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Allergy

The symptoms, diagnosis, and management of allergic rhinitis

02 July 2024
Clinical Focus

Abstract

Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis. It is usually a long-standing condition that often goes undetected in the primary care setting

Allergic Rhinitis (AR) is a very common, under recognised problem in the UK with symptoms significantly impacting on quality of life, work and school performance, social life and is a risk factor for developing asthma. Treatment options for AR include allergen avoidance, antihistamines and intra-nasal pharmacological therapies.

Allergic rhinitis (AR) is an atopic (hypersensitivity) disease presenting with symptoms of sneezing, nasal congestion, clear rhinorrhoea, and nasal pruritis (Akhouri and House, 2023). AR affects one in six individuals and is associated with significant morbidity, loss of productivity, and healthcare costs (Akhouri and House, 2023). In the early phase, AR is an immunoglobulin (Ig) E-mediated response against inhaled allergens that cause inflammation driven by type 2 helper (Th2) cells (Skoner, 2001). Within five to 15 minutes of exposure to an antigen, the initial response occurs resulting in the degranulation of host mast cells (Skoner, 2001). A variety of pre-formed and newly synthesized mediators are released including histamine, which induces sneezing via the trigeminal nerve resulting in rhinorrhoea by stimulating mucus glands (Akhouri and House, 2023). Nasal congestion in AR is caused by leukotrienes and prostaglandins which act on the blood vessels. Four to six hours after the initial response, an arrival of cytokines, such as interleukins (IL)-4 and IL-13, from mast cells occurs which signifies the late-phase response of AR (Pawankar et al, 2011). This process facilitates the infiltration of eosinophils, T-lymphocytes, and basophils into the nasal mucosa and produces nasal oedema, resulting in congestion (Fig 1) (Pawankar et al, 2011).

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Allergic rhinitis
Atopic
Histamine
Allergy
Allergen