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What you need to know about

Allergic Rhinitis (AR)

What is Allergic Rhinitis (AR)?

  • A condition involving immune system overreaction to allergens resulting in release of chemicals that cause reactive symptoms in nose, eyes, throat, ears, skin and roof of mouth
  • Most common chronic disease in children; commonly affects adults also
  • Can lead to asthma, sinus infections, ear infections and sleep apnea if left untreated

Signs and symptoms

  • Allergic shiners – dark circles under the eye due to chronic nasal congestion
  • Allergic crease – visible line in skin across middle of nose caused by constant rubbing
  • Allergic salute – upward rubbing of the nose to decrease itch
  • Itching of the nose, ears, mouth or throat
  • Sneezing, watery nasal discharge
  • Nasal congestion
  • Snoring
  • Dry, irritated or sore throat
  • Chronic cough
  • Continuous throat clearing
  • Headaches
  • Fatigue


Seasonal Allergic Rhinitis (sometimes called hay fever)

  • Periodic flares that usually occur during plant-pollinating seasons
  • Spring season for trees
  • Late spring and early summer for grasses
  • Autumn for weeds

Perennial Allergic Rhinitis

  • Symptoms occurring year-round
  • Caused by allergens such as animal dander, dust mites, molds, cockroaches
  • Can occur after several weeks or months of daily exposure

Seasonal and perennial AR may be present in the same person. The treatment for both is similar.

Causes and types

  • Genetics play an important role in the development of allergies.
    • About 20-30% of general population has allergies
    • 30-40% of children have allergies
    • Each child has 80% chance of becoming allergic if both parents have allergies,
  • Inhalant allergens (pollens, animal dander, dust mites and molds) are the most frequent triggers.


  • Adults – decreased work performance
  • Children – more likely to exhibit shyness, depression, anxiety, fearfulness and fatigue
  • Contributes to two million school absences each year
  • Risk of child’s learning ability impairment in poorly controlled AR

Allergic Rhinitis and co-occurring conditions

Alleric Rhinitis and asthma

  • Often present together
  • Share a common respiratory pathway
  • Asthma flares more frequent during pollen seasons
  • Asthma symptoms decreased with effective AR treatment (Read more about asthma)

Allergic Rhinitis and sinusitis (sinus infection)

In one study of patients with recurrent sinusitis, 92% were found to be allergic. (Read more about sinusitis) These conditions share many features, including:

  • Mucosal drainage dysfunction
  • Nasal mucosal swelling
  • Increased mucous production

AR and otitis media (ear infections)

  • Allergic children more susceptible to both AR and ear infections
  • Fewer ear infections from improved nasal functioning due to AR treatment

Diagnosis and testing

Allergist performs thorough medical history, environmental history and physical examination. Allergy skin testing (Read more about allergy skin testing) is not generally performed before age two since it can take two or more seasons of pollen exposure for children to develop sensitivity.

How it works:

A small sample of an allergen (pollen, grass, animal dander, mold, food) is applied to skin, assessing for reaction or hive to appear.

Our allergists have access to samples of 100+ allergens to determine which allergens to test for based on medical history, environmental survey and physical examination.

Once allergens are placed, results are read in 20 minutes.

Prevention and treatment

Environmental control (Read more)


Oral and nasal antihistamines

  • First-generation antihistamines
    • First developed, most available over-the-counter meds used alone or in combination with decongestants
    • Common brand names: Benadryl, Dimetapp, Chlortrimeton
    • Reduce symptoms of sneezing, itching, runny nose and eye irritation but have little effect on congestion
    • Usually work in 1-3 hours
    • Possible side effects – tiredness, dizziness, impaired driving and ability to operate heavy equipment, dry mouth, constipation and difficulty urinating
    • Should be used cautiously
  • Second- and third-generation antihistamines
    • Very effective, typically do not cause many side effects
    • Cause less fatigue than first-generation antihistamines
    • Second-generation brand names: Astepro, Astelin, Patanase, Zyrtec, Claritin
    • Third-generation brand names: Clarinex, Allegra


  • Reduce nasal congestion
  • No effect on sneezing, itching or eye symptoms
  • May be most effective in combination with antihistamines

Topical nasal decongestants

  • Should only be used for short duration (three days)
  • Can cause rebound congestion after stopping if used for prolonged periods

Nasal steroids

  • Treatment for both seasonal and perennial AR
  • Work best when taken regularly on daily basis
  • Rapid onset of action (12-24 hours)
  • Increasing evidence of effectiveness if used intermittently

Leukotriene modifiers

  • Have been found helpful to modify effects of leukotrienes, which cause inflammation and bronchial constriction
  • Can contribute to nasal congestion
  • Common brand names: Singulair, Accolate, Zyflo

Allergy immunotherapy (Read more)
Should be considered if:

  • Other treatments are failing or ineffective
  • Medications cause side effects
  • Symptoms occur for a significant part of the year and require daily medications
  • Patients/families prefer long-term decrease in allergic inflammation and minimal medication exposure
  • Children are at higher risk of developing asthma