Allergic rhinitis

Background

• Also called hay fever - inflammation of the nasal mucosa secondary to allergens in the air.

Clinical Features

• Patient present with a constellation of symptoms
  • thin clear rhinorrhea (if thick or discolored, consider infectious causes)
  • sneezing
  • itching of the nose
  • nasal congestion
  • nasal obstruction
  • clogged feeling in the ears
• triggers often easily identified
  • animals
  • season changes
• symptoms last until triggers are removed
• should not have fevers

Differential Diagnosis

• viral upper respiratory infection
• bacterial upper respiratory infection
• acute sinusitis
• chronic sinusitis
• fungal sinusitis
• nasal polyposis
• nasal mass
• nasal foreign body

Evaluation

• Clinical diagnosis
• ensure no signs of bacterial infection

Management

• Saline nasal irrigation (netipot) twice a day- washes out allergens
• combination of topic nasal steroids (flonase, nasonex) and/or nasal antihistamines (patanase). Must be used for several weeks before symptomatic relief is realized

Disposition

• Discharge home
  • Allergist referral if nasal sprays not helping
  • ENT referral to evaluate for the need for sinus surgery which may help by opening up the sinuses allowing for better distribution of topical medications

References

Authors

Jay, Michael Holtz