Allergic rhinitis is an IgE-mediated reaction of the nasal lining to inhaled allergens such as pollen, dust mites, mold or animal dander. It can be seasonal or year-round and often occurs with asthma, eczema and allergic conjunctivitis.
Key symptoms
- Sneezing and clear runny nose
- Nasal congestion and itchy nose
- Itchy, watery eyes
- Postnasal drip, cough and poor sleep
- Symptoms tied to seasons or exposures
What you find on exam
- Pale, boggy, swollen nasal turbinates
- Dark circles under the eyes (allergic shiners)
- Horizontal crease across the nose from rubbing
- Red, watery conjunctiva
- Wheeze, which points to asthma
Tests
- Diagnosis is usually clinical
- Skin prick testing or specific IgE blood tests to identify allergens
- Peak flow or spirometry if asthma is suspected
Treatment basics
- Avoid triggers: dust mite covers, air filters, windows closed in pollen season
- Intranasal steroid such as fluticasone, the most effective single drug
- Second-generation oral antihistamine such as cetirizine or loratadine
- Intranasal antihistamine such as azelastine; montelukast in selected patients
- Allergen immunotherapy for persistent symptoms
Red flags
- One-sided blockage, bleeding or foul discharge (think polyp or tumor)
- Wheeze or shortness of breath (asthma)
- Fever, facial pain and swelling suggesting a sinus infection
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.