Allergic Rhinitis: Clinical Symptoms and Treatment Methods

Allergic rhinitis is a common condition characterized by inflammation of the nasal mucosa caused by exposure to allergens. It is classified into allergic rhinitis and non-allergic rhinitis. Allergic rhinitis can be further categorized as seasonal or year-round, depending on the timing and duration of symptoms. 

This article explores the clinical symptoms of allergic rhinitis and various treatment methods employed to manage the condition effectively.

Classification of Rhinitis:

1. Allergic Rhinitis:

Allergic rhinitis is caused by one or more allergens and can be divided into seasonal and year-round subtypes.
Seasonal allergic rhinitis is associated with seasonal allergens such as pollen or mold. Symptoms occur during specific times of the year and may improve or resolve by the end of the season.
Year-round allergic rhinitis is caused by perennial allergens like house dust mites, molds, cockroaches, and animal dander. Symptoms persist throughout the year.
However, this classification may vary based on geographical locations, as seasonal allergens in one region may be present year-round in another. Additionally, many individuals are sensitive to multiple allergens.

2. Non-allergic Rhinitis:

Non-allergic rhinitis refers to rhinitis symptoms that occur without a known allergic cause. The triggers for non-allergic rhinitis are diverse and can include irritants, infections, hormonal changes, and medications.

Clinical Symptoms of Allergic Rhinitis:

Allergic rhinitis is characterized by a classic triad of symptoms: sneezing, itchy nose, and runny nose. These symptoms occur episodically throughout the day, but some individuals may experience continuous symptoms.

The progression of symptoms typically follows this order:

Early symptom: Itchy nose
Subsequent symptom: Runny nose, which may produce clear nasal discharge. Cloudy mucus may indicate superinfection.
Sneezing: Sneezing bouts may occur multiple times in succession, often triggered by allergen exposure or upon awakening.
Nasal congestion: Nasal obstruction may vary in severity, with intermittent or bilateral blockage.
However, it is important to note that not all individuals with allergic rhinitis experience all of these symptoms. Some individuals may predominantly exhibit sneezing, a runny nose, or nasal congestion.

Methods of Treating Allergic Rhinitis:

1. Principles of Treatment:

The management of allergic rhinitis involves the following principles:
Avoidance of allergen exposure: Identifying and minimizing exposure to allergens that trigger symptoms is crucial.
Preferred use of non-sedating antihistamines: Antihistamines that do not cause drowsiness are preferred for symptomatic relief.
Limited use of vasoconstrictors and oral corticosteroids: These medications are only recommended for short-term use in specific cases.
Daily use of corticosteroid nasal sprays: Corticosteroid sprays are used regularly and discontinued once symptoms have subsided for at least one month.

2. Treatment Goals:

The treatment goals for allergic rhinitis are as follows:
Improve quality of life by alleviating symptoms and minimizing their impact on daily activities.
Provide prompt relief from symptoms and prevent their recurrence.
Ensure the safety and tolerability of medications used for treatment.

3. Medications for Treatment:

Corticosteroids:

Corticosteroids, such as beclomethasone, budesonide, fluticasone, methylprednisolone, and dexamethasone, exhibit systemic and local anti-inflammatory effects. Fluticasone propionate (Flixonase) is a preferred inhaled corticosteroid for treating allergic rhinitis. It reduces the production of inflammatory cells, inhibits the release of inflammatory chemical mediators, and decreases vasodilation in the nasal mucosa. 

This medication is highly effective in managing both seasonal and year-round allergic rhinitis in adults and children aged four and above. It is generally well-tolerated, with minimal side effects.

Dosage:

Nasal spray solution: 50mg per dose, aerosol with 60 doses.
Adults: Administer two sprays in each nostril. If necessary, it can be used twice daily.
Children aged 4-11 years: Administer one spray in each nostril.
Another corticosteroid spray available is beclomethasone (Beconase).

Topical Cromones:

Topical cromone medications also possess anti-inflammatory effects and inhibit both the early and late stages of allergic reactions. These medications are typically administered as nasal sprays, with a recommended dosage of 4-6 sprays into the nose per day. Commonly used drugs include sodium cromoglicate and nedocromil sodium.

Antihistamines:

Oral antihistamines are commonly used to alleviate symptoms of allergic rhinitis. They are convenient to use, with a typical dosage of one tablet per day. Commonly prescribed antihistamines include loratadine (10mg), terfenadine (Teldan, 10mg), clarityn (10mg), cetirizine (Zyrtec, 10mg), and fexofenadine (Telfast, 180mg).

Nasal Decongestants:

In addition to corticosteroids, nasal decongestants can provide quick relief from nasal congestion. These medications are available as nasal drops or sprays and have rapid effects on nasal blockage. However, it is important to note that nasal decongestants do not possess anti-inflammatory properties. Prolonged use can lead to rebound congestion, known as drug rhinitis. Commonly used nasal decongestants include ephedrine and oxymetazoline. They are typically sprayed 2-3 times a day.

Conclusion:

Allergic rhinitis, whether seasonal or year-round, presents with characteristic symptoms such as sneezing, itchy nose, runny nose, and nasal congestion. Effective treatment methods involve allergen avoidance, non-sedating antihistamines, short-term use of vasoconstrictors and oral corticosteroids, and regular use of corticosteroid nasal sprays. 

Medications like corticosteroids, topical cromones, antihistamines, and nasal decongestants are commonly employed to manage allergic rhinitis symptoms. It is essential to consult with a healthcare professional for proper diagnosis, individualized treatment, and guidance in managing allergic rhinitis effectively.