Allergic rhinitis is an allergic reaction to aspirate allergens such as pollen, fungus, dust or animal hair onto the nasal mucosa. Allergic rhinitis can be separated into seasonal allergic rhinitis and perennial allergic rhinitis. The former has much to do with pollen induced allergy caused by exposure to pollen for several months; main symptom is sneezing. The later shows chronic or intermittent nasal congestion and nasal stuffiness related to allergens such as dust, animal hair, and animal droppings. Clinically, patients are allergic to more than one allergen.
The classical symptoms of allergic rhinitis include sneezing, watery nasal discharge, and nasal stuffiness. Some people might have eyes and throat itching, eyes congestion, tears, headache. Patient’s medical history and family history may show allergic conjunctivitis, asthma or atopic dermatitis. If one of the patient’s parents has allergic rhinitis, the child has 25% rate to have allergic rhinitis; if both parents have allergic rhinitis, the rate of having allergic child will increase to 75-80%.
Diagnosing of allergic rhinitis includes the following 3 categories:
a. in vivo: The skin test includes intradermal skin test, prick test and scratch test. The specificity and sensitivity of these tests can reach 98%, But chances are the tests will induce anaphylaxis and have poor sensitivity to detect food allergy.
Treatment
Medical treatment include antihistamine, decongestant, mast cell stabilizers（cromolyn）, steroid and anticholinergic drugs. New antihistamine can improve nasal itching, sneezing, and watery nasal discharge effectively without the side effect of sedation. The main function is to prevent histamine from stimulating nasal mucosa.
Decongestant can stimulate α-receptor of sympathetic nerve to decrease nasal mucosa swelling and keep nasal cavity patent. It can relive symptoms rapidly but long-term use is not recommended because stopping taking after long term use or overdosing can worsen the nasal mucosa swelling. Besides, patients with hypertension, cardiovascular disease, and hyperthyroidism should use it carefully.
For severe allergic patients, we can give low dose oral steroid for 1-2 weeks combined with nasal spray with mast cell stabilizers or steroid at the same time. Modify oral medication after 2weeks and then use it for another 2 weeks. If the medicine works well, we reduce doses so that its effect can cover allergic attack and then use it for another month.
We give the lowest dose nasal spray in the third month. Oral steroid only is used in severe symptoms patients. We use small dose of steroid and stop using it several days later, so no worries. Steroid nasal spray is a local treatment with rare systemic side effect and occasional nasal mucosa dryness and bloody-tinged nasal discharge. These symptoms will improve after stopping the medicine.
If poor medication response happens, we can use immunotherapy, which focuses on specific allergen and injects allergen into body gradually and thus induces tolerance to allergens. the treatment lasts 1-2 years.
Besides, we can use laser to burn the surface of nasal mucosa, making submucosal tissue produce local reaction and fibrosis, and shrink nasal mucosa to improve nasal stuffiness.
Preventing allergens is the most essential and important way. For example, patients can use dust-proof bedcover, wash pillowcase and duvet cover every 2 weeks, never use carpet and heavy curtain cloth, don’t raise pets unless necessary.
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