Rhinitis, which occurs most commonly as allergic rhinitis, is an inflammation of the nasal membranes that is characterized by sneezing, nasal congestion, nasal itching, and rhinorrhea, in any combination.
Although allergic rhinitis itself is not life-threatening (unless accompanied by severe asthma or anaphylaxis), morbidity from the condition can be significant.
Signs and Symptoms
Signs and symptoms of allergic rhinitis include the following:
Itching: Nose, eyes, ears, palate
Complications of this allergic rhinitis include the following:
Acute or chronic sinusitis
Sleep disturbance or apnea
Dental problems (overbite): Caused by excessive breathing through the mouth
Eustachian tube dysfunction
Nasal features of allergic rhinitis can include the following:
Nasal crease: A horizontal crease across the lower half of the bridge of the nose; caused by repeated upward rubbing of the tip of the nose by the palm of the hand
Thin, watery nasal secretions
Deviation or perforation of the nasal septum: May be associated with chronic rhinitis, although there can be other, unrelated causes
Manifestations of allergic rhinitis affecting the ears, eyes, and oropharynx include the following:
Ears: Fullness, retraction, or abnormal flexibility of the tympanic membrane
Eyes: Injection and swelling of the palpebral conjunctivae, with excess tear production; Dennie-Morgan lines (prominent creases below the inferior eyelid); and dark circles around the eyes (“allergic shiners”), which are related to vasodilation or nasal congestion
Oropharynx: “Cobblestoning,” that is, streaks of lymphoid tissue on the posterior pharynx; tonsillar hypertrophy; and malocclusion (overbite) and a high-arched palate
See Clinical Presentation for more detail.
Laboratory tests used in the diagnosis of allergic rhinitis include the following:
Allergy skin tests (immediate hypersensitivity testing): An in vivo method of determining immediate (IgE-mediated) hypersensitivity to specific allergens
Fluorescence enzyme immunoassay (FEIA): Indirectly measures the quantity of immunoglobulin E (IgE) serving as an antibody to a particular antigen
Total serum IgE: Neither sensitive nor specific for allergic rhinitis, but the results can be helpful in some cases when combined with other factors
Total blood eosinophil count: Neither sensitive nor specific for the diagnosis, but, as with total serum IgE, can sometimes be helpful when combined with other factors
Imaging studies used in the diagnosis and evaluation of allergic rhinitis include the following:
Radiography: Can be helpful for evaluating possible structural abnormalities or to help detect complications or comorbid conditions, such as sinusitis or adenoid hypertrophy
Computed tomography scanning: Can be very helpful for evaluating acute or chronic sinusitis
Magnetic resonance imaging: Also can be helpful for evaluating sinusitis
See Workup for more detail.
The management of allergic rhinitis consists of the following 3 major treatment strategies:
Environmental control measures and allergen avoidance: These include keeping exposure to allergens such as pollen, dust mites, and mold to a minimum
Pharmacologic management: Patients are often successfully treated with oral antihistamines, decongestants, or both; regular use of an intranasal steroid spray may be more appropriate for patients with chronic symptoms
Immunotherapy: This treatment may be considered more strongly with severe disease, poor response to other management options, and the presence of comorbid conditions or complications; immunotherapy is often combined with pharmacotherapy and environmental control