Dr Ray O’Connor discusses the latest clinical research into the rise of allergic rhinitis among younger people.
Allergic rhinitis (AR) affects approximately 15% of the US population (approximately 50 million people) and is associated with asthma, eczema, chronic or recurrent sinusitis, cough, and both tension headaches and migraines.
This condition occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of the nasal cavity, resulting in the production of allergen-specific IgE.The symptoms of allergic rhinitis typically include nasal congestion, runny nose, postnasal drip, sneezing, and itchy eyes, nose, and throat.
This topic was the subject of a recent comprehensive review.1 The most common symptoms of allergic rhinitis are rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis primarily present with nasal congestion and postnasal drip, often accompanied by sinus pressure, stuffy ears, muffled sounds and pain, and Eustachian tube dysfunction that is poorly responsive to nasal corticosteroids.
Patients with seasonal allergic rhinitis typically have physical examination findings of pallor of edematous nasal turbinates.
Patients with perennial allergic rhinitis also tend to have erythematous and inflamed turbinates with serous secretions that appear similar to other chronic rhinitis on physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Patients with allergic rhinitis should avoid irritating allergens.
Additionally, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) or intranasal antihistamines (e.g., azelastine, olopatadine), whereas patients with moderate to severe persistent allergic rhinitis should be initially treated with intranasal corticosteroids (e.g., fluticasone, triamcinolone, budesonide, mometasone) alone or in combination with intranasal antihistamines.
In contrast, the first-line therapy for patients with nonallergic rhinitis is intranasal antihistamines alone or in combination with intranasal corticosteroids.
Allergic rhinitis is increasingly seen in younger age groups; this topic was also addressed in a recent review. Studies specifically targeting physician-diagnosed allergic rhinitis report a childhood incidence of approximately 13%. Most people develop symptoms of allergic rhinitis by the age of 20, and almost half of these patients have symptoms by the age of 6. There are several seasonal and perennial triggers for allergic rhinitis, including airborne pollen, mold, dust mites, and animals.
Avoidance, medications, and immunotherapy may help treat allergic rhinitis.
Additionally, immunotherapy for allergic rhinitis can prevent further allergic sensitization and the development of asthma.
A recent review article on the subject found that in addition to environmental exposures, growing evidence suggests that climate change and lifestyle are important risk factors in the AR3.
The authors also point out that allergen immunotherapy (AIT) is increasingly being recognized as a natural and effective treatment for AR, but significant efforts are still needed to understand and accurately evaluate the efficacy of AIT in the future.
A systematic review of treatments4 has further expanded the treatment options. The authors concluded that when antihistamine monotherapy fails to control symptoms, the addition of a decongestant, saline, or a leukotriene receptor antagonist (LTRA) can improve outcomes. LTRAs improve ocular symptoms, and saline irrigation also improves quality of life.
References
Bernstein JA et al. Allergic rhinitis: a review. JAMA. 2024 Mar 12;331(10):866-877. doi:10.1001/jama.2024.0530. Schuler CF et al. Allergic rhinitis in children and adolescents. Pediatr Clin N Am 66 (2019) 981–993 https://doi.org/10.1016/j.pcl.2019.06.004 Zhang Y et al. Advances and highlights in allergic rhinitis. 2021;76:3383–3389. Chitsuthipakorn W et al. Combination therapies in the treatment of allergic rhinitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2022 Dec;12(12):1480-1502. doi: 10.1002/alr.23015. Epub May 8, 2022.
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