Signs and Symptoms of Allergic Rhinitis
Allergic rhinitis is characterized by nasal congestion, runny nose, itchy nose, and sneezing, often accompanied by clear rhinorrhea, pale discoloration of the nasal mucosa, and red and watery eyes. 1
Primary Symptoms
- Nasal congestion (stuffiness) - reported in up to 94% of patients with allergic rhinitis 2
- Rhinorrhea (runny nose) - clear discharge is typical and present in approximately 90% of patients 2
- Sneezing - often occurring in paroxysms or fits 1
- Nasal itching - a distinguishing feature of allergic versus non-allergic causes 1
- Postnasal drip - mucus draining down the back of the throat 1, 3
Associated Ocular Symptoms
Physical Examination Findings
- Pale or bluish discoloration of nasal mucosa - classic finding in allergic rhinitis 1
- Clear nasal discharge - though colored discharge may exist with comorbid conditions 1
- Frequent throat clearing - due to postnasal drip 1, 3
- "Allergic shiners" - dark circles under eyes due to venous congestion 1
- "Allergic salute" - upward rubbing of the nose with the palm of the hand (more common in children) 1
Temporal Patterns
Allergic rhinitis can present in different patterns:
- Seasonal - symptoms occur during specific pollen seasons 1
- Perennial - symptoms present year-round, often due to indoor allergens 1
- Episodic - symptoms occur sporadically after specific allergen exposures 1
- Intermittent - symptoms occur less than 4 days/week or less than 4 consecutive weeks/year 2
- Persistent - symptoms occur more than 4 days/week and for more than 4 consecutive weeks/year 2
Associated Conditions
Patients with allergic rhinitis should be assessed for common comorbidities:
- Asthma - frequently coexists with allergic rhinitis 1, 4
- Atopic dermatitis - part of the "atopic triad" 1, 4
- Sleep-disordered breathing and snoring - due to nasal obstruction 1, 5
- Conjunctivitis - ocular symptoms frequently accompany nasal symptoms 1
- Rhinosinusitis - inflammation can extend to the sinuses 1, 3
- Otitis media - especially in children 1
Severity Assessment
The severity of allergic rhinitis ranges from mild to severe:
- Mild - symptoms present but do not interfere with sleep, daily activities, work or school performance 1
- Moderate-severe - symptoms lead to sleep disturbance, impairment of daily activities, or problems at work/school 2
Differentiating Features
- Allergic rhinitis typically presents with itching and sneezing more prominently than non-allergic rhinitis 2, 6
- Exposure to specific allergens often triggers or worsens symptoms 1
- Family history of atopy strengthens the diagnosis 1
- Symptoms that develop on exposure to irritants (smoke, fumes, chemicals) are less likely to represent allergic rhinitis 1
Warning Signs (Not Typical of Allergic Rhinitis)
- Unilateral symptoms 1
- Epistaxis (nosebleeds) 7
- Severe headache 1
- Anosmia (loss of smell) 1
- Purulent discharge 2
- Facial pain 1
These atypical symptoms may suggest alternative diagnoses such as sinusitis, nasal polyps, or more serious conditions that require further investigation 1.