OVERVIEW

What is allergic rhinitis?

Allergic rhinitis, also known as hay fever, is an excessive defensive reaction of the nasal mucosa upon exposure to allergens, and it is a common chronic condition. Typical symptoms include repeated sneezing, clear nasal discharge, nasal itching, and nasal congestion.

Main treatment methods include avoiding allergens, medication, and desensitization therapy^[1]. Surgery is only an auxiliary treatment for allergic rhinitis.

Although allergic rhinitis currently cannot be completely cured, with proper treatment, patients' quality of life can remain unaffected.

Is allergic rhinitis common in the population?

Yes, it is common. Research shows that the prevalence rate among children in China is 15.79% (approximately 16 out of every 100 children), while the adult prevalence rate is 13.26% (approximately 13 out of every 100 adults). The prevalence rate is higher in children than in adults^[2].

What are the types of allergic rhinitis?

Classification based on onset time:

• Seasonal allergic rhinitis: Such as "hay fever," which typically occurs during pollen dispersal seasons.
• Perennial allergic rhinitis: Caused by allergens that are present year-round in the surrounding environment, such as dust mites, cockroaches, animal dander, and certain occupational allergens^[1].

Which department should I visit for allergic rhinitis?

If you suspect this condition, you may first visit the allergy department. If such a department is not available, you can go to the otolaryngology or ENT department. If, in addition to nasal symptoms, you also experience recurrent wheezing, coughing, shortness of breath, or chest tightness, you should promptly visit the respiratory department. If accompanied by eye symptoms such as itching, tearing, or redness, you may also need to consult the ophthalmology department.

SYMPTOMS

What are the common manifestations of allergic rhinitis?

The most common symptoms of allergic rhinitis include nasal itching, clear watery nasal discharge, sneezing, and nasal congestion. During episodes, patients may experience a reduced sense of smell (hyposmia)^[1,3].

In children, severe allergic rhinitis may lead to frequent upward rubbing of the nose with the palm or fingers due to nasal itching and congestion. Swelling of the lower eyelids can also impair venous return, resulting in dark circles under the eyes.

What allergic diseases often co-occur with allergic rhinitis, and what are their symptoms?

Allergic rhinitis is often accompanied by other allergic conditions such as bronchial asthma and allergic conjunctivitis.

Bronchial asthma: Patients with allergic rhinitis who also have asthma may experience recurrent wheezing, coughing, shortness of breath, and chest tightness^[3].

Allergic conjunctivitis: Symptoms include eye itching, tearing, and redness, and sometimes itching in the external ear canal, soft palate, or throat^[1].

What are the risks of allergic rhinitis?

• Nasal congestion can cause headaches and difficulty concentrating. Frequent sneezing and runny nose may affect social interactions and even impact mental health. Reduced sense of smell can impair appetite and even pose safety risks.
• Allergic rhinitis may also coexist with other conditions, such as asthma, chronic rhinosinusitis, upper airway cough syndrome, secretory otitis media, and obstructive sleep apnea hypopnea syndrome.
• Chronic nasal congestion, mouth breathing, and hypoxia caused by allergic rhinitis and its complications may also affect facial development and cognitive function in children.

What complications can allergic rhinitis cause?

• Chronic rhinosinusitis: Caused by long-term nasal mucosal swelling, symptoms include nasal congestion, purulent nasal discharge, loss of smell, and headaches.
• Allergic pharyngitis: Triggered by allergen exposure, leading to hypersensitivity reactions in the respiratory tract. Symptoms include throat itching, coughing, mild hoarseness, and laryngeal mucosal swelling.
• Secretory otitis media: Nasal mucosal swelling obstructs the Eustachian tube, causing symptoms like ear fullness, tinnitus, and hearing loss.
• Sleep disorders: Seasonal allergic rhinitis can cause nasal mucosal swelling and airway obstruction, leading to sleep apnea, snoring, shortness of breath, cyanosis (bluish skin/mucous membranes), and in severe cases, sudden nocturnal death.

CAUSES

What are the causes of allergic rhinitis?

When common substances in daily life (such as dust mites, pollen, animal dander, etc.) come into contact with the nasal mucosa, the immune system of allergic rhinitis patients mistakenly identifies them as harmful to the body. As a result, it launches an excessive attack against these "harmful substances," attempting to expel them through frequent sneezing and excessive watery nasal discharge^[1].

What are the common allergens for allergic rhinitis?

Common seasonal allergens include pollen and fungi, while perennial allergens include dust mites, cockroaches, animal dander, and certain occupational allergens such as lime and coal dust^[4].

Who is more likely to develop allergic rhinitis?

Allergic rhinitis can occur in all types of people, with similar incidence rates between men and women. Those working in the textile or flour processing industries or in close contact with animals^[1] have a relatively higher incidence of allergic rhinitis.

Textile or flour industry workers: Chemicals and dust can irritate the nasal mucosa, and long-term exposure may trigger the condition.

People in close contact with animals: Animal fur can irritate the nasal mucosa, making them more susceptible to the condition.

Is allergic rhinitis contagious?

Allergic rhinitis is not contagious.

Is allergic rhinitis hereditary?

Allergic rhinitis has a certain hereditary tendency, but it does not mean that children will definitely develop it if their parents have it. Besides genetic factors, environmental factors also determine whether allergic rhinitis occurs. If one parent has the condition, the offspring's risk is 50%^[5], and if both parents have it, the incidence rate is even higher.

DIAGNOSIS

How is allergic rhinitis diagnosed? What tests are needed?

Doctors primarily diagnose it based on clinical symptoms, medical history, and laboratory test results. The typical symptoms of allergic rhinitis include sneezing, clear nasal discharge, nasal itching, and congestion. If two or more of these symptoms persist or accumulate for more than one hour daily, allergic rhinitis should be suspected. Common tests include:

1. Physical examination:

   • Inspect the nasal condition and examine adjacent areas like the eyes and throat;
   • Review medical and family history, including work environment and allergy history, to identify potential allergens.

2. Specific tests: To identify allergens, allergy testing can be performed, though it is not mandatory for diagnosis. Common methods include:

   • Allergen skin prick test: The most widely used clinical method, where allergen solutions are pricked into the skin to observe reactions and confirm allergies.
   • IgE testing: Measures IgE levels in serum and nasal secretions to determine allergic reactions.
   • Nasal provocation test: Introduces allergen solutions or sprays into the nasal cavity to observe allergic responses.

3. Anterior rhinoscopy or nasal endoscopy: Examines nasal anatomy, mucosal condition, and secretions. Pale, swollen, congested, or bluish mucosa with visible secretions^[1] supports an allergic rhinitis diagnosis.

Why is allergen testing necessary for allergic rhinitis?

Allergic diseases, including allergic rhinitis, conjunctivitis, dermatitis, and asthma, are the body's hypersensitive reactions to environmental triggers. Allergen testing identifies specific allergens to avoid exposure (reducing symptoms) or pursue desensitization therapy (e.g., for dust mites), potentially curing some cases. However, not all patients can pinpoint allergens due to complex causes.

How is allergen testing performed for allergic rhinitis?

Two common methods exist: skin tests (quick results but unsuitable for very young children) and blood tests.

• Allergen skin prick test: Allergen solutions are pricked into the skin; a wheal ≥3 mm with redness after 15–20 minutes indicates positivity^[6], confirming allergy and identifying the allergen.
• IgE testing: Detects specific IgE in serum/nasal secretions; positive results suggest allergies.
• Nasal provocation test: The gold standard but carries risks. Allergen solutions/sprays are introduced into the nose, gradually increasing concentration until symptoms (e.g., nasal discharge/congestion) appear, confirming diagnosis and allergen.

How is the allergen skin prick test conducted?

The test involves pricking the skin with common allergens (typically 10 pricks based on local prevalence). After 20 minutes, redness/swelling at the site indicates allergy, with high accuracy. Discomfort is mild, akin to a mosquito bite, tolerable even for children.

What precautions apply to skin prick testing?

• Oral antihistamines (e.g., chlorpheniramine, cetirizine, loratadine) suppress skin reactions; stop them one week before testing.
• Skin conditions like dermatitis, fresh wounds, or large burns require postponement until healed.
• Contraindicated for those with adrenaline use restrictions.
• Pregnant individuals should avoid due to allergy risk.

What does blood testing involve in allergen detection?

Serum-specific IgE testing is most valuable, applicable at any age, unaffected by skin conditions or antihistamines. It matches skin prick test accuracy but is costlier.

Which diseases are easily confused with allergic rhinitis?

Vasomotor rhinitis, non-allergic rhinitis with eosinophilia, infectious rhinitis, hormonal rhinitis, drug-induced rhinitis, aspirin-exacerbated respiratory disease, and cerebrospinal fluid rhinorrhea may mimic allergic rhinitis with similar symptoms but negative allergen tests.

TREATMENT

Can allergic rhinitis heal on its own without treatment?

Allergic rhinitis symptoms may disappear on their own after avoiding allergens. If allergens cannot be avoided, symptoms may improve or worsen depending on changes in immune function. If allergic rhinitis recurs frequently, it is recommended to seek medical attention as soon as possible.

How is allergic rhinitis treated?

Treatment for allergic rhinitis (i.e., allergic rhinitis) includes avoiding allergens, medication, and desensitization therapy.

Avoiding allergens:

• This is the most important measure for prevention and treatment. Using specialized masks, nasal filters, or pollen blockers can reduce inhalation of allergens like pollen or dust mites, alleviating nasal symptoms.
• For patients allergic to dust mites, improving indoor environments (e.g., maintaining cleanliness, ventilation, and frequent bedding exposure to sunlight) can reduce exposure.

Medication:

• Nasal corticosteroids: Common medications include mometasone furoate nasal spray, budesonide nasal spray, and fluticasone propionate nasal spray. Possible side effects include nasal dryness, irritation, nosebleeds, pharyngitis, and coughing, mostly mild^[1].
• Antihistamines: Second-generation oral antihistamines (e.g., loratadine, cetirizine) or nasal antihistamines (e.g., levocabastine hydrochloride spray) may be used. These are suitable for patients with nasal itching or sneezing. Drowsiness is a common side effect, so avoid driving or operating machinery after use.
• Leukotriene receptor antagonists: Montelukast is commonly used but may cause rashes, drowsiness, nausea, vomiting, or palpitations^[1].
• Anticholinergics: Ipratropium bromide may be used for severe runny nose, but side effects like dry mouth, headache, or nasal dryness may occur^[1].
• Other treatments: Nasal irrigation can serve as adjunctive therapy. Avoid self-purchasing unverified nasal drops or solutions to prevent drug-induced rhinitis.

Desensitization therapy:
Gradually increasing allergen exposure can reduce hypersensitivity. This method is effective for dust mites, certain pollens, molds, and animal dander^[1].

What are the common side effects of allergic rhinitis medications?

• Nasal corticosteroids: Generally safe with mild side effects like nasal dryness, irritation, or nosebleeds. To minimize risks, spray with the left hand for the right nostril and vice versa, avoiding the nasal septum.
• Oral antihistamines: Drowsiness is the main side effect; avoid driving or hazardous activities after use.
• Desensitization therapy: The primary risk is triggering asthma.

Note: Decongestants (e.g., ephedrine nasal drops) provide quick relief but are not recommended for long-term use due to the risk of drug-induced rhinitis. Always follow medical advice.

Does allergic rhinitis require surgery? Who needs it?

Surgery is a supplementary treatment and should be considered carefully. It is mainly recommended for:

• Patients with chronic sinusitis.
• Patients whose symptoms persist despite medication or desensitization therapy, severely affecting their quality of life^[1].

Can allergic rhinitis be cured?

Unfortunately, allergic rhinitis currently has no cure. However, symptom control is the primary treatment goal^[1].

How much does desensitization therapy cost, and how effective is it?

Currently, desensitization therapy is only available for dust mites and requires two years of continuous treatment. Costs vary: subcutaneous injections cost around ¥30,000, while sublingual tablets are cheaper (around ¥4,000). The therapy is effective and may prevent allergic rhinitis from progressing to asthma while reducing new allergen sensitivities.

Can allergic rhinitis be life-threatening?

Generally, allergic rhinitis is not life-threatening. However, patients with asthma should be cautious, as severe asthma attacks can lead to suffocation.

Are there folk remedies for allergic rhinitis?

No.

Unverified "folk remedies" or "secret formulas" carry risks like poisoning or allergic reactions. Always consult a medical professional.

If symptoms like sneezing, runny nose, itching, or congestion occur, seek diagnosis and treatment at a reputable hospital.

DIET & LIFESTYLE

What should allergic rhinitis patients pay attention to in their diet?

Patients with allergic rhinitis should observe their daily reactions and avoid foods that worsen their symptoms. Generally, there is no need to set strict dietary restrictions.

Common hot, spicy, or irritating foods can cause blood vessel dilation and increased secretions, aggravating symptoms like nasal congestion, runny nose, and sneezing^[1]. If these effects occur, it’s best to avoid such foods.

Additionally, some pollen allergens in allergic rhinitis may cross-react with certain fruits and vegetables. Patients, especially those allergic to pollen, might experience oral discomfort (oral allergy syndrome) when consuming raw or undercooked produce. Cooking vegetables thoroughly can often prevent this reaction.

What should allergic rhinitis patients pay attention to in daily life?

Key recommendations include:

• Avoid colds and minimize respiratory infections.
• Stay away from allergens like pet dander, dust mites, and pollen.
• Wear a mask in environments prone to triggering allergies.
• For dust mite allergies: Maintain indoor cleanliness, ventilate frequently, avoid carpets in humid areas, wash bedding and clothes regularly, sun-dry or machine-dry them, clean air conditioner filters periodically, and minimize contact with plush toys.
• For pollen allergies: Reduce outdoor activities during pollen seasons, wear masks or use pollen blockers, and start preventive treatments (e.g., antihistamines, nasal corticosteroids) about two weeks before pollen dispersal. Since pollen types and seasons vary, track personal symptom patterns for timely prevention.

Does exercise benefit allergic rhinitis?

For some patients, moderate exercise like jogging or swimming may help relieve nasal congestion symptoms.

PREVENTION

How to Prevent Recurrent Allergic Rhinitis?

Reducing or avoiding exposure to allergens is crucial.

• For those allergic to dust mites, maintain indoor cleanliness, ventilate frequently, avoid using carpets in humid areas, wash and sun-dry clothes and bedding regularly (or use a dryer), clean air conditioner filters periodically, stay away from plush toys, and wash hair frequently.
• For those allergic to pollen, minimize outdoor activities during pollen dispersal seasons, wear masks or use pollen blockers when going out. About two weeks before pollen dispersal begins, preventive medication can be taken under a doctor’s guidance. Since the types of pollen and dispersal periods vary among individuals, symptoms may occur in different seasons. Pay attention to your personal symptom patterns each year and take timely preventive measures.
• For those allergic to pet dander, avoid keeping pets at home.

Additionally, choose suitable physical exercises based on personal conditions to boost immunity.