Rhinitis, Allergic

Basics

Description

  • Inflammation of the nasal and sinus mucosae, associated with sneezing, swelling, increased mucus production, and nasal obstruction; may be classified as seasonal, perennial, or a combination
    • Seasonal: periodic symptoms, involving the same season for at least 2 consecutive years; most often due to pollens (e.g., trees, grass, weeds) and outdoor spores
    • Perennial: occurring at least 9 months of the year; may be more difficult to detect because of overlap with viral infections; may be due to multiple seasonal allergies or continual exposure to allergens (e.g., dust mites, cockroaches, molds, and animal dander)
    • Perennial, with seasonal exacerbations
  • The Allergic Rhinitis and its Impact on Asthma (ARIA) World Health Organization expert panel prefer the classification for allergic rhinitis of intermittent or persistent, with subclassifications of mild, moderate, or severe.

Epidemiology

Prevalence

Most common allergic disease, affecting approximately 40 million Americans; affects 40% of children and 15–30% of adolescents

Risk Factors

Genetics

Increased incidence in families with atopic disease. If one parent has allergies, each child has approximately a 30% chance of having an allergy; if both parents have allergies, each child has a 70% chance of having an allergy.

General Prevention

  • Minimize exposure to dust mites: Consider removal of carpets, upholstered furniture, and curtains; wash bedding in hot water (130°F for at least 10 minutes) at least every 1 to 2 weeks; use pillow and mattress covers; use of acaricides to kill dust mites
  • Minimize exposure to animal dander and all animals; consider using solutions containing tannic acid, which will denature animal allergens; shampoo pets frequently if they cannot be removed from the household; use air vent filters or air-filtration systems.
  • Minimize exposure to pollens: Keep windows closed, use air-conditioning, and avoid leaf raking or lawn mowing.
  • Minimize exposure to molds: Keep houseplants out of the bedroom; avoid spending time in the basement; keep humidity at 35–50%.

Etiology

  • Indoor allergens: house dust mite, cockroaches, animal dander, cigarette smoke, hair spray, paint, molds
  • Pollens: tree pollens in early spring, grass in late spring and early summer, ragweed in late summer and autumn
  • Multiple environmental factors
  • Changes in air temperature

Commonly Associated Conditions

  • Asthma
  • Allergic conjunctivitis
  • Atopic dermatitis (eczema)
  • Pollen food allergy syndrome (PFAS)
  • Urticaria
  • Otitis media with effusion
  • Sleep, taste, and/or smell disturbance
  • Nasal polyps
  • Mouth breathing
  • Snoring and sleep-disordered breathing
  • Adenoidal hypertrophy
  • Decreased appetite
  • Delayed speech

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