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Allergic Rhinitis

Practice Essentials

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


Postnasal drip






Red eyes

Eye swelling




Complications of this allergic rhinitis include the following:

Acute or chronic sinusitis

Otitis media

Sleep disturbance or apnea

Dental problems (overbite): Caused by excessive breathing through the mouth

Palatal abnormalities

Eustachian tube dysfunction

Physical examination

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

See Treatment and Medication for more detail.

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