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Impact, symptoms and diagnosis

What is allergic rhinitis?

Allergic rhinitis is inflammation of the membranes lining the nose, which occurs when they become sensitised to allergens.3

Impact on sufferers

Allergic rhinitis affects about 30% of the world's population, and 26% of the UK population, and the incidence is increasing.1,5

Patients can have allergic rhinitis symptoms all year round,5 which affects their daily activities and their control of other atopic conditions.6

Impact on allergic rhinitis suffers

‘It’s about time to take allergic rhinitis seriously:

52% of patients do not feel rested after sleep.’ 7

Many aspects of people’s lives are affected, including:

Sleep

52% of persistent allergic rhinitis patients do not feel rested after sleep (n=2305). Even for intermittent sufferers, the proportion is 35% (n=1257).7

Productivity at work

As a result of ‘serious’ hay fever symptoms, sufferers reported 4 days off work per year and a noticeable impact on productivity 38 days per year.8

Productivity at school

GCSE students with hay fever symptoms are 40% more likely to drop a grade than those without. They are also 70% more likely to drop a grade if they reported taking sedating antihistamines at the time of their exams.9

Leisure and social life

61% of persistent allergic rhinitis patients feel their symptoms affect their ability to do outdoor activities (n=2305). For intermittent sufferers, the proportion is 52% (n=1257).7

37% of persistent allergic rhinitis patients feel their symptoms affect their willingness to visit friends (n=2305). For intermittent sufferers, the proportion is 24% (n=1257).7

Well-being

53% of sufferers feel moderately or severely tired or worn out by their allergic rhinitis, and 47% feel moderately or severely irritable or frustrated.7

33% feel moderately or severely embarrassed by their appearance.7

Asthma

Allergic rhinitis is a risk factor for the development of asthma.11 An estimated 70-90% of patients with asthma also have allergic rhinitis.11

Common symptoms

A person with allergic rhinitis typically presents with cold-like symptoms including, sneezing, itching of the nose and eyes, nasal discharge and/or blockage, and redness in the eyes.3 These symptoms will usually appear shortly after exposure to the allergen.

INSIGHT

COMMON CAUSES OF ALLERGIC RHINITIS3

House dust mites

Rhinitis is caused by a protein in the excrement of dust mites. Symptoms are worse on waking and are present throughout the year, but may peak in autumn and spring.

Animal dander

Symptoms follow exposure to animal dander. Symptoms may be all-year-round or occasional, depending on exposure.

Tree pollen

Intermittent or persistent symptoms occur from early to late spring.

Grass pollen

Intermittent or persistent symptoms occur from late spring to early summer.

Weed pollen

Intermittent or persistent symptoms may occur from early spring to early autumn.

Allergens in workplace

Intermittent or persistent symptoms tend to improve when the person is away from work at weekends and during holidays.

Diagnosing allergic rhinitis

1The first step in diagnosing allergic rhinitis is taking a history from the patient.

A detailed history is required, including associated symptoms and any other atopic conditions.

2Examine the nose.

Check for:

Allergic crease

Allergic crease

Allergic shiners

Allergic shiners

Turbinate hypertrophy

Turbinate hypertrophy

Deviated nasal septum

Deviated nasal septum

3What increases/decreases the symptoms?

It might be worth considering seasonality, indoor/outdoor location e.g., home or work.

4Current treatments.

Check which treatments are being used by the patient and how they are taking the treatment.

References

  • Scadding GK, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2017; 47(7): 856-889.
  • Scottish Medicine Consortium (SMC). Available at https://www.scottishmedicines.org.uk/medicines-advice/azelastine-hydrochloride-plus-fluticasone-propionate-dymista-abbreviatedsubmission-92113/. Last accessed: November 2018.
  • National Institute of Health and Care Excellence (NICE). Clinical knowledge summary: Allergic rhinitis. October 2015. Available at: https://cks.nice.org.uk/allergic-rhinitis#!topicsummary. Last accessed: November 2018.
  • Jacobs RL. Ciclesonide for the treatment of seasonal allergic rhinitis. Expert Review of Clinical Immunology 2011; 7(6): 735-741.
  • Bousquet J, et al. Characteristics of intermittent and persistent allergic rhinitis: DREAMS study group. Clin Exp Allergy 2005; 35(6): 728-732.
  • Canonica GW, et al. A survey of the burden of allergic rhinitis in Europe. Allergy 2007; 62(Suppl. 85): 17-25.
  • Valovirta E, et al. The voice of the patients: allergic rhinitis is not a trivial disease. Curr Opin Allergy Clin Immunol. 2008; 8(1): 1-9.
  • Pitman R, et al. Episode pattern and healthcare utilisation in patients with seasonal allergic rhinitis. Allergy 2012; 67(Suppl. 96): 342.
  • Walker S, et al. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol. 2007; 120(2): 381-387.
  • Barry B. Rhino-sinus manifestations of systemic diseases. Rev Prat. 2000; 50(14): 1548-1550.
  • World Allergy Organization, 2015. Available at: http://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/combined-allergic-rhinitis-and-asthma-syndrome. Last accessed: November 2018.

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