Allergic rhinitis

Introduction:
Allergic rhinitis is an allergic reaction that happens when your immune system overreacts to substances that you have inhaled, such as pollen. The two types of allergic rhinitis are seasonal allergic rhinitis (hay fever) and perennial allergic rhinitis, which occurs year-round. Hay fever is caused by outdoor allergens. Perennial allergic rhinitis is caused by indoor allergens such as dust mites, pet dander, and mold. Symptoms of allergic rhinitis resemble a cold, but they are not caused by a virus the way a cold is. When you breathe in an allergen, your immune system springs into action. It releases substances known as IgEs into your nasal passages, along with inflammatory chemicals such as histamines. Your nose, sinuses, or eyes may become itchy and congested. Scientists aren't sure what causes your immune system to overreact to an allergen. Allergic rhinitis is common, affecting about 1 in 5 Americans. Symptoms can be mild or severe. Many people who have allergic rhinitis also have asthma.

Signs and Symptoms:

Allergic rhinitis can cause many symptoms, including the following:

Stuffy, runny nose Sneezing Post-nasal drip Red, itchy, and watery eyes Swollen eyelids Itchy mouth, throat, ears, and face Sore throat Dry cough Headaches, facial pain or pressure Partial loss of hearing, smell, and taste Fatigue Dark circles under the eyes

Causes:
The immune system is designed to fight harmful substances like bacteria and viruses. But when you have allergic rhinitis, your immune system overreacts to harmless substances -- like pollen, mold, and pet dander -- and launches an assault. This attack is called an allergic reaction. Seasonal allergic rhinitis is triggered by pollen and mold spores. Sources include:

Ragweed -- the most common seasonal allergen (fall)

Grass pollen, in late spring and summer Tree pollen, in spring Fungus, mold growing on dead leaves, common in summer and fall

Year-round allergic rhinitis may be triggered by:

Pet dander Dust and household mites Cockroaches Molds growing on wall paper, house plants, carpeting, and upholstery

Risk Factors:

Family history of allergies Having other allergies, such as food allergies or eczema Exposure to secondhand cigarette smoke Male gender

Diagnosis:
Your doctor will ask about your family and personal history of allergy. You may be asked some of the following questions:

Do symptoms change depending on the time of day or the season? Do you have a pet? Have you made changes to your diet? Are you taking any medications?

Your doctor will do a physical exam and may also recommend a skin test to find out what you are allergic to. In a scratch test, for example, small amounts of suspected allergens are applied to the skin with a needle prick or scratch. If there is an allergy, the area will become swollen and red. Sometimes a blood test may be used to find out which allergens you react to. With young children, it can help to watch what they do. For example, a child with allergic rhinitis may wiggle his nose and push it upward with the palm of the hand.

Prevention:
The best way to control your symptoms is to avoid being exposed to the allergens that trigger your symptoms. These steps may help. If you have hay fever, during days or seasons when airborne allergens are high:

Stay indoors, and close the windows. Use an air conditioner in your home and car. Avoid using fans that draw in air from outdoors.

Don't hang laundry outside to dry. Bathe or shower and change your clothes after being outside. Use a HEPA air filter in your bedroom.

If you have year-round allergies:

Cover your pillows and mattress with dust mite covers. Remove carpet and install tile or hardwood floors. Use area rugs and wash them often in very hot water. Use blinds instead of curtains. Keep pets out of the bedroom. Use a HEPA filter on your vacuum. Use an air purifier. Wash bedding and toys such as stuffed animals in very hot water once a week.

Treatment:
The best way to reduce symptoms is to prevent exposure to allergens. Drugs such as antihistamines, decongestants, and nasal corticosteroid sprays may help control allergy symptoms. Some complementary and alternative therapies may also be used to treat the symptoms of allergic rhinitis. Your doctor may recommend immunotherapy, or "allergy shots. With this treatment, you receive regular injections of an allergen, with each dose being slightly larger than the previous dose. Your immune system should gradually get used to the allergen so that it no longer reacts to it. In addition, certain lifestyle and dietary changes may help prevent or improve symptoms of allergic rhinitis.

Lifestyle
Although you can't stay indoors during all pollen and ragweed seasons, avoiding peak exposure times can help. Use your air conditioner in your home and car, and wear a dust mask when working in the yard. For year-round allergies, you can take the following measures.

Get rid of carpets and upholstered furniture. Wash bedding every week in very hot water. Keep stuffed toys out of the bedroom. Cover pillows and beds with allergen-proof covers.

To reduce mold:

Clean moldy surfaces. Mold is often found in air conditioners, humidifiers, dehumidifiers, swamp coolers, and refrigerator drip pans. Use a dehumidifier indoors to reduce humidity to less than 50%. Fix water leaks and clean up water damage immediately. Make sure kitchens, bathrooms, and crawl spaces have good ventilation. Installing exhaust fans can help. Vent laundry dryers to the outside. Put flooring in crawl spaces.

Medications
Depending on the type of allergic rhinitis you have, your doctor may recommend medications. If you have perennial allergic rhinitis, you may need to take medication daily. If you have seasonal allergic rhinitis -- hay fever -- you may start medications a few weeks before the pollen season begins. Antihistamines Antihistamines are available in both oral and nasal spray forms, and as prescription drugs and over-the-counter remedies. Over-the-counter antihistamines are short-acting and can relieve mild-to-moderate symptoms. All work by blocking the release of histamine in your body.

Over-the-counter antihistamines -- Include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist). These older antihistamines can cause sleepiness. Loratadine (Claritin), cetrizine (Zyrtec), and fexofenadine (Allegra) do not cause as much drowsiness as older antihistamines. Prescription antihistamines -- These medications are longer-acting than over-thecounter antihistamines and are usually taken once a day. They include desloratadine (Clarinex).

Decongestants Many over-the-counter and prescription decongestants are available in pill or nasal spray form. They are often used with antihistamines.

Oral and nasal decongestants -- Include Sudafed, Actifed, Afrin, Neo-Synephrine. Some decongestants may contain pseudoephedrine, which can raise blood pressure. People with high blood pressure or enlarged prostate should not take drugs containing pseudoephedrine. Using nasal decongestant sprays for more than 3 days can cause "rebound congestion," which makes congestion worse. Avoid using nasal decongestant sprays for more than 3 days in a row, unless your doctor tells you to. Do not use them if you have emphysema or chronic bronchitis.

Nasal corticosteroids These prescription sprays reduce inflammation of the nose and help relieve sneezing, itching, and runny nose. It may take a few days to a week to see improvement in symptoms.

Beclomethasone (Beconase) Fluticasone (Flonase) Mometasone (Nasonex) Triacinolone (Nasacort)

Leukotriene modifiers These prescription drugs block the production of leukotrienes, which are inflammatory chemicals produced by the body. They are taken once a day and do not cause sleepiness, and are also used to treat allergic asthma. Leukotriene modifiers include montelukast (Singulair) and zafirlukast (Accolate). Cromolyn sodium (NasalCrom) This over-the-counter nasal spray prevents the release of histamine and helps relieve swelling and runny nose. It works best when taken before symptoms start and may needed to be used several times a day. Nasal atropine Ipratropium bromide (Atrovent) is a prescription nasal spray that can help relieve a very runny nose. People with glaucoma or an enlarged prostate should not use Atrovent. Eye drops

Antihistamine eye drops -- relieve both nasal and eye symptoms. Examples include azelastine, olopatadine, ketotifen, and levocabastine Decongestant eye drops -- such as phenylephrine and naphazoline

Eye drops may cause stinging or even headache.

Other Treatments
Allergy shots, or immunotherapy, are often recommended to anyone 7 years and older who has severe allergy symptoms or who also has asthma. Immunotherapy helps your immune system get used to allergens through regular injections of small doses of an allergen over a long period of time. Nasal irrigation or nasal lavage can help reduce symptoms of allergic rhinitis, studies show. One study found that doing nasal irrigation three times a day reduced allergy symptoms after about 3 - 6 weeks. To do nasal irrigation, you can use a neti pot, bulb syringe, or squeeze bottle to flush out nasal passages with salt water.

Nutrition and Dietary Supplements

Some people with allergic rhinitis also have food allergies. If you have any food allergies, eliminate those items from your diet.

Lactobacillus acidophilus -- One small study suggests that L. acidophilus, a type of "friendly" bacteria, might help reduce allergic reaction to pollen. More study is needed. Quercetin -- Quercetin is a flavonoid, a plant pigment that gives fruits and vegetables their color. In test tubes, it stops the production and release of histamine, which causes allergy symptoms such as a runny nose and watery eyes. However, there is not yet much evidence that quercetin would work the same way in humans. More studies are needed. Quercetin can potentially interfere with many medications so speak with your physician. Spirulina -- Preliminary test tube and animal studies suggest that spirulina, a type of bluegreen algae, may help protect against harmful allergic reactions. Spirulina stops the release of histamine, which contribute to symptoms of allergic rhinitis. But researchers don' t know whether it would work in people. Vitamin C (2,000 mg per day) -- Vitamin C has antihistamine properties and some preliminary research suggested it might help reduce allergy symptoms. But another placebo-controlled trial failed to show any effect.

Herbs
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care practitioner.

Butterbur (Petasites hybridus, 500 mg per day) -- Butterbur has been used traditionally to treat asthma and bronchitis and to reduce mucus. Several scientific studies suggest it can help with allergic rhinitis. One study of 125 people with hay fever found that an extract of butterbur was as effective as Zyrtec. Another study compared butterbur to Allegra with similar findings. Both studies were small, however, so more research is needed. Researchers don' t know whether taking butterbur longer than 12 - 16 weeks is safe. Butterbur can cause stomach upset, headache, and drowsiness. Pregnant and breastfeeding women, and young children, should not take butterbur. If you take any prescription medications, ask your doctor before taking butterbur. Stinging nettle (Urtica dioica, 600 mg per day for one week) -- Stinging nettle has been used traditionally for treating a variety of conditions, including allergic rhinitis. But studies so far are lacking. Only one small study suggested that stinging nettle might help relieve symptoms of allergic rhinitis. Pregnant women and young children should not take stinging nettle. Talk to your doctor before taking stinging nettle if you take blood pressure medication, blood thinners, diuretics or water pills, or have diabetes. Tinospora cordifolia (300 mg three times daily) -- In one study, people with allergic rhinitis who took a specific formulation of tinospora (Tinofend) for 8 weeks had many fewer symptoms than those who took placebo. But some researchers have questioned the results of the study, and more research is needed. People who have diabetes or an autoimmune disease such as rheumatoid arthritis or Crohn' s disease should not take

tinospora. Pregnant or breastfeeding women should not take it, either. Tinospora can interact negatively with diabetes medications and drugs that suppress the immune system. Astragalus (Astragalus membranaceus, 160 mg two times per day) -- One preliminary study suggested that a specific formulation of astragalus (Lectranal) standardized to contain 40% polysaccharides reduced symptoms of allergic rhinitis including runny nose, sneezing and itching. People who have autoimmune disease such as rheumatoid arthritis or Crohn' s disease should not take astragalus without asking their doctor. People who take lithium or drugs that suppress the immune system should not take astragalus.

Acupuncture
Some evidence suggests that acupuncture may help treat people with allergic rhinitis, although not all studies were positive. In one study that included 45 people with hay fever, acupuncture worked as well as antihistamines in improving symptoms, and the effects seemed to last longer. However, a controlled trial that compared acupuncture to placebo (sham acupuncture) found no real benefit. One study suggested that combining acupuncture with traditional Chinese herbs did help relieve symptoms.

Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of allergic rhinitis symptoms based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Nux vomica -- for stuffiness with nasal discharge, dry, ticklish, and scraping nasal sensations with watery nasal discharge and a lot of sneezing; an appropriate person for this remedy is irritable and impatient. Arsenicum album -- for stuffiness with copious, burning nasal discharge and violent sneezing; an appropriate candidate for Arsenicum feels restless, anxious, and exhausted. Allium cepa -- for frequent sneezing, a lot of irritating nasal discharge and tearing eyes; this person tends to feel thirsty. Euphrasia -- for bland nasal discharge, with stinging, irritating tears; a suitable person for this remedy has worse nasal symptoms when lying down.

Traditional Chinese Medicine

Biminne -- Biminne is a Chinese herbal formula used to treat allergic rhinitis. In a study of 58 people with year-round allergic rhinitis, biminne relieved at least some symptoms in most of the participants. People in the study took the formula five times a day for 12 weeks, and they still showed the benefit of biminne even after one year. It is not known how biminne works, or if it is safe to use for extended periods. Ask your doctor before taking it. Biminne includes these herbs:

Chinese skullcap (Scutellaria baicalensis) -- can interact with sedatives, lithium, and diabetes medications. May also interact with statins, used to lower cholesterol. Ginkgo biloba -- may increase risk of bleeding and bruising. May interact with medications including blood thinners, nonsteroidal anti-inflammatory drugs (such as Advil or Aleve), and Xanax. Horny goat weed (Epimedium sagittatum) -- may interact with blood thinners and blood pressure medications. Schizandra chinensis -- may interact with many medications. Japanese apricot (Prunus mume) -- may interact with blood thinners. Ledebouriella divaricata Astragalus (Astragalus membranaceus) -- may interact with lithium and drugs that suppress the immune system.

Other Considerations:
Using some nasal decongestant sprays for long periods of time can make your allergic rhinitis worse. Call your health care provider if you develop severe symptoms, if treatment that helped before is no longer working, or if symptoms do not get better with treatment.

Pregnancy
If you are pregnant or breastfeeding, avoid the following:

Decongestants, unless you ask your doctor Stinging nettle Chinese skullcap Butterbur (Petasites) extracts High doses of vitamin C Tinospora cordifolia Astragalus

Warnings and Precautions

Do not take stinging nettle without talking to your doctor first if you take blood pressure medication, anticoagulants (blood thinners), diuretics (water pills), or have diabetes. Do not take tinospora cordifolia is you have diabetes or an autoimmune disease such as rheumatoid arthritis or Crohn' s disease. Do not take astragalus if you have an autoimmune disease such as rheumatoid arthritis or Crohn' s disease should not take astragalus. People who take lithium should not take astragalus. Butterbur may interact with some medications that are processed by the liver. If you take any prescription medications, ask your doctor before taking butterbur.

Skullcap can make you sleepy, and should be used with caution or not at all with antihistamines that also make you drowsy.

Prognosis and Complications

You can treat symptoms of allergic rhinitis, but they will appear each time you are exposed to an allergen. Although perennial allergic rhinitis is not a serious condition, it can interfere with your life. Depending on how severe your symptoms are, allergic rhinitis can cause you to miss school or work. Medication may cause drowsiness and other side effects. Your allergies could also trigger other conditions, such as eczema, asthma, sinusitis, and ear infection (called otitis media). Seasonal allergies may get better as you get older. Immunotherapy or allergy shots may cause uncomfortable side effects, such as hives and rash. Rarely, it may have dangerous side effects such as anaphylaxis. It usually works in about twothirds of cases, and may require years of treatment.

Alternative Names:
Hay fever; Perennial allergic rhinitis; Rhinitis - allergic; Seasonal allergies

Reviewed last on: 7/1/2011 Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Supporting Research
Anandan C, Nurmatov U, Sheikh A. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy. 2009 Jun;64(6):840-8. Review. Anonymous. Monograph. Petasites hybridus. Altern Med Rev. 2001;6(2):207-209. Badar VA, Thawani VR, Wakode PT, et al. Efficacy of Tinospora cordifolia in allergic rhinitis. J Ethnopharmacol. 2005;96:445-9. Blanc PD, Trupin L, Earnest G, Katz PP, Yelin EH, Eisner MD. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis : data from a population-based survey. Chest. 2001;120(5):1461-1467. Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.

Chatzi L, Apostolaki G, Bibakis I, Skypala I, Bibaki-Liakou V, Tzanakis N,et al. Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete. Thorax. 2007 Aug;62(8):677-83. Garavello W, DiBerardino F, Romagnoli M, et al. Nasal rinsing with hypertonic solution: an adjunctive treatment for pediatric seasonal allergic rhinoconjunctivitis. Int Arch Allergy Immunol. 2005;137:310-4. Garavello W, Romagnoli M, Sordo L, et al. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Pediatr Allergy Immunol. 2003;14:140-3. Hu G, Walls RS, Bass D, et al. The Chinese herbal formulation biminne in management of perennial allergic rhinitis: a randomized, double-blind, placebo-controlled, 12-week clinical trial. Ann Allergy Asthma Immunol. 2002 May;88(5):478-487. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet. 2001;357(9262):1076-1079. Kankaanpaa P, Nurmela K, Erkkila A, et al. Polyunsaturated fatty acids in maternal diet, breast milk, and serum lipid fattty acids of infants in relation to atopy. Allergy. 2001;56(7):633-638. Karkos PD, Leong SC, Arya AK, Papouliakos SM, Apostolidou MT, Issing WJ. 'Complementary ENT': a systematic review of commonly used supplements. J Laryngol Otol. 2007 Aug;121(8):779-82. Kaufeler R, Polasek W, Brattstrom A, Koetter U. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Adv Ther. 2006 MarApr;23(2):373-84. Kim JI, Lee MS, Jung SY, Choi JY, Lee S, Ko JM, et al. Acupuncture for persistent allergic rhinitis: a multi-centre, randomised, controlled trial protocol. Trials. 2009 Jul 14;10:54. Kopp MV, Salfeld P. Probiotics and prevention of allergic disease. Curr Opin Clin Nutr Metab Care. 2009 May;12(3):298-303. Review. Liu RH, Zhang XM, Zhang SQ. Study on mechanism of biminne in treating allergic rhinitis. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2007 Jul;27(7):623-5. Man LX. Complementary and alternative medicine for allergic rhinitis. Curr Opin Otolaryngol Head Neck Surg. 2009 Jun;17(3):226-31. Review. Matkovic Z, Zivkovic V, Korica M, et al. Efficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis. Phytother Res. 2010;24:175-81.

Meltzer EO; NasalCrom Study Group. Efficacy and patient satisfaction with cromolyn sodium nasal solution in the treatment of seasonal allergic rhinitis: a placebo-controlled study. Clin Ther. 2002;24(6):942-952. Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. Specific probiotics alleviate allergic rhinitis during the birch pollen season. World J Gastroenterol. 2009 Jul 14;15(26):3261-8. Roschek B Jr, Fink RC, McMichael M, Alberte RS. Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis. Phytother Res. 2009 Jul;23(7):920-6. Rudack C. Spectrum of treatments for hay fever. MMW Fortschr Med. 2007 Feb 15;149(7):32-4. Schapowal A; Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ. 2002;324(7330):144-146. Schapowal A, Study Group. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res. 2005;19:530-37. Task Force on Allergic Disorders. The Allergy Report. Vol. I. American Academy of Allergy, Asthma and Immunology. 2000. Tamura M, Shikina T, Morihana T, Hayama M, Kajimoto O, Sakamoto A, et al. Effects of probiotics on allergic rhinitis induced by Japanese cedar pollen: randomized double-blind, placebo-controlled clinical trial. Int Arch Allergy Immunol. 2007;143(1):75-82. Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC. Randomised controlled trial of homeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. BMJ. 2000;321(7259):471-476. Thomet OA, Schapowal A, Heinisch IV, et al. Anti-inflammatory activity of an extract of Petasites hybridus in allergic rhinitis. Int Immunopharmacol. 2002;2:997-1006. Thornhill SM, Kelly AM. Natural treatment of perennial allergic rhinitis. Altern Med Rev. 2000;5(5):448-454. Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:258260. Wakai K, Okamoto K, Tamakoshi A, Lin Y, Nakayama T, Ohno Y. Seasonal allergic rhinoconjunctivitis and fatty acid intake: a cross-sectional study in Japan. Ann Epidemiol. 2001;11(1):59-64.

Xue CC, An X, Cheung TP, Da Costa C, Lenon GB, Thien FC, Story DF. Acupuncture for persistent allergic rhinitis: a randomised, sham-controlled trial. Med J Aust. 2007 Sep 17;187(6):337-41. Xue CC, English R, Zhang JJ, Da Costa C, Li CG. Effect of acupuncture in the treatment of seasonal allergic rhinitis: a randomized controlled clinical trial. Am J Chin Med. 2002;30(1):111.

News Reference Education Log InRegister Reference

Search Me

<script type="text/javascript" language="JavaScript1.2" src="http://as.medscape.com/js.ng/params.richmedia%3Dyes&amp;transactionid%3D3043459795&am p;pos%3D101&amp;pf%3D0&amp;usp%3D0&amp;occ%3D0&amp;tid%3D0&amp;auth%3D0&amp;ct%3 D0&amp;inst%3D0&amp;kw%3D0&amp;artid%3Dckb134825&amp;pub%3D0&amp;spon%3D0&amp;st %3D0&amp;env%3D0&amp;ssp%3D38&amp;cg%3D502&amp;pclass%3Dcontent&amp;scg%3D213&am p;affiliate%3D2&amp;site%3D1&amp;leaf%3D0&amp;tile%3D5985531319"></script>

Print

Allergic Rhinitis

Author: Javed Sheikh, MD; Chief Editor: Michael A Kaliner, MD more...

Overview Presentation DDx Workup

Treatment Medication Follow-up

Updated: Sep 2, 2011

Background Pathophysiology Epidemiology Show All

References

Background
Rhinitis is defined as inflammation of the nasal membranes[1] and is characterized by a symptom complex that consists of any combination of the following: sneezing, nasal congestion, nasal itching, and rhinorrhea.[2] The eyes, ears, sinuses, and throat can also be involved. Allergic rhinitis is the most common cause of rhinitis. It is an extremely common condition, affecting approximately 20% of the population. Although allergic rhinitis is not a life-threatening condition, complications can occur and the condition can significantly impair quality of life,[3, 4] which leads to a number of indirect costs. The total direct and indirect cost of allergic rhinitis was recently estimated to be $5.3 billion per year.[5] A 2011 analysis determined that patients with allergic rhinitis averaged 3 additional office visits, 9 more prescriptions filled, and $1500 in incremental healthcare costs in 1 year than similar patients without allergic rhinitis.[6]

Pathophysiology
Allergic rhinitis involves inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, sinuses, and pharynx. The nose invariably is involved, and the other organs are affected in certain individuals. Inflammation of the mucous membranes is characterized by a complex interaction of inflammatory mediators but ultimately is triggered by an immunoglobulin E (IgE)mediated response to an extrinsic protein.[7] The tendency to develop allergic, or IgE-mediated, reactions to extrinsic allergens (proteins capable of causing an allergic reaction) has a genetic component. In susceptible individuals, exposure to certain foreign proteins leads to allergic sensitization, which is characterized by the production of specific IgE directed against these proteins. This specific IgE coats the surface of mast cells, which are present in the nasal mucosa. When the specific protein (eg, a specific

pollen grain) is inhaled into the nose, it can bind to the IgE on the mast cells, leading to immediate and delayed release of a number of mediators.[7, 8, 9] The mediators that are immediately released include histamine, tryptase, chymase, kinins, and heparin.[8, 9] The mast cells quickly synthesize other mediators, including leukotrienes and prostaglandin D2.[10, 11, 12] These mediators, via various interactions, ultimately lead to the symptoms of rhinorrhea (ie, 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 plasma exudation. 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 interplay of events, lead to the recruitment of other inflammatory cells to the mucosa, such as neutrophils, eosinophils, lymphocytes, and macrophages.[13] This results in continued inflammation, termed the late-phase response. The symptoms of the late-phase response are similar to those of the early phase, but less sneezing and itching and more congestion and mucus production tend to occur.[13] The late phase may persist for hours or days. Systemic effects, including fatigue, sleepiness, and malaise, can occur from the inflammatory response. These symptoms often contribute to impaired quality of life.

Epidemiology
Frequency
United States

Allergic rhinitis affects approximately 40 million people in the United States.[14] Recent US figures suggest a 20% cumulative prevalence rate.[15, 16]
International

Scandinavian studies have demonstrated a cumulative prevalence rate of 15% in men and 14% in women.[17] The prevalence of allergic rhinitis may vary within and among countries.[18, 19, 20, 21] This may be due to geographic differences in the types and potency of different allergens and the overall aeroallergen burden.

Mortality/Morbidity
While allergic rhinitis itself is not life-threatening (unless accompanied by severe asthma or anaphylaxis), morbidity from the condition can be significant. Allergic rhinitis often coexists with other disorders, such as asthma, and may be associated with asthma exacerbations.[22, 23, 24]

Allergic rhinitis is also associated with otitis media, eustachian tube dysfunction, sinusitis, nasal polyps, allergic conjunctivitis, and atopic dermatitis.[1, 2, 25] It may also contribute to learning difficulties, sleep disorders, and fatigue.[26, 27, 28]

Numerous complications that can lead to increased morbidity or even mortality can occur secondary to allergic rhinitis. Possible complications include otitis media, eustachian tube dysfunction, acute sinusitis, and chronic sinusitis. Allergic rhinitis can be associated with a number of comorbid conditions, including asthma, atopic dermatitis, and nasal polyps. Evidence now suggests that uncontrolled allergic rhinitis can actually worsen the inflammation associated with asthma[22, 23, 24] or atopic dermatitis.[25] This could lead to further morbidity and even mortality. Allergic rhinitis can frequently lead to significant impairment of quality of life. Symptoms such as fatigue, drowsiness (due to the disease or to medications), and malaise can lead to impaired work and school performance, missed school or work days, and traffic accidents. The overall cost (direct and indirect) of allergic rhinitis was recently estimated to be $5.3 billion per year.[5]

Race
Allergic rhinitis occurs in persons of all races. Prevalence of allergic rhinitis seems to vary among different populations and cultures, which may be due to genetic differences, geographic factors or environmental differences, or other population-based factors.

Sex
In childhood, allergic rhinitis is more common in boys than in girls, but in adulthood, the prevalence is approximately equal between men and women.

Age
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.[29] The prevalence of allergic rhinitis has been reported to be as high as 40% in children, subsequently decreasing with age.[15, 16] In the geriatric population, rhinitis is less commonly allergic in nature.
Proceed to Clinical Presentation

Read more about Allergic Rhinitis on Medscape Related Reference Topics Related News and Articles

Allergic Rhinitis in Otolaryngology and Facial Plastic Surgery Pediatric Allergic Rhinitis Nasal Polyp Surgery

New Dry Nasal Spray on the Horizon for Perennial Allergic Rhinitis Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-related Agents Seasonal Allergic Rhinitis Symptoms Relieved Quite Quickly With Immunotherapy

Medscape Reference 'Instant Lookup' is now available site-wide from the search box above About Medscape Reference | Editorial & Advisory Board

<script type="text/javascript" language="JavaScript1.2" src="http://as.medscape.com/js.ng/params.richmedia%3Dyes&amp;transactionid%3D3043459795&am p;pos%3D125&amp;pf%3D0&amp;usp%3D0&amp;occ%3D0&amp;tid%3D0&amp;auth%3D0&amp;ct%3 D0&amp;inst%3D0&amp;kw%3D0&amp;artid%3Dckb134825&amp;pub%3D0&amp;spon%3D0&amp;st %3D0&amp;env%3D0&amp;ssp%3D38&amp;cg%3D502&amp;pclass%3Dcontent&amp;scg%3D213&am p;affiliate%3D2&amp;site%3D1&amp;leaf%3D0&amp;tile%3D5985531319"></script>

<script type="text/javascript" language="JavaScript1.2" src="http://as.medscape.com/js.ng/params.richmedia%3Dyes&amp;transactionid%3D3043459795&am

p;pos%3D141&amp;pf%3D0&amp;usp%3D0&amp;occ%3D0&amp;tid%3D0&amp;auth%3D0&amp;ct%3 D0&amp;inst%3D0&amp;kw%3D0&amp;artid%3Dckb134825&amp;pub%3D0&amp;spon%3D0&amp;st %3D0&amp;env%3D0&amp;ssp%3D38&amp;cg%3D502&amp;pclass%3Dcontent&amp;scg%3D213&am p;affiliate%3D2&amp;site%3D1&amp;leaf%3D0&amp;tile%3D5985531319"></script>

About Medscape Privacy Policy Terms of Use WebMD Health MedicineNet eMedicineHealth RxList WebMD Corporate Help Contact Us

All material on this website is protected by copyright, Copyright 1994-2011 by WebMD LLC. This website also contains material copyrighted by 3rd parties. DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.

Fig. 5. Morphology of the laryngeal mucosa in control nonsensitized (A) and sensitized allergic rhinitis (B) guinea pigs. The area confined with the black square in B is blown up in C to underscore the excessive vascular dilatation, congestion, edema, and eosinophilic infiltration in the mucosa. Magnification - 4x in A and B, and 40x in C.