Allergic Rhinitis

Publication Date: February 2, 2015

Key Points

Key Points

  • Allergic rhinitis (AR) is one of the most common diseases affecting adults. In the United States today it is the most common chronic disease in children and the fifth most common disease overall.
  • AR is estimated to affect nearly one in every six Americans and generates $2 to $5 billion dollars in direct health expenditures annually.
  • Many diagnostic tests and treatments are used in managing patients with this disorder, yet there is considerable variation in their use.

Definitions

  • AR is defined as an immunoglobulin E (IgE)-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens. Symptoms include rhinorrhea (anterior or postnasal drip), nasal congestion, nasal itching, and sneezing. AR can be seasonal, perennial, or episodic with symptoms being intermittent or persistent.
  • AR may be classified by
    • the temporal pattern of exposure to a triggering allergen as:
      • seasonal, (e.g., pollens) or
      • perennial/year round, (e.g., dust mites) or
      • episodic (environmental from exposures not normally encountered in the patient’s environment, e.g., visiting a home with pets)
    • frequency of symptoms
      • intermittent (<4 days/week or <4 weeks/year) or
      • persistent (>4 days/week and >4 weeks/year)

      Note: This classification of symptom frequency has limitations. For example, the patient who has symptoms 3 days/week year round would be classified as “intermittent” even though he or she would more closely resemble a “persistent” patient. It may be best for the patient and the provider to determine which frequency category is most appropriate and would best guide the treatment plan. Based on these definitions, it is possible that a patient may have intermittent symptoms with perennial AR or persistent symptoms with seasonal AR.

    • severity of symptoms
      • 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)
  • Although the FDA uses "seasonal" or "perennial" when approving new medications for AR, classifying a patient’s symptoms by frequency and severity allows for more appropriate treatment selection.

Table 1. Abbreviations and Definitions of Common Terms

Having trouble viewing table?
Term Definition
Allergic rhinitis (AR) An IgE-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens. Symptoms include rhinorrhea (anterior or posterior nasal drainage), nasal congestion, nasal itching, and sneezing.
Seasonal allergic rhinitis (SAR) An IgE-mediated inflammatory response to seasonal aeroallergens. The length of seasonal exposure to these allergens is dependent on geographic location and climatic conditions.
Perennial allergic rhinitis (PAR) An IgE-mediated inflammatory response to year-round environmental aeroallergens. These may include dust mites, mold, animal allergens, or certain occupational allergens.
Intermittent allergic rhinitis An IgE-mediated inflammatory response and is characterized by frequency of exposure or symptoms (<4 days/week or <4 weeks/year).
Persistent allergic rhinitis An IgE-mediated inflammatory response and is characterized by persistent symptoms (>4 days/week and >4 weeks/year).
Episodic allergic rhinitis An IgE-mediated inflammatory response and can occur if an individual is in contact with an exposure that is not normally a part of the individual’s environment (i.e., a cat at a friend’s house).

Table 2. Summary of Guideline Key Action Statements (KAS)

...Summary of Guideline Key Action Statements (KA...

...ory and Physical ExaminationClinicians...


...Clinicians should perform and interpret, or...


...ingClinicians should NOT routinely perform...


...nmental FactorsClinicians may advise av...


...nditions and ComorbiditiesClinicians should ass...


...idsClinicians should recommend INSs for patients...


...nesClinicians should recommend ora...


...tranasal AntihistaminesClinicians may...


...ene Receptor Antagonists (LTRAs)Clinicians...


...apyClinicians may offer combination pharmaco...


...therapyClinicians should offer, or refe...


...nferior Turbinate ReductionClinicians may offe...


...upunctureClinicians may offer, or refer to a...


...rapyNo recommendation regarding the use of herba...


Diagnosis

...iagnos...

...e 3. History and Physical Findings...


...e 4. IgE-Specific TestsHaving trouble viewing t...


Treatment

Treatment

.... Environmental Control Measures to Redu...


...le 6. Intranasal SteroidsHaving trouble viewing...


...AntihistaminesHaving trouble viewing table? Expa...


...ntranasal AntihistaminesHaving trouble vi...


Table 9. Medication RecommendationsaHav...


...mparison of Features of SCIT and S...