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 Allergic Rhinits: Definition 

is  as a symptomatic 

disorder of the nose induced by an IgE-mediated  

inflammation after allergen exposure of the membranes 

lining the nose 

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Interesting Facts

• 10% to 20% of population have intermittent rhinitis

• 30% to 50% of patients have persistent rhinitis

• Up to 15% of patients are children 6 to 7 years of age

• Up to 40% of patients are adolescents 13 to 14 years of age

• 18% to 21% of patients are young adults 15 to 24 years of age• less than 8% of patients are adults over 65 years of age

• Allergic rhinitis is one of the major 10 conditions that lead tomedical consultation in U.S. managed-case populations

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Clinical Manifestations

Nasal congestion

Postnasal drainage Nasal pruritus

Ear symptoms Watery rhinorrhea

Eye symptoms

Repetitive sneezing 

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Quality Of Life• Fatigue•

Sleep Disorders• Learning Problems• Chronic Rhinosinusitis• Dental Abnormalities•

Speech Disorders• Emotional problems• Impaired activity and social functioning• Poor perception of general health•

> 800,000 missed days of work, school, anddecreased productivity days• $5.4 to $7.7 billion dollars lost

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 Types of Rhinitis

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Conditions that mimic rhinitis

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   The Allergic Reaction

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Moderate-severeone or more items 

abnormal sleep

impairment of dailyactivities, sport, leisure

abnormal work and school

troublesome symptoms

Persistent• ≥ 4 days per week  

• and ≥ 4 weeks 

Mildnormal sleep

& no impairment of daily

activities, sport, leisure& normal work and school

& no troublesome symptoms

Intermittent 

• < 4 days per week

• or < 4 weeks

ARIA Classification

 ARIA Report 2001

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Diagnosis of AR 

History 

Physical / Nasal Examination

Laboratory Testing - Skin Prick Test

- Peak Nasal Inspiratory Flow Rate

- Rhinomanometry 

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PHYSICAL EXAMINATION

 Allergic shiner

Dennie Morgan line

 Allergic crease

 Allergic salute

Nasal mucosa may appear normal or pale bluish,

swollen with watery secretions but only if patient issymptomatic

Exclude structural problems (polyps, deflected nasalseptum)

Others :

nasal voice, constant mouth breathing, frequentsnoring, coughing, repetitive sneezing, chronic opengape of the mouth, weakness, malaise, irritability

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Why?-Trees: Spring and Fall

Oak, Maple, Cedar, Olive and Elm

- Grasses: Early Summer and FallKentucky Blue Grass, Orchard, Redtop, Timothy, and Bermuda

-Weed: Late Summer and Fall

Pigweed, Sage, Mugwort, lamb’s quarters 

-Outdoor Molds: Summer and Early Fall Alternaria and CladosporiumDry and Windy days

-Indoor Molds: Aspergillus and Penicillium

-Pets-Cockroaches

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Management of AR 

 Allergen Avoidance

Pharmacotherapy 

Immunotherapy - Subcutaneous

- Sublingual

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Pharmacotherapy

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 Actions of Various Nasal Preparations in

the Treatment of Rhinitis

Nasal

Preparation

Sneezing Itching Rhinorrhea Congestion

 Antihistamines +++++ ++++ +++ 0

 Anticholinergics 0 0 +++++ 0

Corticosteroids +++++ +++++ +++ +++

Decongestants 0 0 + +++++

 Antileukotrienes +++ ++ 0 ++++

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The “Ideal” Drug For Allergic Rhinitis 

Should Have The Following Features: 

Inhibit both early and late phases

Be an H1 blocker

Counter effects of other mediators Fast-acting, to control the early phase

Dosing-od or bd for compliance

No side effects Manage all symptoms

Intranasal administration

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 The “Ideal” Drugs Are…… 

“Corticosteroids are undoubtedly the

pharmacotherapeutic agents with the broadest

application for the treatment of many types of 

rhinitis” 

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Intranasal corticosteroid therapy

Potent topical activity   Administration of low doses directly at site of action

Considerable efficacy at low doses

High topical: systemic activity ratios Rapid first-pass hepatic metabolism of any systemically 

absorbed drug, to compounds with negligible activity 

Markedly greater inhibition of EAR than with oral

steroids

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