Allergic Rhinitis: Overview, Diagnosis, and Treatment

About Allergic Rhinitis

Seasonal allergies, often called rhinitis or hay fever, can have a significant impact on a patient’s quality of life and has a significant burden on the healthcare system.1,3 Symptoms such as sleep disturbance and daily fatigue, along with inappropriate use of antihistamines, can result in impaired performance at school and work.1-3

Rhinitis is generally divided into two groups: allergic and non-allergic. Differentiating between allergic and non-allergic rhinitis is critical, as half of patients prescribed antihistamines for their reported allergic rhinitis have symptoms that are not due to allergy.4

It is important to use testing for allergen sensitization to help you decipher allergic from non-allergic rhinitis. These results, along with a physical exam and medical history, can ensure that patients receive appropriate treatment sooner, as well as helping to reduce avoidable antihistamine use.5,6

Allergic Rhinitis Graph

Allergic rhinitis usually presents as a blocked or runny nose, symptoms that arise from the sinuses, middle ear, nasopharynx, and lower airways.

Common symptoms of rhinitis can include:7

  • Post nasal drip
  • Red, itching eyes
  • Watering eyes
  • Repeated sneezing
  • Headache


  • Nasal itching
  • Facial pain
  • Ear pain
  • Tiredness

As allergic rhinitis and non-allergic rhinitis have such similar symptoms, but different management, it is imperative to correctly diagnose the cause and target the correct management.9

Allergic rhinitis: Refining differential diagnosis through testing

Approximately 65 percent of patients diagnosed as having allergic rhinitis and prescribed a non-sedating antihistamine are not allergic.7,8 As allergic rhinitis and non-allergic rhinitis have such similar symptoms, but different management, it is imperative to correctly diagnose the cause and select the correct management.9

Fortunately, guidelines provide a foundation for the process of diagnosing allergic rhinitis, which starts with a physical examination and an allergy-focused patient history.1,5

Guided by the findings of an allergy-focused patient history, you can continue to work through the most appropriate next steps, which may include specific IgE tests. Skin-prick testing (SPT) and specific IgE blood testing can help you determine allergen sensitization, which may give you the ability to correctly diagnose and improve clinical management.10,11 The patient medical history should be supplemented by allergen testing for accurate results.12

Who should be tested?

It is important to consider allergic rhinitis in patients with asthma, atopic dermatitis (eczema), conjunctivitis, sinusitis, polyposis, upper respiratory tract infections, otitis media, sleeping disorders, and in children with learning and attention impairments.

More than 80 percent of people with asthma also suffer from rhinitis,7 suggesting the concept of “one airway, one disease.”13,14 The presence of allergic rhinitis commonly exacerbates asthma, increasing the risk of asthma attacks, emergency visits, and hospitalizations for asthma. It is not clear whether allergic rhinitis represents an earlier clinical manifestation of allergic disease in atopic patients who will later develop asthma or whether rhinitis itself is causative for asthma.14-17

If your patient suffers from allergic rhinitis triggered by pollen and has an allergic reaction that typically occurs upon ingestion of certain foods, he or she may be experiencing pollen food allergy syndrome (PFAS), also known as oral allergy syndrome (OAS).5  

Asthma Graph

In a UK general practice survey of adults with asthma and comorbid allergic rhinitis (n=4,611), versus patients with asthma alone (n=22,692), the presence of concomitant allergic rhinitis with asthma increases the following:20

  • Annual number of GP visits (P<0.0001)
  • Likelihood of hospitalizations (P<0.01)
  • Increased asthma drug costs (P<0.0001