ALLERGIC RHINITIS

• Allergic rhinitis (AR) accounts for 50% of all cases of rhinitis in childhood and adolescence
• AR is classified as seasonal, perennial, or mixed (perennial with seasonal exacerbation)
• Confirmation of allergic sensitization through a detailed history and physical examination is essential for diagnosing AR
• Diagnosis of AR involves skin prick testing and specific immunoglobulin E (IgE) measurements
• Nasal allergen provocation and/or measurement of allergen-specific IgE in nasal secretions are preferred tests for complex cases
• Treatment for AR includes topical corticosteroids, topical antihistamines, oral nonsedating histamine 1 antihistamines, reduction of allergen exposure, and allergen-specific immunotherapy
• Risk factors for AR include environmental factors, genetic predisposition, atopic dermatitis, family history of AR, heavy outdoor air pollution, tobacco smoke exposure, and being born during pollen season
• High prevalence of AR leads to impaired quality of life, high treatment costs, presence of comorbidities like asthma and otitis media, and decreased workplace productivity
• Seasonal AR is caused by outdoor allergens like pollen and mold, while perennial AR is triggered by indoor allergens such as house dust mites
• Symptoms of AR include sneezing, itching, rhinorrhea, nasal congestion, and symptoms involving the eyes, ears, and throat
• Diagnostic tests for AR include skin prick testing, measurement of allergen-specific IgE in serum and nasal lavage, and a thorough history and physical examination
• Management of AR involves patient education, allergen avoidance, correct use of medications, and non-drug treatments
• Drug treatment for AR aims to alleviate symptoms like nasal obstruction, rhinorrhea, sneezing, and nasal itching, with intranasal steroids being the most effective class of medication
• Intranasal steroids are considered first-line treatment for AR and are effective for all symptoms, including those affecting the eyes in patients with allergic conjunctivitis
• Oral antihistamines are effective for nasal and ocular symptoms, while leukotriene-receptor antagonists are suitable for severe congestion not responding to steroids
• Nasal irrigation with saline can improve quality of life and reduce medication requirements in AR patients