Diagnostics and treatment of allergic rhinitis

How the diagnosis is made

Patient examination is based on the sequential execution of several steps:

• Anamnesis collection. This is a crucial stage. The physician investigates a family history of allergies, the association of exacerbations with the flowering season or contact with specific triggers (dust, animals). An improvement in condition upon allergen elimination and a positive response to antihistamines indicate an IgE-dependent nature of the disease.
• Symptom assessment. The severity of current manifestations is determined.
• Allergy testing. Performed to confirm sensitization using skin tests or blood tests for specific immunoglobulins E (IgE).
• Instrumental methods and consultations. An ENT specialist performs anterior rhinoscopy to assess the condition of the mucosa and rule out other pathologies (structural anomalies, infections). Spirometry is also mandatory to exclude latent bronchospasm, as the disease frequently accompanies bronchial asthma.

Patient routing

Treatment is usually managed by a pediatrician in an outpatient setting. However, there are clear indications for referral to an allergist-immunologist or otolaryngologist:

• suspected allergic nature of the disease (for confirmation and prescription of specific treatment);
• severe course of the disease;
• presence of complications or comorbid diagnoses;
• lack of improvement with prescribed baseline therapy.

Principles of combination therapy

The treatment program includes five main areas aimed at achieving full control over symptoms:

1. Elimination. Maximum restriction of contact with the causal allergen and environmental control.
2. Irrigation therapy. Nasal cavity lavage, which helps mechanically wash away allergens and inflammatory factors.
3. Pharmacotherapy. Use of medications from various groups depending on the severity of the condition.
4. Allergen-specific immunotherapy (AIT). The baseline pathogenetic treatment capable of modifying the disease course (prescribed exclusively by an allergist).
5. Education. Explaining the rules of medication intake and creation of a hypoallergenic environment to the patient and relatives.

Step-by-step approach to drug treatment

The choice of therapy volume depends on the severity of rhinitis and its impact on concomitant asthma. If symptoms escalate, treatment is intensified (step-up). Before each step up, the diagnosis must be reviewed and ENT pathologies excluded.

• Step 1 (Mild course). A single drug is prescribed: H1-receptor blockers, intranasal cromones (cromoglicic acid), or leukotriene receptor antagonists (LTRA).
• Step 2. Intranasal glucocorticosteroids (INGCs) are added to the monotherapy options.
• Step 3 (Combination treatment). INGCS become the cornerstone. Antihistamines or LTRAs are added to them.
• Step 4 (Complex cases). The level of specialized care. Surgical correction of concomitant ENT problems or targeted biological therapy (omalizumab) is discussed, although the evidence base for the latter in this pathology is currently insufficient.

Class and exam questions

What else to study on this topic

• Technique of anterior rhinoscopy
• Mechanism of action of intranasal glucocorticosteroids (INGCs)
• Indications and contraindications for AIT
• Assessment of pulmonary function (spirometry) in children

Other topics in "Chapter 5. Allergic Diseases"

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