Allergic Rhinitis
IgE-mediated inflammation of the nasal lining causing sneezing, congestion and itch.
Overview
Allergic rhinitis affects 10–30% of adults and up to 40% of children. Seasonal (hay fever) is driven by pollens; perennial by dust mites, animal dander or moulds. It commonly coexists with asthma, eczema and conjunctivitis and significantly impacts sleep, school and work performance.
Symptoms
- • Sneezing, clear nasal discharge, nasal blockage
- • Itchy nose, eyes, palate or throat
- • Postnasal drip and cough
- • Watery, red eyes (allergic conjunctivitis)
- • Fatigue and poor concentration from disturbed sleep
Risk factors
- • Personal or family history of atopy
- • Early-life allergen exposure and tobacco smoke
- • Air pollution
Causes
- • Pollens (tree, grass, weed) — seasonal pattern
- • House dust mite, animal dander, moulds, cockroach — perennial pattern
- • Occupational allergens (flour, latex, laboratory animals)
🚨 Red flags — seek urgent care
- • Unilateral bloody nasal discharge — exclude tumour, foreign body
- • Facial pain, fever, purulent discharge — bacterial sinusitis
- • Breathlessness or wheeze — assess asthma
When to seek care
- • Symptoms uncontrolled with over-the-counter treatment
- • Sleep, school or work performance affected
- • Coexisting asthma not well controlled
Diagnosis
- • Clinical pattern (timing, triggers, family history)
- • Skin-prick testing or specific IgE blood tests
- • Nasal examination: pale, swollen turbinates with clear secretions
- • Spirometry if asthma symptoms
Treatment
- • Allergen avoidance (mite-proof bedding, HEPA filtration, pet exclusion)
- • Intranasal saline rinses
- • Intranasal corticosteroid (mometasone, fluticasone) — first-line for moderate–severe
- • Non-sedating oral antihistamine (loratadine, cetirizine, fexofenadine)
- • Combined intranasal corticosteroid + antihistamine spray for inadequate control
- • Leukotriene receptor antagonist (montelukast) if comorbid asthma
- • Allergen immunotherapy (sublingual or subcutaneous) for refractory or single-allergen disease
Prevention
- • Pollen avoidance during peak counts; sunglasses outdoors; shower after high-exposure days
- • Damp-dust and HEPA vacuum weekly; wash bedding at 60°C
- • Stop smoking and reduce indoor air pollution
Complications
- • Asthma development or worsening
- • Recurrent sinusitis, otitis media with effusion
- • Sleep disturbance, reduced productivity
Prognosis
Symptoms often persist for life but are well controlled with consistent therapy. Immunotherapy modifies disease and reduces long-term medication burden.
Education & self-care
Allergic rhinitis is more than a nuisance. Treated well, it improves sleep, asthma control and quality of life — most cases respond to a simple step-up plan.
Frequently asked questions
Is allergic rhinitis the same as hay fever?
Hay fever is seasonal allergic rhinitis. Perennial allergic rhinitis is the year-round form.
Are nasal steroid sprays safe long term?
Yes — at standard doses they are safe for prolonged use; technique matters more than dose.
Will it ever go away on its own?
Allergic rhinitis often eases with age but rarely disappears entirely. Daily intranasal steroid sprays remain the most effective long-term treatment, and allergen immunotherapy can produce lasting remission in selected people.
Are non-drowsy antihistamines safe long-term?
Yes. Loratadine, cetirizine and fexofenadine are well tolerated for years of continuous use. Older sedating antihistamines (chlorphenamine, promethazine) should be reserved for short-term night-time use.
Can it trigger asthma?
Up to 40% of people with allergic rhinitis also have asthma, and poorly controlled nasal symptoms worsen asthma control. Treating the nose often improves chest symptoms too.