What are the symptoms of allergic rhinitis?

From the Guidelines

Allergic rhinitis symptoms include nasal congestion, runny nose with clear discharge, sneezing, itchy nose, and watery or itchy eyes, which can be seasonal or perennial and vary in severity from mild to severe, impacting quality of life and sleep. These symptoms occur when your immune system overreacts to allergens like pollen, dust mites, pet dander, or mold 1. You may also experience postnasal drip, fatigue, decreased sense of smell, and sometimes headaches or facial pressure. The underlying mechanism involves allergens triggering the release of histamine and other inflammatory chemicals when they contact the nasal mucosa, causing blood vessels to dilate and tissues to swell, leading to increased mucus production and irritation of nerve endings, resulting in the characteristic symptoms 1.

Classification of Allergic Rhinitis

Allergic rhinitis can be classified by the temporal pattern of exposure to a triggering allergen, such as seasonal, perennial, or episodic, as well as by the frequency and severity of symptoms 1. This classification can assist in choosing the most appropriate treatment strategies for an individual patient. For example, patients with intermittent symptoms may require different treatment approaches compared to those with persistent symptoms.

Symptoms and Severity

Symptoms of allergic rhinitis can vary widely between individuals, from mild occasional sniffling to severe symptoms that significantly impact quality of life and sleep 1. Some people may also develop allergic conjunctivitis (eye inflammation) alongside nasal symptoms, particularly with outdoor allergens. The severity of symptoms can be classified as mild or more severe, with factors such as exacerbation of coexisting asthma, sleep disturbance, and impairment of daily activities contributing to a more severe classification.

Treatment Approaches

Treatment approaches for allergic rhinitis may include avoidance of known allergens, environmental controls, pharmacologic therapy, and immunotherapy 1. Clinicians should recommend intranasal steroids for patients with allergic rhinitis whose symptoms affect their quality of life, and oral second-generation/less sedating antihistamines for patients with primary complaints of sneezing and itching. Combination pharmacologic therapy and immunotherapy may also be considered for patients with inadequate response to monotherapy.

Key Considerations

When diagnosing and treating allergic rhinitis, clinicians should consider the patient's history, physical examination, and symptoms, as well as the presence of associated conditions such as asthma, atopic dermatitis, and sleep-disordered breathing 1. A comprehensive approach to diagnosis and treatment can help improve patient outcomes and quality of life. The most effective treatment approach will depend on the individual patient's symptoms, severity, and response to treatment, and may involve a combination of pharmacologic and non-pharmacologic therapies.

From the FDA Drug Label

Rhinitis can be caused by allergies to pollen, animals, molds, or other materials-or it may have a nonallergic cause. When you spray Fluticasone Propionate Nasal Spray, USP, into your nose, it helps to reduce the symptoms of allergic reactions and the stuffiness, runniness, itching, and sneezing that can bother you The trials included 2,633 adults (1,439 men and 1,194 women) with a mean age of 37 (range, 18 to 79 years). A total of 440 adolescents (405 boys and 35 girls), mean age of 14 (range, 12 to 17 years), and 500 children (325 boys and 175 girls), mean age of 9 (range, 4 to 11 years) were also studied. Subjects treated with Fluticasone Propionate Nasal Spray, USP exhibited significantly greater decreases in TNSS than vehicle placebo-treated patients Patients were instructed to take the study medication only on days when they thought they needed the medication for symptom control, not to exceed 2 sprays per nostril on any day, and not more than once daily. The studies demonstrated significantly greater reduction in TNSS (sum of nasal congestion, rhinorrhea, sneezing, and nasal itching) with Fluticasone Propionate Nasal Spray, USP, 200 mcg compared to placebo.

Allergic Rhinitis Symptoms: Fluticasone Propionate Nasal Spray, USP can help treat symptoms of allergic rhinitis, including stuffiness, runniness, itching, and sneezing.

• Key Benefits:
  • Reduces symptoms of allergic reactions
  • Decreases nasal congestion, rhinorrhea, sneezing, and nasal itching
  • Can be used in adults and children 4 years of age and older
• Dosage: The usual starting dose is 200 mcg once daily (two 50-mcg sprays in each nostril once daily) 2, 2.

From the Research

Allergic Rhinitis Symptoms

• Allergic rhinitis is characterized by symptoms such as rhinorrhea, nasal congestion, nasal itching, and sneezing 3
• The most common symptoms of allergic rhinitis are rhinorrhea (90.38%) and nasal congestion (94.23%) 4
• Other symptoms include postnasal drainage, sneezing, and itching of the eyes, nose, and throat 4
• Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates, while those with perennial allergic rhinitis have erythematous and inflamed turbinates with serous secretions 4

Classification of Allergic Rhinitis

• Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year 4
• Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year 4

Treatment of Allergic Rhinitis

• First-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine) 4
• Patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine 4
• Intranasal corticosteroids are first-line treatment for allergic rhinitis 5
• Second-line therapies include antihistamines and leukotriene receptor antagonists, with neither showing superiority 5