Comprehensive Guide to Allergic Rhinitis: Causes, Symptoms & Treatment

What is Allergic Rhinitis?

Allergic rhinitis (AR), also known as hypersensitive rhinitis, refers to a chronic inflammatory disease of the nasal mucosa with paroxysmal spray, runny nose, and nasal congestion as the main symptoms, which is mainly mediated by immunoglobulin E (IgE) and involves the body's immune active cells and cytokines after susceptible individuals come into contact with allergens.

Causes of Allergic Rhinitis

Allergic rhinitis is a multifactorial disease caused by the combined effects of genes and the environment. Genetic studies have shown that allergic rhinitis is a complex multi-gene hereditary disease, and environmental factors mainly refer to various allergens present in the human living environment.

Genetic factors

The various phenotypes of allergic rhinitis are under strong genetic control, making it a disease with a multi-genetic tendency.
Multiple genes and related transcription factors have been found to be involved in the pathogenesis of this disease, including candidate pathogenic genes such as immunoglobulin E (lgE)-related candidate genes, important transcription factors, cytokines, and T cell surface antigens.

Genetic factors

The various phenotypes of allergic rhinitis are under strong genetic control, making it a disease with a multi-genetic tendency.
Multiple genes and related transcription factors have been found to be involved in the pathogenesis of this disease, including candidate pathogenic genes such as immunoglobulin E (lgE)-related candidate genes, important transcription factors, cytokines, and T cell surface antigens.

Inducing factors

Allergens in the environment can induce the production of specific IgE antibodies and react with them. They mainly include airborne allergens (also known as inhalation allergens) and food allergens, among which exposure to inhalation allergens is the main cause of allergic rhinitis.

Inducing factors

Allergens in the environment can induce the production of specific IgE antibodies and react with them. They mainly include airborne allergens (also known as inhalation allergens) and food allergens, among which exposure to inhalation allergens is the main cause of allergic rhinitis.

Inhalation allergens

Include fungal spores, pollen particles, dust mites, animal excrement, etc. The concentration of such allergens is significantly correlated with the severity of symptoms of respiratory allergic diseases.

Inhalation allergens

Include fungal spores, pollen particles, dust mites, animal excrement, etc. The concentration of such allergens is significantly correlated with the severity of symptoms of respiratory allergic diseases.

Food allergens

Food allergens can cause skin and digestive tract allergies, and can also cause nasal symptoms, but it is rare for them to cause only allergic rhinitis. For infants, food allergens are mainly milk and soybeans; for adults, common food allergens include peanuts, nuts, fish, eggs, milk, soybeans, apples, pears, etc.

Food allergens

Food allergens can cause skin and digestive tract allergies, and can also cause nasal symptoms, but it is rare for them to cause only allergic rhinitis. For infants, food allergens are mainly milk and soybeans; for adults, common food allergens include peanuts, nuts, fish, eggs, milk, soybeans, apples, pears, etc.

Examinations of Allergic Rhinitis

Personal history and family history Understand the patient's work and living environment, occupation, whether there is a history of allergies to pollen, food, etc., and whether there are people in the family who suffer from allergic diseases.

Medical History and Physical Examination

If the patient has typical symptoms of allergic rhinitis such as paroxysmal sneezing, clear watery nasal discharge, nasal itching, nasal congestion, and eye symptoms such as itchy eyes, red eyes, and tears (indicating a high possibility of pollen allergy).

Subjective Symptoms

Check whether the patient has symptoms such as swollen eyelids, conjunctival congestion, dark red, light blue, or pale nasal mucosa, edema, enlarged nasal conchae, small nasal polyps, and watery or mucous secretions in the nasal cavity; auscultate the lungs to see if there is wheezing (if there is, it indicates that there may be asthma)

Physical Examination

Differentiation of Allergic Rhinitis

The differential diagnosis of allergic rhinitis is extensive and somewhat complex. When the nasal mucosa is inflamed and symptoms such as sneezing, itching, runny nose, and nasal congestion occur, an appropriate diagnosis must be made based on a detailed medical history and targeted examinations.

Vasomotor Rhinitis
The symptoms of vasomotor rhinitis are very similar to those of allergic rhinitis, especially sneezing and watery nasal discharge, which can usually be caused by cold air, pungent tobacco smoke, alcohol, exercise, and emotional reactions. The cause is unclear, and it can be differentiated based on negative allergen skin tests and specific IgE assays, as well as the absence of typical changes in nasal secretion smears.
Endocrine Rhinitis
It is more common in women with premenstrual syndrome, and can also be seen in women in the honeymoon period, the so-called honeymoon rhinitis, with nasal discharge and congestion as the main symptoms, which may be accompanied by sneezing attacks, caused by abnormal levels of endocrine hormones such as sex hormones, thyroid hormones, and pituitary hormones. The allergen sensitivity test is negative, and there are no eosinophils in the nasal secretions.

Treatment of Allergic Rhinitis

The principle of treatment is to avoid allergen exposure as much as possible, use antihistamines and glucocorticoids rationally, and specific immunotherapy can be used in patients who can afford it. In addition, monoclonal antibodies against IgE also have good effects on severe allergic rhinitis but are expensive. Aggressive and effective treatment of allergic rhinitis can prevent and reduce asthma attacks. Although allergic rhinitis can’t be completely cured yet, standardized comprehensive treatment can achieve optimal symptom control and significantly improve a patient's quality of life.

What are the possible complications of allergic rhinitis?

Complications directly related to allergic rhinitis include the following diseases.

Secretory Otitis Media

It is a non-suppurative inflammatory disease. Symptoms include ear fullness, tinnitus, and hearing loss, which may be mild or severe as the nasal symptoms change, and may be related to exposure to allergens. Allergic rhinitis is one of the risk factors that may induce secretory otitis media in children.

Sleep Disordered Breathing Syndrome

Due to severe nasal congestion, the minute ventilation volume of the respiratory tract during sleep is significantly reduced, and the quality of sleep is reduced.

Prognosis of Allergic Rhinitis

The disease can’t yet be completely cured, but through standardized comprehensive prevention and treatment, the patient's various symptoms can be well controlled and the quality of life can be significantly improved. Targeted health education should be carried out for patients, and disease management and follow-up visits should be strengthened.

What is Allergic Rhinitis?

Causes of Allergic Rhinitis

Examinations of Allergic Rhinitis

Medical History and Physical Examination

Subjective Symptoms

Physical Examination

Differentiation of Allergic Rhinitis

Treatment of Allergic Rhinitis

Prognosis of Allergic Rhinitis

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