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Allergic rhinitis
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Allergic rhinitis is the leading chronic disease of the upper airways because of its:
- prevalence
- effect on the quality of life
- effect on productivity at work or in school
- economic burden
- connection to asthma
Allergic rhinitis is joined with other comorbidities, and one of the most common is conjunctivitis.
It is divided into:
- intermittent
- persistent
According to the severity of the clinical image it can be typed as "mild" or "moderately severe".
In treatment of allergic rhinitis we combine:
- pharmacotherapy
- immunotherapy
- education
In order to consider allergic rhinitis diagnosis of a patient with nasal symptoms, it is necessary to ask the following questions with the expected answer of yes or no:
Question
1. Do you have any of these symptoms:
- symptoms in only one side of your nose
- thick green or yellow secretion of the nose
- confluence of secretion back to the throat
- facial pain
- frequent nose bleeding
- lack of sense of smell
2. Do you have any of these symptoms for at least an hour on majority of days (or a specific number of days during one period of the year if your symptoms are seasonal)
- watery secretion of the nose
- heavy breathing through the nose
- itching in the nose
- itching and redness of the eyes
The symptoms described in question 1. are not commonly the ones of allergic rhinitis. The presence of some of them suggests alternative diagnoses therefore the patient is to be referred to a specialist for an examination.
Diagnostic of allergic rhinitis:
Includes a physical examination, attempt of therapy introduction, allergic skin testing and measurement of the allergen-specific IgE in the serum.
Classification
- intermittent (symptoms < 4 days a week or < 4 consecutive weeks)
- persistent (> 4 days a week and > 4 consecutive weeks)
Mild
- without sleeping disorders
- without limitation of daily activities during sport and leisure time
- without performance disorder in school or at work
- without exhausting symptoms
Moderately severe (one or more)
- sleeping disorder
- disorder in performance of daily activities during sport and leisure time
- performance disorder in school or at work
- exhausting symptoms
Therapy: oral H1 antihistamine, intranasal H1 antihistamine, intranasal corticosteroid, intranasal chromone, leukotriene receptor antagonists, subcutaneous and sublingual specific immunotherapy, avoiding allergens.
With all patients suffering from allergic rhinitis it is necessary to consider whether it is linked with asthma.
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