From the Guidelines
Allergic rhinitis can lead to severe complications, including sinusitis, asthma, sleep disturbances, otitis media, nasal polyps, and impaired cognitive function, emphasizing the need for prompt and effective treatment to prevent these complications and improve quality of life. Severe complications of allergic rhinitis can significantly impact morbidity, mortality, and quality of life, making it essential to address the condition promptly and effectively. According to the study by 1, patients with allergic rhinitis are at increased risk for the development of asthma, and treatment of allergic rhinitis may improve asthma control in patients with coexisting allergic rhinitis and asthma. Some key complications include:
- Sinusitis, where inflammation spreads to the sinuses causing pain, pressure, and infection
- Contribution to asthma development or worsening existing asthma through the unified airway concept
- Sleep disturbances, including sleep apnea and chronic fatigue from nasal obstruction
- Otitis media (middle ear infections) in children due to eustachian tube dysfunction
- Prolonged inflammation causing nasal polyps, further obstructing breathing
- Impaired cognitive function, affecting work and school performance
Treatment typically involves a combination of:
- Allergen avoidance
- Antihistamines
- Intranasal corticosteroids
- Immunotherapy in severe cases As noted in the study by 1, education of patients and family members or other patient advocates is a key element in promoting adherence and optimizing treatment outcomes in allergic rhinitis, and should encompass knowledge of and sensitivity to the cultural, socioeconomic, and demographic characteristics of the patient. Effective management of allergic rhinitis requires a comprehensive approach, including patient education, environmental changes, and medication, to prevent severe complications and improve quality of life.
From the Research
Severe Complications of Allergic Rhinitis
- Allergic rhinitis can lead to various severe complications, including asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches 2
- Patients with allergic rhinitis are at risk of developing these complications due to the disruption of the epithelial barrier, allowing allergens to penetrate the mucosal epithelium of nasal passages and inducing a T-helper type 2 inflammatory response 2
- The presence of asthma, eczema, and other allergic conditions can increase the severity of allergic rhinitis and lead to more severe complications 3
Symptoms and Diagnosis
- Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat 2, 4
- Diagnosis is clinical and based on history, physical examination, and at least one symptom of nasal congestion, runny or itchy nose, or sneezing 3
- Serum or skin testing for specific allergens should be performed when there is inadequate response to empiric treatment, if diagnosis is uncertain, or to guide initiation or titration of therapy 3
Treatment and Management
- Intranasal corticosteroids are first-line treatment for allergic rhinitis, particularly for patients with moderate to severe symptoms 2, 4, 5, 3
- Second-line therapies include antihistamines and leukotriene receptor antagonists, but neither shows superiority over intranasal corticosteroids 3
- As-needed use of intranasal corticosteroids can be effective in managing perennial allergic rhinitis, but regular use may provide greater improvement in nasal peak inspiratory flow 6