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What is allergic rhinitis?

AR is often associated with other inflammatory disorders, such as asthma, sinusitis, and allergic conjunctivitis2. It is considered a major chronic respiratory disease because of its high prevalence and its impact on quality of life2. It reduces quality of life by:

  • Interfering with sleep3
  • Reducing productivity at work and school3
  • Impacting social life2
  • Increasing healthcare costs1.


In accordance with World Health Organization (WHO) guidelines, AR can be classified as intermittent or persistent3.

Intermittent AR

  • Lasts fewer than four days per week or fewer than four consecutive weeks3.
  • Presents with symptoms which are easy to identify, and which are directly linked to seasonal allergens, such as tree, grass or weed pollens or fungi2.
  • Is subject to the length of the “allergy season”, which varies according to location, climate, and the range of allergens to which the person is sensitive2.

Persistent AR

  • Lasts for more than four days a week or more than four consecutive weeks3.
  • Presents with symptoms that are harder to identify as they are similar to those of sinusitis, respiratory infections, and other types of rhinitis2.
  • Is triggered by non-seasonal allergens, such as dust mites, animal hair and mould2.

AR is further classified according to severity3,4. Mild AR is when symptoms do not interfere with the person’s quality of life; severe is when symptoms impact asthma control, sleep, participation in sport, or performance at work or school4.


Symptoms of AR occur in two phases2. The early, acute phase happens within minutes of being exposed to an allergen2. Symptoms include2:

  • Sneezing
  • Itchy nose
  • Upper airway congestion
  • Runny nose with clear nasal discharge
  • Itchy or watery eyes.

As inflammation worsens, a second, late phase of symptoms develops after 6 – 12 hours, peaking after 12 – 24 hours2. Symptoms during the second phase are similar to early-phase symptoms, but the main symptom is congestion as a result of swelling of the mucous membranes in the nose2.

The membranes of the nose can remain sensitive for a few days after being exposed to an allergen. This is termed priming2. The result of this increased sensitivity is that the person becomes even more reactive to the allergen, as well as other allergens and even non-allergenic stimuli, like strong smells5.


AR occurs when an allergic person is exposed to an indoor or outdoor allergen to which he/she is sensitive4.

Risk factors for the development of AR include:

  • Family history: People with family members who have allergies are more likely to develop allergies themselves6. Having a parent with AR doubles the risk5.
  • Other conditions associated with a genetic predisposition for allergies: Atopic eczema often occurs before AR5.
  • Upbringing: Children with many older siblings and those who grow up on farms are less likely to develop AR5.
  • Age: AR prevalence peaks in the teens, twenties and thirties and then slowly decreases5.


AR is often diagnosed on examination by a healthcare provider, based on what the symptoms are and whether they respond to anti-allergy medication5.

It is easier to diagnose when there is a clear, single trigger or when the symptoms are seasonal5. It is difficult to diagnose AR in children under three years old, as the symptoms are similar to viral infections, which young children get frequently5.

If your healthcare provider cannot make a definitive diagnosis, they may refer you for an allergy test, which could be a skin-prick test or a blood test5. This will indicate whether the symptoms are caused by AR or non-allergic rhinitis (NAR)3.


There are three main approaches to treating AR2. These are:

  • Avoiding triggers: Includes allergens that you have identified, as well as allergens picked up by an allergy test2.
  • Medication: Includes medicine to relieve symptoms and anti-inflammatory treatments3.
  • Immunotherapy3.

Treatment tips

Many AR medication options are available over the counter (OTC)2. Pharmacists should be able to recommend OTC treatment options, especially for intermittent and mild cases of AR1. The pharmacist should also be able to advise if you should see another healthcare provider, such as a primary care physician2.

Treatment options

Second-generation non-sedating antihistamines (oral)4

  • Use for mild intermittent symptoms
  • Ease symptoms of sneezing, itching and runny nose
  • Typically work within 15 – 30 minutes
  • Safe for children over two years old
  • Use as needed.

Second-generation non-sedating antihistamines (intranasal)4

  • Use for mild intermittent symptoms
  • Ease symptoms of sneezing, itching and runny nose
  • Typically work in under 15 minutes
  • Fewer side-effects than oral antihistamines
  • May improve congestion.

Intranasal corticosteroids4

  • Main treatment for AR
  • Use for persistent symptoms that affect quality of life
  • Start working in under 30 minutes, but need to build up over hours to days and only achieve maximum effect after two to four weeks
  • More effective than antihistamines (oral or intranasal) for severe and persistent AR.

Intranasal decongestants4

  • Use for short-term relief of blocked nose where intranasal corticosteroids did not provide relief from congestion
  • Side-effects may include sneezing and dry nose
  • Do not use for more than three days to avoid rebound symptoms
  • Not recommended for children.

Intranasal cromolyn4

  • Available OTC
  • Safe for general use
  • Not as effective as antihistamines and intranasal corticosteroids
  • Typically used three to four times daily.

Intranasal anticholinergics4 such as ipratropium

  • Use for severe runny nose
  • May relieve congestion and sneezing in children but not as effectively as corticosteroids
  • Side-effects include dry nose, nosebleeds, headache
  • Recommended use 2 – 3 times a day.

Leukotriene receptor antagonists4 such as montelukast

  • Similar effectiveness to oral antihistamines
  • Less effective than intranasal corticosteroids
  • Possibly useful for treating concurrent AR and asthma as it reduces bronchospasm and lessens inflammation.

Combination therapy4

  • Often considered for severe, persistent symptoms
  • Newer combinations consisting of an intranasal antihistamine and corticosteroid appear to hold great promise4.


  • A small amount of allergen is either injected subcutaneously (underneath the skin) or administered under the tongue (sublingually).
  • Subcutaneous injections are administered in a doctor’s rooms at regular intervals, usually three times per week during a build-up phase and then every two to four weeks during a maintenance phase.
  • The first sublingual dose is usually administered in a doctor’s rooms and then, in the absence of adverse effects, daily at home.
  • This typically continues for 3 – 5 years.
  • Effects may last 7 – 12 years after treatment is stopped.
  • It should be considered for moderate-to-severe persistent AR that does not respond to other treatments, if you:
    • Cannot use other treatments
    • Want to avoid long-term medication; or
    • Have chronic asthma.
  • Proven effective for certain allergens, including dust mites, certain plants, dogs and acts, certain moulds, and cockroaches.
  • Expensive.


People with AR should avoid allergens such as4:

  • Cigarette smoke
  • Pets
  • Any allergens known to trigger their symptoms.

Nasal saline rinses, alone or in combination with traditional treatments, can help improve quality of life, and may also help to reduce the need for allergy medication4.

Helpful tools

Symptoms of AR are often mistaken for those of a cold or another medical condition2.

See a healthcare provider if you experience any of the following symptoms that may require more than just over-the-counter treatment for AR2:

  • Symptoms in only one nostril
  • Blocked nose with no other symptoms
  • Thick mucous that smells badly
  • Postnasal drip
  • Pain
  • Recurring nosebleeds
  • Loss of smell.