Nose is the gateway to the respiratory tract and any inflammation of the membranes lining the nose is termed Rhinitis.
Rhinitis is characterized by one or more of the following cardinal nasal symptoms: sneezing, itching, rhinorrhea and nasal congestion. It is frequently accompanied by symptoms that involve the eyes, ears and throat. Previously thought of as a disease restricted to the nasal passages, allergic rhinitis (AR) is now viewed as a manifestation of systemic airway disease and is major risk factor for development of asthma. Approximately 50% of all cases of rhinitis are caused by allergy.
AR significantly reduces Quality of Life (QOL), interferes with performance at work and at school, and is associated with various comorbid conditions. Therefore, all patients with rhinitis should be appropriately treated based on an accurate diagnosis. At ages 6 to 7 years, boys with allergic rhinitis outnumber girls; however, at ages 13 to 14, girls outnumber boys. In general, equal numbers are affected during adulthood.
Allergic rhinitis is caused by hypersensitivity to various allergens in the environment like pollens, weeds, animal dander, insect droppings etc. Most common culprit for AR is house dust mite.
Approximately 10% to 20% of the global population suffers from AR, the most common cause of reversible nasal congestion. Of patients with AR, 80% develop symptoms before the age of 20 years.
Classification of AR
Allergic Rhinitis can be intermittent (seasonal) or persistent throughout the year and its classified into mild AR or moderate-severe AR.
Symptoms and Signs
Cardinal symptoms of AR are Sneezing, runny nose, itchy nose, nasal block.
Recurrent headaches, mouth breathing, lethargy, poor sleep are some of the associated features.
Although an accurate history is paramount in diagnosing AR, the physical examination is useful to help rule out other conditions or even concomitant pathology.
Markers of allergic rhinitis –
- Allergic shiners– dark, bluish, puffy lower eyelids
- Horizontal nasal crease across the lower half of bridge of nose caused by repeated rubbing and upward rubbing of tip of nose by palm of hand (Allergic salute).
- Morgan Dennie’s line – infraorbital fold or line on the skin
- Adenoid facies
Diagnosis
Allergy testing for specific IgE can be done by the skin prick test and is confrimatory of allergic rhinitis in the presence of the symptoms.
Treatment
Safe and effective prevention and relief of symptoms are the two main goals of treatment of allergic rhinitis. The primary goal of treatment is to control the symptoms and to improve the quality of life without altering the patient’s ability to function. A second but equally important goal is to prevent the development of sequelae of allergic rhinitis, including sinusitis, otitis media and asthma exacerbations. Effective management of allergic rhinitis may require a combination of
- Allergen avoidance measures
- Pharmacological therapy
- Allergen immunotherapy
