Allergic rhinitis
Background
- Also called hay fever - inflammation of the nasal mucosa secondary to allergens in the air.
- Associated with asthma and atopic dermatitis
Clinical Features
- Constellation of symptoms:
- Thin, clear rhinorrhea (if thick or discolored, consider infectious causes)
- Sneezing, itching of the nose
- Nasal congestion and/or obstruction
- Clogged feeling in the ears
- Common triggers:
- Animals
- Environmental (e.g. grassess, pollens); often symptomatic with seasonal changes
- Symptoms last until triggers are removed
- Should not have actual fever
Differential Diagnosis
Rhinorrhea
- Upper respiratory infection, influenza
- Sinusitis
- Juvenile nasopharyngeal angiofibroma
- Nasal polyp
- Nasal mass
- Nasal foreign body
- CSF leak (e.g. basilar skull fracture)
- Toxic inhalation (e.g. selenium toxicity, neurotoxic shellfish poisoning)
Evaluation
- Clinical diagnosis
- PE may show infraorbital edema and darkening (allergic shiner), transverse nasal crease (allergic salute), and cobble-stoning of the posterior oropharynx
- Rule out bacterial infection
Management
- Reduce exposure to allergen
- If environmental, sleep with windows closed, change clothes and/or shower when returning home after being outdoors
- Saline nasal irrigation (neti pot) twice a day- washes out allergens
- Combination of topic nasal steroids (fluticasone propionate, nasonex) and/or nasal antihistamines (patanase)
- Must be used for several weeks before symptomatic relief is realized
Disposition
- Discharge home
- Consider allergist referral if nasal sprays not helping
- Consider ENT referral to evaluate for the need for sinus surgery, which may be help by opening up the sinuses allowing for better distribution of topical medications