Allergic Rhinitis (Hay Fever): Symptoms, Severity vs. Anaphylaxis, and Management
Allergic Rhinitis: Clinical Overview
IgE-mediated type I hypersensitivity to airborne allergens (pollen, dust mite, animal dander, mold).
Symptoms
- Nasal: sneezing, rhinorrhea (clear), congestion, pruritus.
- Ocular: itching, tearing, redness (allergic conjunctivitis).
- Palate/ear itching, postnasal drip, cough, fatigue, sleep disruption.
- NO systemic hypotension, airway obstruction, or mucosal swelling beyond nose/eyes.
Severity Classification (ARIA)
| Intermittent | Persistent |
|---|
| <4 days/week or <4 weeks | ≥4 days/week and ≥4 weeks |
| Mild: normal sleep, activities, work/school |
|---|
| Moderate-Severe: impaired sleep/activities/work/school |
|---|
Comparison: Hay Fever vs. Anaphylaxis
| Feature | Allergic Rhinitis | Anaphylaxis (Bee/Food) |
|---|
| Onset | Minutes-hours post-exposure | Seconds-minutes |
| Systems | Nasal/ocular only | ≥2 systems (skin, resp, GI, CV) |
| Life-threatening | No | Yes (airway, breathing, circulation) |
| Treatment | Antihistamines, INCS, immunotherapy | Epinephrine IM, fluids, airway, ICU |
| Prognosis | Chronic, manageable | Acute emergency; recurrence risk |
Management
- Avoidance: Pollen counts, HEPA, encasings, pet removal.
- Pharmacologic: INCS (fluticasone, mometasone) first-line; 2nd-gen oral antihistamines (cetirizine, fexofenadine); antihistamine nasal spray; leukotriene RA; ipratropium (rhinorrhea).
- Immunotherapy: SCIT (shots) or SLIT (tablets/drops) – disease-modifying.
Comorbidities
- Asthma (unified airway), sinusitis, otitis media, sleep apnea, dental malocclusion (mouth breathing).
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