Diagnosis
Allergic rhinosinusitis
An atopic disease presenting with symptoms of sneezing, nasal congestion, clear rhinorrhea, and nasal pruritis.
Also known as: Allergic rhinitis, Allergic sinusitis
Etiology
Cause [dys]
Allergens: pollens, animal dander, flooring/upholstery, mold, humidity, perfume, smoke
Genetic component
Seasonal (20%): sneezing, rhinorrhea, and watery eyes
Perennial/chronic (40%): postnasal drip, chronic nasal congestion, and obstruction
Both (40%)
Pathophysiology [dys]
IgE-mediated type 1 hypersensitivity reaction against inhaled allergens
Degranulation of host mast cells
Releases of mediators (histamine, leukotrienes and prostaglandins)
Sneezing via the trigeminal nerve and rhinorrhea by stimulating mucous glands
Risk factors
family history of atopy
male
serum IgE > 100 IU/mL before age 6
higher socioeconomic status
Associated with [dys]
Allergic conjunctivitis
Non-productive cough
Eustachian tube dysfunction
Chronic sinusitis.
Epidemiology
Prevalence per 100.000 [8yf][w12][rha][gtm]
Symptoms & findings
Symptoms
Anosmia, Epistaxis, Headache, Nasal congestion, Post-nasal drip, Pruritus, Rhinorrhea, Sneezing
Clinical findings
None listed.
Anamneses
None listed.
Localized findings
Approach
Anterior rhinoscopy
Nasal endoscopy
Middle meatus culture
Maxillary sinus aspiration
Treatment
Avoidance of triggers
Saline nasal spray: rinsing the nasal passages and removing the allergen
Inhaling steam may reduce nasal congestion
Decongestants
Allergy medicines: reduces inflammation and swelling
Antihistamines
Intranasal steroids
Leukotriene receptor antagonists
Desensitization allergy vaccine
Surgery to provide better drainage
Differential diagnoses
Acute sinusitis, Chronic sinusitis, CSF leak, Drug side effects, Nasal polyps, Sarcoidosis, Wegener's granulomatosis
References
[1] Akhouri S, House SA. Allergic Rhinitis. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538186/
[2] Settipane RA. Demographics and epidemiology of allergic and nonallergic rhinitis. Allergy Asthma Proc. 2001 Jul-Aug;22(4):185-9.
[3] Singh K, Axelrod S, Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988-1994. J Allergy Clin Immunol. 2010 Oct;126(4):778-783.e6.
[4] Wu et al. Prevalence, severity, and time trends of allergic conditions in 6-to-7-year-old schoolchildren in Taipei. J Investig Allergol Clin Immunol. 2011;21(7):556-62.
[5] Meltzer et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009 Sep;124(3 Suppl):S43-70.
[6] Abdulrahman. Nasal allergies in the Middle Eastern population: results from the "Allergies in Middle East Survey". Am J Rhinol Allergy. 2012 Nov-Dec;26 Suppl 1:S3-23.