Allergic rhinitis
Background
- Also called hay fever - inflammation of the nasal mucosa secondary to allergens in the air.
Clinical Features
- Constellation of symptoms:
- Thin, clear rhinorrhea (if thick or discolored, consider infectious causes)
- Sneezing, itching of the nose
- Nasal congestion and/or obstruction
- Clogged feeling in the ears
- Common triggers:
- Animals
- Environmental (e.g. grassess, pollens); often symptomatic with seasonal changes
- Symptoms last until triggers are removed
- Should not have actual fever
Differential Diagnosis
Rhinorrhea
- Upper respiratory infection, influenza
- Sinusitis
- Juvenile nasopharyngeal angiofibroma
- Nasal polyposis
- Nasal mass
- Nasal foreign body
- CSF leak (e.g. basilar skull fracture)
- Toxic inhalation (e.g. selenium toxicity, neurotoxic shellfish poisoning)
Evaluation
- Clinical diagnosis
- Rule out bacterial infection
Management
- Reduce exposure to allergen
- If environmental, sleep with windows closed, change clothes and/or shower when returning home after being outdoors
- Saline nasal irrigation (neti pot) 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
- Consider allergist referral if nasal sprays not helping
- Consider ENT referral to evaluate for the need for sinus surgery, which may be help by opening up the sinuses allowing for better distribution of topical medications
See Also
External Links
References
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