Allergic rhinitis

Confirming the Disease Name

• Disease name: Allergic rhinitis (Allergic rhinitis) — This is the medically accepted and accurate name.
  (An inflammatory disease of the nasal passages caused by a hypersensitivity reaction to IgE-mediated inhaled allergens)

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1) Disease Description (Causes and Symptoms)

• Causes and pathophysiology
  • When inhaled allergens (house dust mites, pet dander, cockroach allergens, pollen, etc.) come into contact with the nasal mucosa, a Th2 response occurs → specific IgE is produced → mediators such as histamine and leukotrienes are released from mast cells and basophils → inflammation of the nasal mucosa, vasodilation, increased mucus secretion, and neural hypersensitivity develop.
  • It is classified as seasonal (e.g., pollen) or perennial (e.g., house dust mites and pets).
• Main symptoms
  • Sneezing (paroxysmal), clear runny nose (watery rhinorrhea), itching of the nose, throat, pharynx, and eyes, nasal obstruction (stuffy nose), decreased sense of smell, eye redness, and tearing.
  • Symptoms may be intermittent or persistent depending on age and degree of exposure, and asthma or atopic dermatitis may coexist.
• Prevalence (for reference)
  • It is a common disease worldwide and is reported to occur in approximately 5–20% of the population.

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2) Treatments and Precautions

• Non-pharmacological treatment (avoidance and environmental control)
  • House dust mites: Maintain indoor humidity at 50% or lower, use bedding covers (allergen-blocking), wash bedding at 60°C or higher once a week, avoid carpets and fabric sofas, and use a vacuum cleaner equipped with a HEPA filter or clean with a wet mop.
  • Pets: Avoid contact if possible, limit bringing them indoors, and clean frequently.
  • Cockroaches: Keep the kitchen clean and use insecticides.
  • Pollen: Avoid going outdoors during seasons and times with high pollen levels (generally mornings), wear a mask and glasses when going outside, and remove pollen by changing clothes and showering after returning home.
• Pharmacological treatment (standard treatment)
  • Topical corticosteroids (nasal sprays): The most effective for all symptoms, including nasal obstruction, and the first-line treatment.
  • Antihistamines (oral and topical): Effective for sneezing, runny nose, and itching (relatively limited effect on nasal obstruction).
  • Leukotriene receptor antagonists: Useful for symptom relief in some patients.
  • Nasal decongestants (topical sprays): Recommended for short-term use only (usually 3–7 days); long-term use may cause rhinitis medicamentosa.
  • Topical anticholinergics (such as ipratropium): Helpful when watery rhinorrhea is predominant.
• Immunotherapy (allergen immunotherapy)
  • Performed selectively after identifying the causative allergen through skin or blood testing.
  • It may be administered subcutaneously (injections) or sublingually (under the tongue), usually for a 3–5-year treatment course, and may provide long-term symptom relief and prevent the development of asthma.
• Surgical treatment
  • Procedures such as turbinate reduction may be considered when there are structural problems, such as persistent inferior turbinate hypertrophy, that are not controlled with medication.
• Precautions
  • Do not use topical nasal decongestants long term (risk of rebound rhinitis).
  • Yellow or purulent discharge, fever, or severe facial pain may indicate sinusitis and require medical attention.
  • Consult a doctor when selecting medications for children, pregnant women, or people with underlying diseases.

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3) Outpatient Visit Checklist (Items to Prepare and Example Questions)

• Items to prepare (recommended to bring)
  • A list of all medications currently being taken, including prescription and OTC medications
  • Previous allergy test results (blood tests or skin-prick tests), if available
  • Previous medical certificates and surgical records (such as nasal surgery)
  • A symptom diary (when symptoms occur, whether they are seasonal, triggering factors, symptom severity and time of day, and effects on sleep and daily life)
  • Photos (if photographs of the inside or external appearance of the nose are needed)
• Information that is helpful to provide in advance at the outpatient visit
  • Family history (asthma, atopy, etc.), whether you have pets, occupation (workplace allergens), home structure (carpets and mold), and indoor humidity.
• Items the doctor may ask about during the visit (prepare in advance)
  • When the symptoms began and their course, response to medications and side effects, and whether you have previously undergone immunotherapy.

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4) Examples of General Questions to Ask the Doctor

• When should I expect this medication to start working? What are its side effects?
• Is it safe to use a nasal steroid (nasal spray) long term?
• Is immunotherapy suitable for my symptoms? What are the expected treatment duration and effects?
• Are there any interactions between the medication and pregnancy, breastfeeding, or other chronic diseases (such as hypertension or diabetes)?
• My nasal obstruction is severe. When is surgery necessary? What are the expected benefits and risks of surgery?

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5) Examples of Disease-Specific Questions

• If a house dust mite allergy is suspected, what environmental improvements should I prioritize at home?
• My seasonal (pollen) allergy is severe. What specific preventive measures should I take outdoors and indoors (such as the type of mask and air purifier settings)?
• I have used a nasal decongestant (spray) for a long time and feel that my nose is becoming more blocked. What safe alternative treatments are available?

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Note: The choice of diagnosis and treatment varies depending on the individual’s symptom pattern, severity, coexisting diseases, and allergen test results. For accurate testing and an individualized treatment plan, consult an allergy specialist or an otolaryngologist.