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Allergic Rhinitis

Rhinitis is defined as inflammation of the nasal membranes and is characterized by a symptom complex that consists of sneezing, nasal congestion, nasal itching, and runny nose. The eyes, ears, sinuses, and throat can also be involved. Allergic rhinitis is an extremely common condition, affecting approximately 20% of the population. Allergic rhinitis involves inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, sinuses, and pharynx, but the nose is invariably involved. The tendency to develop allergic reactions to environmental allergens and inflammation has a genetic component but is also based upon repeat exposure to the allergen.

Through inflammatory mediators, via various interactions, ultimately lead to the symptoms of nasal congestion, sneezing, itching, redness, tearing, swelling, ear pressure, postnasal drip. Mucous glands are stimulated, leading to increased secretions. Vascular permeability is increased, leading to runny nose. Vasodilation occurs, leading to congestion and pressure. Sensory nerves are stimulated, leading to sneezing and itching. All of these events can occur in minutes; hence, this reaction is called the early, or immediate, phase of the reaction.

Over 4-8 hours, these mediators, through a complex series of events, lead to the recruitment of other inflammatory cells to the lining of the nose, resulting in continued inflammation, termed the late-phase response. The symptoms of the late-phase response are similar to the early phase, but less sneezing and itching and more congestion and mucus production tend to occur. The late phase may persist for hours or even days. Systemic effects, including fatigue, sleepiness, and malaise, can occur from the inflammatory response. These symptoms often contribute to impaired quality of life.

Allergic rhinitis is also associated with ear infections, ear popping, sinusitis, nasal polyps, asthma, eye problems, and sleep problems. It may also contribute to learning difficulties, sleep disorders, and fatigue.

Onset of allergic rhinitis is common in childhood, adolescence, and early adult years, with a mean age of onset 8-11 years, but allergic rhinitis may occur in persons of any age. In 80% of cases, allergic rhinitis develops by age 20 years. The prevalence of allergic rhinitis has been reported to be as high as 40% in children, subsequently decreasing with age. In the geriatric population, rhinitis is less commonly allergic in nature.

There are a series of medications that can be used to treat allergic rhinitis which include tablets, nasal sprays, and nasal rinses. If these are not effective or only marginally effective, allergy testing and immunotherapy (either allergy shots or allergy drops under the tongue), can more effectively treat your allergies and will lead to improvement in more than 80% of individuals. Immunotherapy is the only chance for cure of allergies.

Your NW-ENT doctor will determine which allergy treatment would be best for you.

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