Expert view: Correct diagnosis of rhinitis is key to management
Allergic rhinitis is one of the most frequently neglected and underappreciated diseases. When the symptoms are limited to sneezing and itchy eyes, many sufferers decide to treat themselves with do-it-yourself remedies or remedies recommended by friends and relatives; however, this is a mistake.
In Europe, 113 million patients suffer from allergic rhinitis. According to data from the European Federation of Allergy and Airway Disease Patient Association, 30–35% of the total European population suffers from respiratory allergies during their lifetime, and 20% of the entire population is affected by allergic rhinitis. In light of these high numbers, however, there are still too many allergy sufferers who treat themselves without having received an accurate diagnosis, and who utilise over the counter symptom relief. A total of 45% of the subjects complaining of allergic symptoms never arrive at a certain diagnosis because they do not report the symptoms to the doctor, and 18% of patients experience a worsening of the disease with severe symptoms.
A study by Canonica et al analysed perceptions of patients and physicians regarding the symptoms and impact of allergic rhinitis in a prospective, cross‐sectional, international survey, and reported the results from Germany, France, Italy, Spain and the UK.1 They found that allergic rhinitis was a significant health problem and that there was a poor correlation between patients and physicians in the reporting of disease severity.
Even when rhinitis is mild, and therefore does not bring with it the above consequences, it is important to accurately diagnose its pathology, understand which allergens trigger it, and follow the therapy prescribed by the clinician to avoid the condition deteriorating and becoming worse.
For the diagnosis of allergic rhinitis, it is sufficient to perform a skin prick test or the dosage of specific IgE for inhalant allergens. In the first case, the allergist or paediatrician can directly perform the skin test; in the second case, a blood sample is necessary and the result will come from the lab.
Based on the duration of symptoms, allergic rhinitis can be classified as intermittent or persistent, whereas it can be defined as mild or moderate to severe based on symptom severity. The intermittent/seasonal forms are less problematic, as they are generally related to pollen allergies and therefore depend on the flowering of certain plants (usually in the Spring). The more enduring forms are instead often linked to allergens derived from dust mites and pets, which are present throughout the year.
Rhinitis is considered moderate or severe when the symptoms cause consequences such as an alteration of sleep patterns, limitations on sporting or leisure time, or repercussions on work or school performance.
Badly/inadequately treated allergic rhinitis is an important risk factor for the development of asthma but can also lead to other pathologies such as rhinosinusitis, nasal polyposis, otitis and conjunctivitis.
Consequently, the treatment needs to take into account the duration and intensity of the events. In addition to oral antihistamine therapy – often considered the only remedy for allergies – there are other therapeutic approaches that can be used in case of rhinitis, such as nasal corticosteroids.
- Canonica W et al. A survey of the burden of allergic rhinitis in Europe. Allergy 2007; doi.org/10.1111/j.1398-9995.2007.01549.x