From the Guidelines
Allergic rhinitis is an IgE-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens, characterized by symptoms such as rhinorrhea, nasal congestion, nasal itching, and sneezing.
Key Characteristics
- Definition: Allergic rhinitis (AR) is an IgE-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens 1.
- Symptoms: Include rhinorrhea (anterior or posterior nasal drainage), nasal congestion, nasal itching, and sneezing 1.
- Classification: Can be classified by temporal pattern of exposure to a triggering allergen as seasonal, perennial/year round, or episodic, as well as by frequency and severity of symptoms 1.
- Frequency: Can be intermittent (<4 days/week or <4 weeks/year) or persistent (>4 days/week and >4 weeks/year) 1.
- Severity: Can be classified as mild (when symptoms are present but are not interfering with quality of life) or more severe (when symptoms are bad enough to interfere with quality of life) 1.
Epidemiology
- Prevalence: Affects 10% to 40% of the population 1.
- Impact: Reduces quality of life and school and work performance, and is a frequent reason for office visits in general practice 1.
- Cost: Generates significant direct health expenditures and lost productivity annually 1.
Clinical Practice
- Diagnosis: Involves evaluating the patient's symptoms, medical history, and allergy test results 1.
- Treatment: May involve medication, immunotherapy, or other management options, with the goal of optimizing patient care and reducing harmful or unnecessary variations in care 1.
From the Research
Definition and Prevalence of Allergic Rhinitis
- Allergic rhinitis (AR) is a common chronic respiratory disease characterized by immunoglobulin E (IgE)-mediated reactions to inhaled allergens 2, 3, 4, 5, 6.
- It is a heterogeneous disorder that affects millions of individuals worldwide, with a significant impact on quality of life, productivity, and other existing conditions such as asthma and conjunctivitis 2, 4.
- The prevalence of AR is high, with an estimated 20 to 40 million people affected in the United States alone, and the incidence is increasing 6.
Symptoms and Diagnosis of Allergic Rhinitis
- The main symptoms of AR include sneezing, itchy nose, rhinorrhoea, and nasal congestion 4, 6.
- The diagnosis of AR is based on the clinical history and, if needed, on skin tests or the presence of serum-specific IgE antibodies to allergens 2.
- IgE antibody tests to detect specific allergens are the standard method used today, and diagnosis must be confirmed with a positive history and demonstration that the symptoms are the result of IgE-mediated inflammation 6.
Treatment and Management of Allergic Rhinitis
- The treatment of AR aims to relieve or control symptoms, resolve allergic inflammation, and potentially induce allergen tolerance, using allergen immunotherapy 4.
- Pharmacological treatment options include oral, intranasal, or ocular antihistamines, intranasal corticosteroids, or combined intranasal antihistamines and corticosteroids 2, 3, 4, 5.
- Intranasal corticosteroids are the most effective treatment and should be first-line therapy for persistent symptoms affecting quality of life 5.
- Subcutaneous or sublingual immunotherapy should be considered if usual treatments do not adequately control symptoms and in patients with allergic asthma 5.
Classification and Risk Factors of Allergic Rhinitis
- AR can be classified into intermittent or persistent and mild or moderate/severe 2.
- Risk factors for AR include inhalant and occupational allergens, as well as genetic factors 2.
- The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative has classified AR into different categories to guide treatment and management 2.