Allergic Rhinitis

📚Definitions 

Allergic Rhinitis: Inflammatory nasal condition caused by immune hypersensitivity to allergens (e.g., pollen, dust mites), characterized by:

• Sneezing, nasal congestion, rhinorrhea (clear or yellow), itchy eyes/nose.
• Symptoms typically occur within minutes of allergen exposure.

🔑 Key Points

• Prevalence: Affects 10–30% of children/adults in the U.S.; often persists from childhood into adulthood.
• Comorbidities: Linked to asthma (33% of patients), sinusitis, and sleep disturbances.
• Environmental controls are foundational to management.

✏️ Assessment  

History

• Symptoms: Itching (nose/eyes), sneezing, congestion, postnasal drip, fatigue.
• Triggers: Pollen (seasonal), dust mites, pet dander (perennial).
• Red flags: Unilateral symptoms (rule out polyps/foreign body), fever (suggests infection).
• Risk factors: Family history of atopy, young age (rare <2 years).

Examination (Telehealth Adaptations)

• Eyes: Allergic shiners (infraorbital darkening), conjunctival injection.
• Nose: Transverse crease ("allergic salute"), pale/bluish nasal mucosa.
• Throat: Cobblestoning (posterior pharynx), clear postnasal drip.

🎯 Differential Diagnosis 

💆 Treatment 

• Environmental Controls

• Outdoors: Close windows during high pollen counts; shower after exposure.

   

• Indoors:

1.  
   1. Dust mite covers for bedding; wash linens in hot water weekly.
   2. Dehumidify (<50% humidity); remove carpets if possible.

   3. Pet avoidance or weekly bathing (for pet allergies).

       

Pharmacologic Therapy

First-Line (Mild/Moderate Symptoms)

• Intranasal Corticosteroids (INS):

• Examples: Fluticasone (OTC), triamcinolone (OTC), budesonide (Rx).

• Onset: 12–24 hours; maximal effect in 3–7 days.

   

• Second-Generation Oral Antihistamines:

1.  
   1. Examples: Cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra).

Add-On Therapies (Severe/Refractory Symptoms)

1. Antihistamine Nasal Sprays: Azelastine (Astelin) or olopatadine (Patanase).
2. Leukotriene Receptor Antagonists: Montelukast (especially if asthma coexists).
3. Decongestants: Short-term use only (≤3 days; avoid in hypertension).

Avoid:

1. First-gen antihistamines (e.g., diphenhydramine) due to sedation.
2. Prolonged decongestant sprays (risk of rhinitis medicamentosa).

🚨 Special Considerations

• Pregnancy: Cetirizine/loratadine (Category B) preferred.ase).

📩 Referral Indicators 

• Allergy testing/immunotherapy: For perennial symptoms unresponsive to therapy.
• ENT evaluation: Unilateral symptoms, suspected structural abnormalities.

 🔮 Follow Up 

• Expected response: Improvement within 2 weeks.
• Preemptive therapy: Start INS 2–4 weeks before pollen season for recurrent cases.

📘 Coding

ICD-10 Codes: 

• J30.1: Pollen-induced allergic rhinitis
• J30.81: Animal dander-induced allergic rhinitis

If you have any questions or would like more information, please reach out to the Delegating Physician.