Allergic rhinitis involves inflammation of the nasal mucosa, leading to nasal congestion, itching and sneezing. It is predominantly IgE-mediated (type I hypersensitivity reaction). It is very common and can significantly affect sleep, mood, hobbies, work and school performance and quality of life.
Allergic rhinitis may be:
- Seasonal (e.g., hay fever associated with pollen)
- Perennial (e.g., house dust mite allergy)
- Occupational (e.g., associated with the school or work environment)
Triggers
Typical triggers include:
- Pollen from trees, grass or weeds
- House dust mites
- Pet dander (e.g., cats and dogs)
- Mould spores
- Wood dust
Presentation
Allergic rhinitis typically causes:
- Runny, blocked and itchy nose
- Sneezing
- Itchy, red and swollen eyes
Allergic rhinitis is associated with a personal or family history of other atopic conditions, such as asthma, eczema and food allergies.
Diagnosis is usually made based on the history. Skin prick testing or serum allergen-specific IgE testing may be useful in supporting the diagnosis.
Management
Management involves avoiding the trigger where possible. This involves:
- Washing bedding regularly at high temperatures and using synthetic pillows for house dust mite allergy
- Staying indoors during high pollen counts for pollen allergy
- Minimise contact with pets that are known to trigger allergies
Oral antihistamines are taken regularly to reduce allergic symptoms:
- Non-sedating antihistamines include cetirizine, loratadine and fexofenadine
- Sedating antihistamines include chlorphenamine and promethazine
Nasal corticosteroid sprays (e.g., fluticasone and mometasone) can be taken regularly as a preventative measure.
Nasal antihistamines (e.g., azelastine hydrochloride) can provide rapid symptom relief (within minutes).
Oral steroids (e.g., prednisolone) may be used rarely, short-term, in severe and uncontrolled symptoms.
Specialist referral may be necessary if symptoms remain unmanageable. Immunotherapy may be an option for severe symptoms caused by a specific allergen (e.g., house dust mite or grass pollen).
Nasal Spray Technique
Steroid nasal sprays are often misused, which means they will not be as effective. A good question to ask is, “Do you taste the spray at the back of your throat after using it?” Tasting the spray means it has gone past the nasal mucosa and will not be as effective.
The technique involves:
- Tilting the head slightly forward
- Using the left hand to spray into the right nostril, and vice versa (this directs the spray slightly away from the septum)
- NOT sniffing hard during the spray
- Very gently inhaling through the nose after the spray
TOM TIP: It is worth learning and practising how to explain the use of a steroid nasal spray. You may be asked to explain how to use a steroid nasal spray in your OSCEs.
Last updated April 2026
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