Characterized by sneezing; rhinorrhea; obstruction of the nasal passages; conjunctival, nasal, and pharyngeal itching; and lacrimation, all occurring in a temporal relationship to allergen exposure. Prevalence in North America is 10-20% with a peak prevalence >30% occurring in the fifth decade. Commonly seasonal due to triggering by airborne pollens; can be perennial in response to allergens present throughout the year such as house dust mites and animal danders.
Deposition of pollens and other allergens on nasal mucosa of sensitized individuals results in IgE-dependent triggering of mast cells with subsequent release of mediators that cause development of mucosal hyperemia, swelling, and fluid transudation.
Accurate history of symptoms correlated with time of seasonal pollination of plants in a given locale; special attention must be paid to other potentially sensitizing antigens.
- Physical examination: nasal mucosa may be boggy or erythematous; nasal polyps may be present; conjunctivae may be inflamed or edematous; manifestations of other allergic conditions (e.g., asthma, eczema) may be present.
- Skin tests to inhalant and/or food antigens.
- Nasal smear may reveal large numbers of eosinophils.
- Total and specific serum IgE (as assessed by immunoassay) may be elevated.
Vasomotor rhinitis, upper respiratory infection (URI), irritant exposure, pregnancy with nasal mucosal edema, rhinitis medicamentosa, nonallergic rhinitis with eosinophilia, rhinitis due to α-adrenergic agents.
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Allergic Rhinitis
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