Allergic Rhinitis

What is an allergy?
Allergic disorders, including anaphylaxis, allergic rhinitis/hayfever, eczema, and asthma, affect approximately 25% of people in the developed world1
An allergy is an excessive or abnormal adaptive immune response directed against non‐infectious, often inert environmental substances (allergens), including non‐infectious components of certain infectious organisms1. For people with allergies, persistent or repetitive exposure to allergens, which are typically innocuous substances, results in chronic allergic inflammation1.
In turn, this can produce long‐term changes in the structure of the affected organs and substantial abnormalities in their function1.
Allergens and allergic inflammation:
Allergen
There are two main types of allergen:
1. Any non‐infectious environmental substance that can induce immunoglobulin E (IgE) production (thereby ‘sensitising’ the subject) so that later re‐exposure induces an allergic reaction1.
Common allergen sources include1:
- Grass and tree pollens
- Animal dander (from skin and fur)
- House dust mite faecal particles
- Certain foods (eg, peanuts, tree nuts, fish, shellfish, milk, and eggs)
- Latex
- Various medicines
- Insect venoms
2. A non‐infectious environmental substance that can induce an adaptive immune response linked to local inflammation—but one thought to occur independently of IgE (eg, allergic contact dermatitis to poison ivy or nickel)1.
Allergic inflammation
This is the inflammation produced in sensitised subjects after exposure to a specific allergen(s). With persistent or repetitive exposure to allergens, chronic allergic inflammation develops, with associated tissue alterations1.
What is allergic rhinitis?
Allergic rhinitis (AR) is defined as an IgE antibody‐mediated, inflammatory disease characterised by one or more of the following symptoms2:
- Nasal congestion
- Rhinorrhea—runny nose (anterior and posterior)
- Sneezing and itching
There are several AR classification characteristics that can be helpful to determine appropriate patient treatment strategies, including2:
1. Temporal pattern and context of exposure to a triggering allergen:
a). Seasonal (e.g., pollens) or perennial (year‐round exposures such as house dust mites),
or
b). Episodic environmental (from allergen exposures not normally encountered in the patient’s home or occupational environment, e.g. visiting a home with pets not present in an individual’s home)
2. Frequency and duration of symptoms
3. Severity of symptoms
AR has traditionally been categorised as seasonal AR (SAR) or perennial AR (PAR), both of which are conditions recognised as having similar pathophysiologic and end‐organ manifestations. In general, the differences between the two conditions are primarily based on the causes and duration of disease2.
Quality of life impact
Many patients will “suffer in silence” without talking about their symptoms. They may be purposefully diminishing their allergy symptoms and the impact they have on their quality of life for a variety of reasons19:
- They believe allergies aren’t that serious or are not a “real disease,” but more of a nuisance20
- They may not know that while allergies may seem benign, they can still significantly impact their quality of life19
- They may be unaware that untreated allergies can increase the risk for more serious diseases, such as anaphylaxis, asthma, sinusitis, altered mood, and cognitive impairment19,21
Patients may not recognise some symptoms as being related to allergies. In addition to the more obvious symptoms, these surprising symptoms may be due to allergies19,21,22:
- Chronic fatigue
- Asthma
- Upper respiratory infection
- Bronchitis
- Sinus infection
- Depression
- Sleeping problems
- Difficulty concentrating
- Lack of exercise endurance
You can help patients with allergic rhinitis by making an effective recommendation.

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