Allergic rhinitis

Causes and Course Features

The disease occurs upon contact with a causally significant allergen, which triggers an inflammatory cascade in the nasal mucosa.

In pediatrics, this is one of the most frequent chronic diseases, significantly reducing the child's quality of life. The first manifestations can occur as early as infancy. The clinical picture largely depends on the duration of allergen exposure; two main types of course are distinguished:

• Perennial (with persistent allergen contact).
• Seasonal (with intermittent contact).

Also, symptom severity is influenced by the patient's age and concomitant diseases.

Classification

Allergic rhinitis is classified along two independent axes: how often symptoms appear and how severely they disrupt life.

By symptom duration (the key threshold is 4 days a week / 4 weeks a year):

• Intermittent (episodic): manifestations disturb less than 4 days a week or last less than 4 weeks in total.
• Persistent (constant): symptoms are present more than 4 days a week and last more than 4 weeks.

By severity:

• Mild: daily life, performance, studies, and sleep are not impaired. Symptoms are easily tolerated.
• Moderate/Severe: at least one criterion is present — sleep is disturbed, daytime activity suffers, difficulties arise at school or work, and the symptoms themselves are distressing for the patient.

Clinical presentation

The classic picture of allergic rhinitis includes the basic tetrad of signs:

1. Rhinorrhea — profuse watery, transparent, or mucous discharge.
2. Nasal congestion (nasal obstruction) — occurs due to mucosal edema.
3. Sneezing — often paroxysmal in nature ("in runs"), especially in the mornings.
4. Pruritus (pruritus) — a tickling or burning sensation in the nose, which can spread to the palate and pharynx.

Due to the anatomical proximity of ENT organs, additional symptoms occur:

• Cutaneous: redness and skin irritation under the nose due to friction and discharge, epistaxis during forced blowing.
• Respiratory: mouth breathing, snorting, snoring, nasal voice, decreased sense of smell (hyposmia).
• Pharyngeal and auricular: throat clearing (due to postnasal drip), pain and clicking in the ears upon swallowing, hearing loss (allergic tubotympanitis against the background of eustachian tube edema).
• Ophthalmological: lacrimation, eye itching, photophobia, scleral injection (signs of allergic conjunctivitis).

Separately, a systemic vascular sign is distinguished — "allergic shiners" (dark circles under the eyes). They appear due to venous congestion triggered by marked edema of the nasal mucosa and sinuses.

Systemic Reactions

Allergic inflammation affects the entire body, causing a number of nonspecific syndromes:

• Asthenic: weakness, rapid fatigue, general malaise.
• Psychoemotional disorders: irritability, decreased concentration, depressed mood, sleep problems.
• Somatic complaints: headaches, decreased appetite (sometimes with nausea).

Class and exam questions

What else to study on this topic

• Pathogenesis of the IgE-mediated allergic reaction in the nasal mucosa
• Specific allergens causing seasonal and perennial rhinitis
• Mechanism of development of allergic tubotympanitis and naso-ocular reflex
• Impact of concomitant pathology (e.g., bronchial asthma) on the course of AR
• Differential diagnosis of allergic rhinitis with infectious lesions

Other topics in "Chapter 5. Allergic Diseases"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.