Intreated allergic rhinitis may have serious consequences and may significantly impair a patient’s quality of life. Often, patients with nasal obstruction wake up in the morning feeling tired and unrested, impacting their work performance, concentration, and emotional well-being. School performance may also be affected, and children may be incorrectly diagnosed with learning disabilities and even attention deficit disorder as a result. Recurrent otitis media, atopic dermatitis, chronic rhinosinusitis, and asthma are frequent co-morbid conditions associated with allergic rhinitis. Allergic conjunctivitis frequently occurs with allergic rhinitis – a condition known as allergic rhinoconjunctivitis.
The diagnosis of allergic rhinitis is made only after a good medical history is taken, followed by an adequate physical examination. This includes a meticulous examination of the nose, ears and throat and eyes. Skin prick testing is considered the gold standard for identifying allergens. Alternatively, blood can be drawn to measure antibodies against specific allergens based on the patient’s clinical history. These tests indicate sensitisation and not necessarily a true allergy. The results should therefore be interpreted with caution and clinicians should decide which allergen sensitisations (positive results) are relevant to the patient’s nasal and eye symptoms.
Four integrated pillars, all implemented simultaneously, should form part of effective allergic rhinitis treatment:
- Patient/ parent education
- Adequate and practical patient allergen and trigger avoidance strategies
- Allergen immunotherapy.
Common flaws and pitfalls in the management of AR:
- Patients are not properly educated about their allergic rhinitis
- Patients do not know how to use their nasal sprays and nasal rinses
- Patients are often scared to use nasal steroids, because of ‘steroid phobia’
- Patients overuse nasal decongestants and intramuscular antihistamines
- Over-the-counter, older-generation antihistamines are often prescribed for viral colds in an uncontrolled manner
- Medical practitioners may fail to recognise the need for referral to a specialist
- Rotating through different antihistamines because of possibly developing ‘tolerance’ should be avoided.
For more information on allergic rhinitis and other allergic and immunodeficiency conditions, go to www.allergyfoundation.co.za
Allergy Foundation of South Africa https://www.allergyfoundation.co.za