Frequency of Incidence

Allergic rhinitis is the most common genetically inherited allergic disease and is found in approximately 10-20% of the population in many developed countries. The disease has increased in the last 10 years. The frequency of allergic rhinitis was found to be 7% in Northern European countries, 9-11% in South America, and 27.6% in Australia. It ranks 6th among chronic diseases in the USA. The average age of onset of allergic rhinitis is 10 years. In 80% of cases, it begins before the age of 20. In childhood, boys are more affected than girls, but in adults the frequency is the same in both sexes. The disease often persists for years after it occurs.

Allergic rhinitis is not a life-threatening disease, but it is a disease that significantly affects people’s quality of life. Allergic rhinitis causes loss of work days in adults and school days in children; It also causes economic harm because the money spent for its treatment is quite high. Therefore, the diagnosis and treatment of allergic rhinitis is very important.

Allergic rhinitis is defined as inflammation (edema – inflammation not due to infection) of the nasal mucosa (the membrane covering the inner surface of the nose). It is characterized by nasal itching, sneezing, watery nasal discharge and nasal congestion. It may also be accompanied by symptoms such as headache, olfactory dysfunction and conjunctivitis.

Allergic rhinitis can be classified as seasonal (pollens, some mold fungi) and perennial = year-round (house dust mites, animal skin dander and dander, some mold fungi) depending on the allergen that causes it. However, the distinction between these two groups may not always be clear.

In recent years, findings and quality of life parameters have been used in the classification of allergic rhinitis.
by duration

According to the severity of the disease (effects on quality of life)

are divided into groups.

In addition to allergens, some environmental factors such as air pollution and cigarette smoke can also cause or aggravate allergic reactions.

In addition, various irritating substances, temperature or humidity changes may increase the complaints of allergic patients.

Risk Factors for the Development of Allergic Rhinitis
Family history of allergy
High socioeconomic level
Exposure to indoor allergens such as pets and dust mites
Serum IgE level above 100IU/ml before age 6
Having a positive allergic skin test

Diagnosis of Allergic Rhinitis

The most important step in the diagnosis of allergic rhinitis is detailed questioning, including family history and previous tests and treatments applied to the patient. The patient’s age and the environments in which his complaints occur should be asked. Since there is a genetic predisposition, it is also important to pay attention to family history. Additionally, lower respiratory tract diseases, skin findings, and food allergy should be questioned. Following detailed questioning, an ear, nose and throat examination should be performed. There are no intranasal examination findings that are found only in allergic patients.

There may be wrinkles in the transverse skin line on the outside of the nose. This condition occurs after the nose is constantly rubbed upwards in childhood and is called “allergic salute”. Dark colored changes under the eyes due to edema in the nasal mucosa are called “Allergic eye circles”. Patients with allergic rhinitis may have typical facial appearances called ‘Allergic face (adenoid face). When breathing with an open mouth for a period of one year in the first years of life, this causes abnormal development of the facial and jaw bones, the jaw angles downwards, and development disorders in the teeth occur.

The most important role of the examination is to look for structural causes of nasal obstruction, such as curvature of the nasal bone, polyp in the nose, tumor or enlarged turbinate (nasal cartilage).

Allergic skin tests are very important in the diagnosis of allergic rhinitis. Today, the most used and practical diagnostic method is skin tests. Allergic skin tests give reliable results and allow diagnosis in a short time, and are also inexpensive.

The diagnostic value of blood IgE level in allergic diseases is limited. Values above 100-150u/ml are considered high. While normal values can be found in 50% of those with allergic diseases, high IgE levels may be found in those without allergic diseases and in those with parasites.

The specific IgE test, defined as the detection of IgE against the allergen in the blood, is another diagnostic method used today. Its advantages are that it is not affected by skin sensitivity and does not have drug interactions, but its disadvantages are that it gives late results, lacks sensitivity (high risk of false negative results), and is missing some allergens.

Allergic skin tests are more reliable than allergen-specific antibody (specific IgE) tests in the blood.
Checking the number of eosinophils in the blood is a general test. Eosinophil is a type of white blood cell normally found in the blood. It increases in allergic diseases, the presence of parasites, the use of certain medications, and some lung diseases. If other findings suggest allergy, high eosinophil count in the blood supports allergy, but does not give an idea about what the allergy is.

By cellular examination of nasal smear (nasal swab), it can be seen that eosinophil cells are increased in patients with allergic rhinitis. Supports the diagnosis of allergic rhinitis.


Studies have found that 20-40% of patients with allergic rhinitis also have asthma. Additionally, 60-80% of asthmatic patients have complaints and symptoms related to the upper respiratory tract. In fact, when the questioning in terms of rhinitis was made in more detail, the presence of rhinitis was found in 98% of patients with allergic asthma. Bronchial hyperresponsiveness was found to be high when respiratory function tests were performed on allergic rhinitis patients, even though they did not have asthma symptoms. It is thought that the risk of developing asthma in patients with rhinitis is three times higher than in those without rhinitis, and rhinitis is a risk factor for asthma. It has been determined that untreated allergic rhinitis negatively affects asthma control in patients with asthma accompanied by rhinitis.

Therefore, patients with allergic rhinitis should be examined for allergic asthma, and patients with allergic asthma should be examined for allergic rhinitis.


Allergic Rhinitis Treatment

  1. Avoiding Allergens
    Allergen avoidance should be an integral part of the treatment strategy.
  2. Drug Treatment
    a) Antihistamine drugs
    The most commonly used drugs are; Oral antihistamine drugs are drugs used in the form of a cortisone spray sprayed through the nose. Medicines should be given by the physician after evaluating the severity of the disease and the patient’s condition. They are useful when used regularly for the period recommended by the physician. They have a protective effect if given 2-5 hours before encountering a known allergen.

b) Cortisone sprays squeezed through the nose
Cortisone sprays applied through the nose are very effective drugs in the treatment of allergic rhinitis. They relieve itching, discharge, sneezing and congestion in the nose. It may cause headache, dryness in the nose and nose bleeding at a rate of 5%. To prevent these, it is recommended to apply good nasal care with physiological saline before applying the medicine.

c) Leukotriene receptor antagonists
Leukotriene receptor antagonists, as a new drug group, are very useful especially in patients with allergic rhinitis combined with asthma. The effects of the drugs do not continue after treatment is stopped. Therefore, continuity of treatment is required for those with persistent disease.

d) Anti IgE (Omalizumab)
Another treatment option for allergic rhinitis is Anti IgE (Omalizumab). Antibodies have been developed to block the IgE antibody to suppress the allergic reaction. Treatment is by intravenous injection for 2-4 weeks. Although the results are satisfactory, the high cost of treatment (around 1000 dollars per month) limits its use.

e) DNA vaccines currently under study seem promising in the treatment of allergic diseases.

  1. Specific immunotherapy (Allergy Vaccine)

Immunotherapy came into use in the treatment of hay fever in the early 1900s. Its place in the treatment of allergic diseases is in third place after environmental control and drug treatment. Immunotherapy should be considered in cases where protection from the allergen is not possible, reactions are life-threatening and the response to drug treatment is low. Allergen immunotherapy can be very effective in controlling allergy symptoms. It consists of administering increasing doses of the specific allergen under the skin once or twice a week until the maximum tolerated dose is reached. After the maintenance dose is reached, injection intervals are increased from 1-2 weeks to once a month, and the treatment is continued for 3-5 years. Unlike drug therapy, the effect of specific immunotherapy lasts for several years after the end of treatment. It is thought that this specific allergen immunotherapy program is also effective in protecting against allergic asthma.

Immunotherapy should be applied by a specialist physician and the patient should be observed for at least 20 minutes after the application. Specific immunotherapy is effective and useful in appropriate patients, including children. However, it is not recommended to start immunotherapy before the age of 5.

  1. Tracking

Proper patient follow-up reduces complaints and improves quality of life, allowing the patient to continue his daily life more comfortably. Regular check-ups help find the lowest dose of medication that will keep the disease under control.

With effective cooperation between the patient, family and physician, allergic rhinitis can be successfully monitored and the patient’s quality of life can be improved.