the nose).[who.int]
    • Symptoms and Complications Most people with allergic rhinitis know they have it, although it can sometimes be confused with the common cold.[medbroadcast.com]
    • It is also known as the common cold or upper respiratory infection (URI).[aafa.org]
    • Most importantly, computed tomography (CT scan) findings have established that the mucosal linings of the nose and sinuses are simultaneously involved in the common cold (previously, thought to affect only the nasal passages).[entnet.org]
    Hoarseness
    • It is rare to be hoarse with allergies and lose your voice," adds Wurster. 3.[collegecentral.com]
    • Allergy symptoms include: Sneezing, watery eyes, or cold symptoms that last more than 10 days without a fever Repeated ear and sinus infections Loss of smell or taste Frequent throat clearing, hoarseness, coughing, or wheezing Dark circles under the eyes[nicklauschildrens.org]
    • Itching of the eyes with redness and watering, headache, intermittent ear plugging, chronic cough, wheezing, intermittent hoarseness, sore throat, and fatigue can also be experienced.[care.american-rhinologic.org]
    • Symptoms include itchy eyes, itchy nose, itchy throat, itchy ears, sneezing, irritability, nasal congestion and hoarseness.[livescience.com]
    • Symptoms Ear, nose, throat, and sinus congestion Hoarseness, coughing Runny nose, congestion Decreased sense of smell Sneezing Sore throat, post nasal drip Serous otitis media and hearing loss Snoring and/or worsening of sleep apnea Watery, itchy, or[theasthmacenter.org]
    Nasal Congestion
    • It is used only when nasal congestion is present and can be used with antihistamines.[en.wikipedia.org]
    • Nasal congestion, which causes the upper airway to narrow, increases the risk of both snoring and OSA among allergic rhinitis patients.[sleepfoundation.org]
    • Nasal congestion and itching.[healthcentral.com]
    • At this level of availability, the quercetin and curcumin in Nasaler will together have an effect on both: the immediate symptoms of allergic rhinitis , the l ater stage nasal congestion .[bioxtract.com]
    • Diagnosis Typically, the patient will present with nasal congestion, runniness, sneezing and/or nasal itchiness.[aaia.ca]
    Nasal Disorder
    • Non-allergic rhinitis is an extremely frustrating sino-nasal disorder that is characterized by all the same symptoms of sinusitis and allergies, but NOT due to sinusitis or allergies.[fauquierent.net]
    Nasal Pruritus
    • Ophthalmic antihistamines (such as azelastine in eye drop form and ketotifen) are used for conjunctivitis, while intranasal forms are used mainly for sneezing, rhinorrhea, and nasal pruritus.[en.wikipedia.org]
    • The symptoms of AR-nasal obstruction, hyaline rhinorrhea, sneezing and nasal pruritus-are reversible (spontaneously or with treatment). (1,2) There is no universally accepted definition for rhinitis.[scielo.br]
    Rhinorrhea
    • , spasmodic rhinorrhea (diagnosis) , seasonal allergic rhinitis , hay fever (diagnosis) , allergic rhinitis due to pollen , hay fever , allergy to pollen , allergy to pollen (history) , Pollen allergy , pollen allergy , allergy to pollens , Rhinitis[fpnotebook.com]
    • Intranasal corticosteroids are used to control symptoms associated with sneezing, rhinorrhea, itching, and nasal congestion.[en.wikipedia.org]
    • Signs are seasonal and occur under warm, moist conditions; they include rhinorrhea, sneezing, and a sudden onset of dyspnea.[merckvetmanual.com]
    • […] include histamine, tryptase, chymase, kinins, and heparin. [8, 9 ] The mast cells quickly synthesize other mediators, including leukotrienes and prostaglandin D2. [10, 11 , 12] These mediators, via various interactions, ultimately lead to the symptoms of rhinorrhea[emedicine.medscape.com]
    • Delves, PhD, Professor of Immunology, Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, UK Click here for Patient Education Allergic rhinitis is seasonal or perennial itching, sneezing, rhinorrhea, nasal[msdmanuals.com]
    Sneezing
    Transverse Nasal Crease
    • This may result in a crease running across the nose (or above each nostril if only one side of the nose is wiped at a time), commonly referred to as the "transverse nasal crease", and can lead to permanent physical deformity if repeated enough.[en.wikipedia.org]
    • Outward signs that may be suggestive of allergic rhinitis include: persistent mouth breathing, rubbing at the nose or an obvious transverse nasal crease, frequent sniffling or throat clearing, and allergic shiners (dark circles under the eyes that are[aacijournal.biomedcentral.com]
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  • Eyes
    Excessive Tearing
    • Eye itching , redness, and excess tears in the eyes frequently accompany the nasal symptoms.[medicinenet.com]
    Ocular Pruritus
    • Clinical findings Paroxysms of sneezing, nasal congestion, nasal and ocular pruritus, tearing, rhinorrhoea, anosmia, ageusia, postnasal drip (which may cause coughing), partial or total obstruction of airflow, throat clearing, and allergic periorbital[medical-dictionary.thefreedictionary.com]
    Red Eye
    • Itchy eyes/ throat Sneezing, blocked/runny nose Watering, red eyes (allergic conjunctivitis) Headaches, blocked sinuses Shortness of breath Tiredness The sensation of mucus running down the back of the throat, which can also be a symptom, is called ‘post-nasal[allergyuk.org]
    • Another difference is that, while seasonal allergic rhinitis often causes red eyes, perennial rhinitis tends to leave the eyes alone.[medbroadcast.com]
    • Symptoms Ear, nose, throat, and sinus congestion Hoarseness, coughing Runny nose, congestion Decreased sense of smell Sneezing Sore throat, post nasal drip Serous otitis media and hearing loss Snoring and/or worsening of sleep apnea Watery, itchy, or red[theasthmacenter.org]
    • Symptoms may include the following: Nose – Watery nasal discharge, blocked nasal passages, sneezing, nasal itching, postnasal drip, loss of taste, facial pressure or pain Eyes – Itchy, red eyes, feeling of grittiness in the eyes, swelling and blueness[uptodate.com]
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  • Ears
    Ear Fullness
    • Symptoms can include: Sneezing Coughing Itching (mostly eyes, nose, mouth, throat and skin) Runny nose Stuffy nose Headache Pressure in the nose and cheeks Ear fullness and popping Sore throat Watery, red or swollen eyes Dark circles under your eyes Trouble[familydoctor.org]
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  • Workup

    • An allergy skin test should be done to check for the immediate hypersensitivity reaction to specific allergens. A limited number of allergens should be used. The total serum IgE could be increased as well as the total blood eosinophil count.
    • Imaging studies like plain radiograph will help to exclude structural abnormalities as well as detect comorbid conditions. CT scan of the sinuses can help in evaluation sinusitis, whether acute or chronic. MRI is useful for checking the soft tissues for features of malignancy.
    • A nasal smear could also be done and may show eosinophilia [7].

    Laboratory

    Serum
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  • Treatment

    The treatment of allergic rhinitis is three pronged.

    • The first is environmental control and avoiding allergens which can be achieved by reducing outdoor exposure, regular washing of bed linens, and avoiding animals [8]. 
    • Second is medications and they include antihistamines, leukotriene receptor antagonists, nasal corticosteroids, and decongestant.
    • The third is immunotherapy which is considered in severe diseases or when there is a poor response to other management options [9].

    Prognosis

    The long term prognosis of allergic rhinitis, if it occurs alone, is good if it has developed early in childhood as symptoms tend to diminish as one gets older. When people with allergic rhinitis have other coexisting disorders, e.g. asthma, the morbidity is increased and mortality is seen in some cases. Although the condition is not considered severe, it causes enough discomfort to interfere with normal daily function.

    Complications

    Adenoid Hypertrophy
    • Rhinoscopy helps identify structural problems such as deviated septum, nasal polyps, ulcer, tumor, adenoidal hypertrophy, granulomatous disease, foreign bodies, infection or sinus disease.[theasthmacenter.org]
    • […] estimated 33% of individuals with rhinitis do not have allergies. 5 These patients are classified as having non-AR, and the causes of symptoms include hormonal changes (eg, pregnancy, puberty, thyroid conditions), structural defects (eg, septal deviation, adenoid[pharmacytimes.com]
    Allergic Conjunctivitis
    • Itchy eyes/ throat Sneezing, blocked/runny nose Watering, red eyes (allergic conjunctivitis) Headaches, blocked sinuses Shortness of breath Tiredness The sensation of mucus running down the back of the throat, which can also be a symptom, is called ‘post-nasal[allergyuk.org]
    • Many people with allergic rhinitis are prone to allergic conjunctivitis (eye allergy).[aaaai.org]
    • Watery, itchy eyes often accompany nasal symptoms, indicating allergic conjunctivitis.[theasthmacenter.org]
    • In some people, these particles also cause reactions in the lungs (asthma) and eyes (allergic conjunctivitis).[uptodate.com]
    Anaphylaxis
    • Manifestations include urticaria or anaphylaxis .[medical-dictionary.thefreedictionary.com]
    • Rarely, the person may have a system-wide immune reaction called anaphylaxis, which can be fatal.[medbroadcast.com]
    • Therefore, injections should be given in a medical clinic where a physician is available to treat possible life-threatening anaphylaxis.[aaia.ca]
    • Anaphylaxis — Also called anaphylactic shock; a severe allergic reaction characterized by airway constriction, tissue swelling, and lowered blood pressure.[encyclopedia.com]
    Chronic Sinusitis
    • If BOTH tests come back normal, one must abandon the diagnosis of chronic sinusitis as well as allergies and consider non-allergic rhinitis as they main culprit.[fauquierent.net]
    • Chronic sinusitis is sinonasal inflammation lasting for more than 12 weeks and can be caused by multiple factors.[hopkinsmedicine.org]
    • Chronic sinusitis may require antibiotics, decongestants or steroid nasal sprays.[who.int]
    • The catalyst relating the two disorders is thought to involve nasal sinus overflow obstruction, followed by bacterial colonization and infection leading to acute, recurrent, or chronic sinusitis.[entnet.org]
    • Chronic sinusitis is subtler, and can be difficult to diagnose.[nicklauschildrens.org]
    Eosinophilia
    • Another type of non-allergic rhinitis is called NARES: Non-allergic rhinitis with eosinophilia.[nyallergy.com]
    • Peripheral eosinophilia can be seen in differential leukocyte count.[en.wikipedia.org]
    • Table 1: Differential Diagnosis of Allergic Rhinitis Vasomotor or irritant rhinitis Chronic sinusitis Nonallergic rhinitis with eosinophilia Gustatory rhinitis Atrophic rhinitis Rhinitis medicamentosa Rhinitis associated with drugs (e.g., antihypertensive[clevelandclinicmeded.com]
    • Some have profuse symptoms with eosinophil cells present in their nasal mucus and this condition is termed Non-allergic Rhinitis with Eosinophilia Syndrome (NARES).[allergy-clinic.co.uk]
    • […] of the nasal mucosa, resulting in eosinophilic and Th2-cell infiltration of the nasal lining • Further classified as intermittent or persistent Autonomic • Drug-induced (rhinitis medicamentosa) • Hypothyroidism • Hormonal • Non-allergic rhinitis with eosinophilia[aacijournal.biomedcentral.com]
    Hay Fever
    Nasal Obstruction
    • Nasal obstruction as a risk factor for sleep-disordered breathing.[scielo.br]
    • Other causes of nasal obstruction.[patient.info]
    • Allergic rhinitis manifests itself in the appearance of at least two symptoms such as nasal obstruction, runny nose, watery eyes, pruritus (itching) POSSIBLE COMPLICATIONS Allergic rhinitis can have a considerable negative effect on quality of life, notably[physiomer.com]
    • The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders.[entnet.org]
    • Systemic corticosteroids are reserved for short-term use in individuals with severe nasal obstruction, when topical sprays cannot penetrate the nasal passageway.[theasthmacenter.org]
    Nasal Polyp
    • Unfortunately, nasal polyps are a common complication of this condition.[nyallergy.com]
    • Nasal Polyps Nasal Polyps develop high up in the nasal cavity and resemble small grapes, occupying the cavity until they eventually protrude from the nostril as shown in the two extreme examples above.[allergiesexplained.com]
    • Surgery is used for patients with persistent sinusitis despite adequate medical therapy and severe nasal polyps caused by chronic inflammation.[hopkinsmedicine.org]
    • Blocked sinuses can be caused by the common cold, hay fever or nasal polyps (small lumps inside the nose).[who.int]
    Obstructive Sleep Apnea
    • Obstructive sleep apnea (OSA), a sleep disorder in which breathing is briefly and repeatedly interrupted during sleep, is linked with allergic rhinitis.[sleepfoundation.org]
    • Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders.[scielo.br]
    Otitis Media
    • Common Symptoms Itching of the nose, eyes, throat Sneezing and stuffiness Watery nasal discharge and post nasal drip Chronic cough Persistent serous otitis media Headache Watery eyes and swelling around the eyes.[pedclerk.bsd.uchicago.edu]
    • Symptoms Ear, nose, throat, and sinus congestion Hoarseness, coughing Runny nose, congestion Decreased sense of smell Sneezing Sore throat, post nasal drip Serous otitis media and hearing loss Snoring and/or worsening of sleep apnea Watery, itchy, or[theasthmacenter.org]
    • David was aged ten, and had had perennial rhinitis, frequent 'otitis media', and frequent tonsillitis for five years, and been hyperactive since infancy.[allergiesexplained.com]
    • Skoner AR, Skoner KR, Skoner DP ; Allergic rhinitis, histamine, and otitis media.[patient.info]
    • Normally, AR symptoms manifest in patients older than 2 years and are especially prevalent in patients 18 to 64 years of age (Table 1). 1 AR is associated with many complications, including otitis media, sinusitis, recurring sore throat, cough, headache[pharmacytimes.com]
    Sinusitis
    • Sinusitis, also known as rhinosinusitis, is a condition involving inflammation in one or more of the paranasal sinuses.[hopkinsmedicine.org]
    • Rhinosinusitis: Clarifying The Relationship Between The Sinuses And Rhinitis Recent studies by otolaryngologist–head and neck surgeons have better defined the association between rhinitis and sinusitis.[entnet.org]
    • Sinusitis is an inflammation of the lining inside the sinuses which can be acute or chronic.[who.int]
    • Chronic sinusitis is subtler, and can be difficult to diagnose.[nicklauschildrens.org]
    • Non-allergic rhinitis is an extremely frustrating sino-nasal disorder that is characterized by all the same symptoms of sinusitis and allergies, but NOT due to sinusitis or allergies.[fauquierent.net]
    Upper Respiratory Infection
    • They can be caused by a virus resulting in a URI or Upper Respiratory Infection or a bacterial sinus infection necessitating antibiotics.[nyallergy.com]
    • It is also known as the common cold or upper respiratory infection (URI).[aafa.org]
    Vasomotor Rhinitis
    • Nonallergic rhinitis (vasomotor rhinitis).[mayoclinic.org]
    • The most common subtype of non-allergic rhinitis is 'idiopathic' or 'vasomotor' rhinitis , which results from imbalance of the neural (nerve) system that manages the function of the nose.[cochrane.org]
    • These other conditions can be confused with allergic rhinitis: vasomotor rhinitis: The nasal mucous membrane swells up with increased blood flow, causing runny nose and congestion, but typically there is no itching.[medbroadcast.com]
    • Non-allergic rhinopathy (also known as vasomotor rhinitis or idiopathic nonallergic rhinitis).[fauquierent.net]
    • Pseudoephedrine is also indicated for vasomotor rhinitis.[en.wikipedia.org]
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  • Etiology

    The pollen responsible for causing haying fever varies from region to region and individual to individual. It is mostly caused by the pollens of wind pollinated plants and examples of these plants include pine, alder, birch, hazel, willow, poplar, plane, lime and olive. It could also result from exposure to grass pollens from grasses like timothy and ryegrass. Weeds that may induce an allergic reaction are plantain, ragweed and mugwort [2]. Allergic rhinitis can also be caused by spores of outdoor molds like apsergillus and penicillin and by house dust mites, furry household pets, cockroaches and rodents [3].

    Some people develop a reaction when they are exposed to certain fragrances, especially ones containing Balsam of Peru.

    Epidemiology

    There is a cumulative prevalence rate of 20% in the United States with as much as 40 million people suffering from this disease. In the international community, the prevalence varies among countries, largely due to their different geographies and availability and potency of allergens.

    Morbidity and mortality from allergic rhinitis on its own is insignificant. The condition however occurs concurrently with other conditions like asthma and otitis media which may cause significant morbidity and even mortality.

    Most cases develop by age 20 years but it may develop far earlier. In children, it affects more males than females but the ratio evens out in adulthood. It affects people of all races and has no predilection for a particular race [4].

    Sex distribution
    Age distribution

    Pathophysiology

    • It primarily involves inflammation of the mucous membrane of the nose. Other organs may be affected in certain individuals like the eye, ear and pharynx. Inflammation is triggered by an immunoglobulin E (Ig E) response to an extrinsic protein which brings about a complex interaction of inflammatory mediators.
    • The tendency to develop this reactions to allergens has a genetic component. When susceptible individuals are are exposed to certain allergens, there is sensitization. This sensitization is characterized by production of specific IgE to act against these allergens. This IgE are present in the surface of mast cells which are seen in the mucosa of the nose. When the allergen, like a pollen, is inhaled, it binds to the IgE on the surface of the mast cells and causes immediate or delayed release of inflammatory mediators like histamine and kinins. The mast cells then synthesize other mediators like prostaglandins and leukotrienes. These mediators, following some complex interactions will cause the symptoms that are seen in allergic rhinitis [5].
    • Stimulation of mucus glands will lead to increased secretions and increased vascular permeability will lead to plasma exudation. The will be congestion due to vasodilation, pruritus from stimulation of sensory nerves and these events can occur in minutes that’s why it is called immediate inflammatory reactions.
    • These mediators then, through a complex interplay, will lead to recruitment of the delayed inflammatory mediators like neutrophils and lymphocytes to the nasal mucosa. This takes up to 8 hours to occur and may last for days and are called the late inflammatory reaction [6].

    Prevention

    Prevention involves reduction of exposure to known allergens as much as possible and regular use of drugs [10].

    Summary

    Allergic rhinitis is popularly called "Hay fever". This is because it is triggered by some precise seasonal plants that are mostly prevalent during the haying season. It is however possible to suffer from this condition throughout the year, haying season or not [1].

    Patient Information

    • Definition: Allergic rhinitis is an inflammation of the nasal mucosa caused by the response of a hyperactive immune system.
    • Cause: It is mainly caused by pollens from plants, flowers, grasses and weed, but can also be caused by exposure to outdoor molds, as well as house dust mites, rodents, cockroaches and household pets like dogs and cats. Some of these allergens are used to make fragrances and allergic reactions to perfumes have been reported.
    • Symptom: This will present with symptoms like, itchy nose, runny nose, postnasal drip, and nasal congestion. Other symptoms are headache, earache, red eyes, itchy eyes, drowsiness, fatigue and a general feeling of unwell.
    • Diagnosis: This is done with the help of certain tests to check what causes the allergic reaction. Laboratory investigations are also done to check the levels of some inflammatory mediators as well as imaging like X-rays and CT scan to examine the surrounding structures and rule out complications.
    • Treatment: This involves avoiding the allergen when it has been detected, using drugs to control the hyperactive immune system and immunotherapy.

    Self-assessment

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    References

    1. Thompson AK, Juniper E, Meltzer EO. Quality of life in patients with allergic rhinitis. Ann Allergy Asthma Immunol. Nov 2000;85(5):338-47; quiz 347-8.
    2. Matheson MC, Dharmage SC, Abramson MJ, et al. Early-life risk factors and incidence of rhinitis: results from the European Community Respiratory Health Study--an international population-based cohort study. J Allergy Clin Immunol 2011; 128:816.
    3. D'Alonzo GE Jr. Scope and impact of allergic rhinitis. J Am Osteopath Assoc 2002; 102:S2.
    4. Settipane RA. Demographics and epidemiology of allergic and nonallergic rhinitis. Allergy Asthma Proc 2001; 22:185.
    5. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. Jul 2001;108(1 Suppl):S2-8
    6. Hansen I, Klimek L, Mosges R, Hormann K. Mediators of inflammation in the early and the late phase of allergic rhinitis. Curr Opin Allergy Clin Immunol. Jun 2004;4(3):159-63.
    7. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008; 122:S1.
    8. Platts-Mills TA. Allergen avoidance. J Allergy Clin Immunol. Mar 2004;113(3):388-91.
    9. Weber RW. Immunotherapy with allergens. JAMA. Dec 10 1997;278(22):1881-7.
    10. Hadley JA. Evaluation and management of allergic rhinitis. Med Clin North Am. Jan 1999;83(1):13-25.

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