immunology allergic disorders
Allergic Rhinitis
Key Points
Seasonal rhinitis is usually an allergic reaction to pollens; perennial allergic rhinitis is caused by year-round exposure to indoor inhaled allergens or by strong reactivity to plant pollens in sequential seasons. Patients with allergic rhinitis may have cough, wheezing, frontal headache, sinusitis, or, particularly in children with perennial rhinitis, otitis media. Diagnosis of allergic rhinitis is usually based on the history; skin tests and sometimes an allergen-specific serum IgE test are needed only when patients do not respond to empiric treatment. Try intranasal corticosteroids first because they are the most effective treatment and have few systemic effects. Other treatments include oral and intranasal antihistamines and decongestants; intranasal mast cell stabilizers are less effective. Desensitization sublingual immunotherapy is indicated when symptoms are severe, allergens cannot be avoided, or drug treatment is inadequate. 