Allergic Rhinitis: Symptoms, Causes & Treatment

Allergic rhinitis is an exaggerated immune response triggered by inhaling allergens such as pollen, dust mites, or animal fur. The immune system mistakenly perceives these harmless substances as threats and releases histamine and inflammatory mediators, causing nasal and throat symptoms.

Allergic rhinitis is divided into two main types: seasonal (peaks during high pollen seasons) and perennial (occurs year-round due to indoor triggers like dust and mold). In the Arab region and Jordan specifically, cases increase in spring due to tree and plant pollination. While it affects quality of life and productivity, it is neither contagious nor life-threatening if properly managed.

Approximately 10-30% of the global population suffers from allergic rhinitis, with higher prevalence in children and adolescents, though it can begin or persist at any age. Mild cases may require only trigger avoidance, while moderate to severe cases require regular medications or specialized treatment.

Symptoms of allergic rhinitis vary in severity and may appear immediately after allergen exposure or develop gradually over hours. Duration depends on allergy type (seasonal vs. perennial). While not fundamentally different between sexes, some research suggests women may experience worsening symptoms during specific menstrual cycle phases due to hormonal changes.

• Frequent sneezing: Often sudden and intense, especially upon waking or direct allergen exposure.
• Nasal congestion (blocked nose): Difficulty breathing through the nose, affecting sleep and concentration.
• Nasal runny nose (rhinorrhea): Clear or white discharge, often worsening in cold environments or when bending.
• Itching in nose, throat, and eyes: Uncomfortable sensation prompting constant rubbing.
• Ear itching: Due to neural connections between nose and ears.
• Red and itchy eyes: May include tearing or sensation of particles in the eye.
• Headache and sinus pressure: Around eyes and forehead from nasal sinus congestion.
• Persistent cough: From post-nasal drip (nasal secretions dripping to throat).
• Sore or scratchy throat: From continuous drainage and mouth breathing.
• Fatigue and drowsiness: Due to sleep disruption from nasal obstruction.
• Loss or altered sense of smell and taste: May be temporary with acute congestion.
• Dark circles under eyes: A hallmark sign of chronic allergic rhinitis (Allergic Shiners).

• Pollen: From trees, grasses, and flowers, especially during spring and summer. Pollen types vary by geographic location and season.
• Dust mites: Microscopic organisms living in bedding, pillows, and carpets—one of the most common year-round triggers.
• Pet dander: Proteins in saliva and hair of dogs, cats, and other pets cause allergies in many people.
• Mold and moisture: Damp and enclosed spaces encourage mold growth, releasing particles into the air.
• Air pollutants and smoke: Air pollution and tobacco smoke irritate the nose and worsen allergic symptoms.
• Strong chemical odors: Fragrances, cleaners, and pesticides with strong odors may trigger symptoms even without true allergy.
• Genetics: People with a family history of allergic rhinitis have a higher risk of developing the condition.

• Family history: Relatives with allergies or asthma significantly increase risk.
• Age: Children and adolescents are more susceptible, though onset can occur at any age.
• Other allergies: People with skin, food, or environmental allergies face higher risk.
• Asthma: Asthma presence increases likelihood and severity of allergic rhinitis.
• Genetic predisposition (Atopy): People genetically prone to allergies are at higher risk.
• Early exposure to pollutants: Childhood exposure to smoke and pollution increases risk.
• High humidity and damp environments: Encourage dust mite and mold growth.
• Poor home hygiene: Dust and debris accumulation increases allergen concentration.
• Occupational exposure: Farmers, mill workers, and warehouse staff face continuous exposure risks.
• Stress and anxiety: Psychological stress weakens immunity and worsens symptoms.

Diagnosis is based on comprehensive medical history and clinical examination, potentially including specialized tests to confirm the specific allergen trigger. The doctor will inquire about symptom timing (seasonal vs. perennial), triggering factors, and family history.

• Clinical examination: The physician examines the nose, throat, and eyes using a nasal speculum, observing redness, swelling of mucous membranes, and discharge.
• Skin prick test (SPT): Considered the gold standard for diagnosis. Small allergen extracts are placed on the skin and scratched. Redness or swelling within 15-20 minutes indicates allergy. Safe, quick, and reliable.
• Blood test (IgE-Specific): Measures levels of IgE antibodies against specific allergens. Useful for patients unable to undergo skin testing (severe skin allergies, medications like antihistamines).
• Nasal challenge test: In certain cases, the nasal cavity is exposed to small controlled amounts of allergen to assess response (rare in clinical practice).
• Sinus imaging (CT or X-ray): Not routinely requested but may be necessary if secondary sinus infection or complications are suspected.
• Additional tests: Airflow measurement or comprehensive allergy testing for complex or uncertain cases.

Medications

• Oral Antihistamines: Such as cetirizine, fexofenadine, and loratadine. Reduce itching, sneezing, and rhinorrhea. Most effective when taken before allergen exposure. Modern non-sedating antihistamines do not cause drowsiness.
• Nasal Antihistamines: Such as azelastine. Nasal spray effective for acute symptoms, working directly on the affected site.
• Nasal Corticosteroids: Such as fluticasone and beclomethasone. First-line therapy for moderate to severe cases. Effectively reduce inflammation and congestion. Safe for long-term use with minimal systemic absorption.
• Mast Cell Stabilizers: Such as cromolyn. Prevent histamine release from sensitized cells. Useful for seasonal allergies when used preventively before the season begins.
• Decongestants: Such as pseudoephedrine and phenylephrine. Provide rapid nasal congestion relief. Not recommended for continuous use beyond 3-5 days to avoid rebound congestion.
• Leukotriene Antagonists: Such as montelukast. Reduce inflammation through a different mechanism, particularly useful if asthma is present.

Procedures and Advanced Treatments

• Allergen Immunotherapy (AIT): Administered as injections or sublingual tablets. Gradually desensitizes the immune system to the allergen, reducing severe reactions. Requires 3-5 years for optimal results; highly effective for resistant cases.
• Ablation or Partial Tissue Removal: In rare cases of severe persistent congestion, enlarged nasal tissue may be partially removed to improve breathing.
• Nasal Saline Irrigation: Using a neti pot or nasal spray bottle with sterile saline (0.9% concentration) to cleanse the nasal cavity and remove allergens and secretions. Safe and effective; can be repeated multiple times daily.

Lifestyle Changes and Preventive Measures

• Allergen avoidance: Identify and avoid specific triggers. If pollen is the trigger, stay indoors with windows closed during pollen season, especially early morning when pollen concentrations peak.
• Improve home hygiene: Wash bedding in hot water (≥60°C) weekly, use dust mite-proof covers for pillows and mattresses, vacuum with HEPA filters.
• Control humidity: Maintain indoor humidity between 30-50% using humidifiers or dehumidifiers. Avoid damp, enclosed spaces where mold grows.
• Cleanse eyes and face: After going outside, wash face, hands, and eyes with clean water to remove pollen and pollutants.
• Wear sunglasses: When outdoors, especially during pollen seasons, to protect eyes from airborne particles.
• Avoid smoking and air pollution: Smoke and pollutants irritate the nasal passages and worsen symptoms. Avoid smokers and polluted environments.
• Use air filters: Install HEPA filters in home and car to purify air and remove fine particles.
• Limit pet exposure or avoid pets: If animal dander is the trigger, avoid keeping pets or restrict them from the bedroom. Short-haired breeds are preferable.

• Chronic Sinusitis: Persistent congestion and discharge impair sinus drainage, leading to secondary bacterial infection. May require antibiotics and additional treatment.
• Otitis Media (Middle Ear Infection): Nasal obstruction affects the Eustachian tube, causing fluid accumulation in the middle ear, pain, and temporary hearing loss.
• Asthma or Worsening Symptoms: Nasal inflammation may lead to allergic asthma or worsen existing asthma. Studies show 80% of asthma patients have allergic rhinitis.
• Sleep Disruption (Sleep Apnea): Severe persistent congestion causes breathing interruptions during sleep, affecting sleep quality, productivity, and overall health.
• Insomnia, fatigue, and academic/work performance decline: Sleep disturbance and bothersome symptoms significantly affect concentration and productivity. Children may experience academic difficulties.
• Secondary structural changes: In rare cases, persistent congestion and inflammation may affect nasal structural development.
• Medication overuse: Unguided frequent use of decongestants may cause chronic rebound congestion.
• Psychological and social impact: Persistent symptoms may cause embarrassment, anxiety, and social withdrawal, especially in children and adolescents.

• Identify and avoid personal triggers: Be aware of substances causing symptoms and avoid them. Keeping a symptom diary helps track patterns.
• Maintain regular home cleanliness: Regular surface cleaning, hot water washing of bedding, and weekly dust removal reduce dust mite and mold allergens.
• Use HEPA air filters: In home, car, and office to filter pollen and fine pollutants.
• Control temperature and humidity: Maintain moderate indoor conditions (30-50% humidity) to reduce mold and dust mite growth.
• Wash clothes and hair after outdoor activities: Especially during pollen season, to remove airborne pollen particles.
• Keep windows closed during pollen season: Use air conditioning with filters instead of opening windows during peak pollen times, especially mornings.
• Avoid smoking and secondhand smoke: Smoke irritates nasal passages and worsens allergies, particularly in children.
• Time outdoor exercise appropriately: Avoid outdoor activities on high pollen days or early mornings.
• Consult a specialist early: Seek medical advice at first symptom signs to start preventive treatment before conditions worsen.
• Adhere to prescribed treatment: Use medications regularly as directed, especially antihistamines and nasal corticosteroids at proper times.