Allergic rhinitis is one of the most common diseases. It is caused by the body’s reaction to allergens circulating in the air and can significantly affect quality of life, sleep, and performance at school or work.

What Causes allergic rhinitis

The most common airborne allergens are:

• Plant pollen (e.g., grasses, olive tree, cypress, Parietaria weed)
• House dust mites
• Molds related to humidity
• Furry animal products (mainly from cats and dogs)

House dust mites, molds, and furry animal products are present in the air throughout the year and therefore cause perennial allergic rhinitis. In contrast, pollen appears during the flowering season of plants and is responsible for seasonal allergic rhinitis. Depending on how much it affects the patient’s life, rhinitis may be mild, moderate, or severe.

Symptoms

The most common symptoms are:

• Runny nose
• Nasal congestion
• Sneezing
• Itching of the nose, mouth, and/or ears

Due to persistent nasal obstruction, many patients:

• Breathe through the mouth
• Snore
• Experience episodes of sleep apnea
• Develop dark circles under the eyes

Itching often leads to the characteristic upward rubbing of the nose, known as the “allergic salute,” which may cause a horizontal nasal crease. Nasal secretions (mucus) that drip internally down the throat may cause persistent cough, particularly when the patient is lying down.

In addition to allergens, symptoms may worsen due to:

• Cigarette smoke
• Exhaust fumes
• Detergents and strong odors
• Sudden changes in temperature or humidity

Associated Conditions

Allergic rhinitis often coexists with:

• Allergic conjunctivitis (red, watery, itchy eyes)
• Allergic asthma – breathing difficulty
• Chronic rhinosinusitis – headaches
• Ear problems – hearing impairment

Recognition and management of associated conditions are very important.

Diagnosis

Diagnosis is based on:

1. Detailed allergy history and clinical examination of the nose
2. Skin prick tests with common allergens
3. Blood tests for detection of specific (IgE) antibodies

In some cases, a nasal allergen provocation test may also be required.

Management and Treatment

Management includes multiple measures:

• Counseling and education of the patient and family
• Allergen avoidance measures (where feasible)
• Avoidance of irritants (e.g., smoke)
• Pharmacological treatment
• Desensitization therapy (allergen-specific immunotherapy)

Pharmacological treatment

Depending on severity and symptoms, the doctor may recommend:

• Second-generation antihistamines (oral or intranasal)^st (oral or intranasal)
• Intranasal spray combining a corticosteroid
• Intranasal spray combining a corticosteroid and an antihistamine

First-generation antihistamines^st may cause drowsiness, dizziness, and other more serious side effects. Therefore, they have no role in the treatment of allergic rhinitis and their use should be avoided.

Other medications such as decongestant sprays/tablets may quickly relieve symptoms but, after a few days, may cause greater issues (medication-induced rhinitis). Therefore, their use should be cautious and under medical guidance.

Allergen-Specific Immunotherapy

Desensitization (allergen-specific immunotherapy) is the only treatment that can address allergic rhinitis at its root cause. It is administered either as drops or tablets under the tongue or as injections and lasts at least 3 and up to 5 years. Its goal is to train the immune system to tolerate and stop reacting to the allergen. It is the only treatment proven to reduce the risk of developing new allergies and may prevent the progression of allergic rhinitis to asthma.