Prognosis of Allergic Rhinitis
Allergic rhinitis is a chronic condition with generally favorable prognosis when properly treated, but left untreated or poorly controlled, it significantly impairs quality of life, increases risk of asthma development, and in children can cause permanent structural facial deformities. 1
Natural History and Disease Progression
Allergic rhinitis does not spontaneously resolve and requires ongoing management, as it is a chronic immunoglobulin E-mediated inflammatory disease that persists with continued allergen exposure. 2, 3 The condition typically peaks in the teenage years but affects individuals across all age groups. 3
Risk of Asthma Development
- Patients with allergic rhinitis face increased risk for developing asthma, making this a critical prognostic consideration. 1
- Allergen immunotherapy is the only intervention that may prevent future asthma development in patients with allergic rhinitis. 1
- Immunotherapy may also prevent development of new allergen sensitizations. 1
Impact on Quality of Life Without Treatment
Adults
Untreated or poorly controlled allergic rhinitis causes substantial morbidity including: 1
- Sleep disorders and chronic fatigue
- Impairment at work with reduced productivity
- Limitations of daily activities
- Impaired social functioning
- Sexual dysfunction (which normalizes with appropriate treatment) 1
- Moderate-to-severe perennial rhinitis produces functional impairment equal to moderate-to-severe asthma 1
Children
The consequences of uncontrolled allergic rhinitis in children are particularly severe and include permanent complications: 1
- Structural facial deformities: increased facial length, high arched palate, class II dental malocclusions, retrognathic maxilla and mandible 1
- Poor sleep and secondary sleep apnea leading to poor growth 1
- School absenteeism and learning impairment 1
- Inability to integrate with peers 1
- Psychological ramifications: low self-esteem, shyness, depression, anxiety, fearfulness 1
- Headache, fatigue, and irritability from chronic nasal congestion 1
Prognosis With Treatment
Pharmacotherapy Outcomes
Most cases of allergic rhinitis respond satisfactorily to pharmacotherapy, though approximately 20% of patients remain highly symptomatic even with optimal medical treatment. 4, 3
- Intranasal corticosteroids are superior to other treatments in meta-analyses and effectively treat all symptoms of allergic rhinitis with good safety profile 3
- After effective treatment of perennial allergic rhinitis, improvement in school attendance, concentration, and sleep can be demonstrated 1
- Treatment brings patients' functioning back toward normal across multiple domains 1
Immunotherapy Outcomes
Allergen immunotherapy is the only treatment that can potentially modify the natural history of allergic rhinitis: 1
- Clinical benefits may be sustained for years after discontinuation of treatment 1
- May prevent development of new allergen sensitizations 1
- Reduces risk for future asthma development 1
- Clinical improvement usually noted after reaching maintenance dose 1
- Lack of improvement after 1 year of maintenance treatment should prompt review and possible discontinuation 1
Long-Term Management Considerations
Continuous treatment is required for perennial allergic rhinitis, as intermittent dosing is less effective due to ongoing allergen exposure. 5 Patients with year-round symptoms from indoor allergens require continuous antihistamine therapy throughout the year. 5
Periodic assessment of quality of life is essential and should include evaluation of: 1
- Time lost from work or activities
- Sleep quality
- Smell and taste function
- Fatigue level
- General well-being
Comorbid Conditions Affecting Prognosis
Allergic rhinitis frequently coexists with and worsens other conditions: 1, 2
- Asthma (treatment of allergic rhinitis may improve asthma control) 1
- Chronic or recurrent sinusitis 2
- Conjunctivitis 2
- Tension and migraine headaches 2
Critical Pitfalls
The disease is frequently underrecognized, underdiagnosed, and inadequately treated by physicians, with symptom severity and reduced functioning often not appreciated. 1, 3 This leads to preventable morbidity and complications, particularly the permanent structural changes in children. 1
Even with optimal pharmacotherapy, one in five patients remains highly symptomatic, indicating need for consideration of immunotherapy or specialist referral. 3