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Allergic rhinitis
Allergic rhinitis is IgE-mediated inflammation of the nasal mucosa; an intranasal steroid is the most effective single treatment, especially for congestion, and a second-generation antihistamine suits mild or intermittent symptoms.
Why it matters in the exam
The exam presents a young woman with sneezing and congestion that worsen with dust and in spring and autumn, and a child with clear rhinorrhoea and an itchy nose. It asks for the first treatment, what to consider when choosing an antihistamine (sedation, driving, age), and the danger of long-term use of a decongestant spray.
Remember the link with asthma — a child or adult with allergic rhinitis should be asked about wheeze — and that a unilateral polyp or nosebleed requires referral to an ear-nose-throat surgeon.
Allergic rhinitis looks "mild", but it harms sleep, concentration and performance at school and work. Correct treatment and regular use of the spray — with teaching on how to aim it towards the outer wall of the nose — change quality of life more than any "strong" drug.
In pregnancy and in young children a nasal steroid and a second-generation antihistamine can be used, so there is no reason to leave severe symptoms untreated. Another recurring question is a child with clear rhinorrhoea, an itchy nose and sneezing for several weeks without fever: the diagnosis is allergic rhinitis, not "recurrent colds", and the treatment is a nasal steroid. Ask about exposure to pets, dust and mould at home as well.
Key points
- Intranasal steroid — the most effective treatment, especially for congestion.
- Second-generation antihistamine — for mild or intermittent symptoms.
- First generation — sedation; not for drivers or older people.
- Decongestant — up to 3–5 days.
- Immunotherapy — for severe symptoms with a defined allergen.
Summary table
| Treatment | When | Advantage | Drawback or warning |
|---|---|---|---|
| Intranasal steroid (mometasone, fluticasone) | Moderate-to-severe symptoms, congestion | The most effective single treatment | Full effect after days; minor nosebleeds |
| Second-generation antihistamine (cetirizine, loratadine, bilastine) | Mild or intermittent symptoms | Fast, convenient | Less effective for congestion |
| Intranasal antihistamine (azelastine) | Intermittent symptoms, combined with a nasal steroid | Acts within minutes | Bitter taste |
| First-generation antihistamine | — | — | Sedation, impaired driving and learning, anticholinergic effects in older people |
| Decongestant spray | Up to 3–5 days only | Fast relief of congestion | Long-term use — rhinitis medicamentosa |
| Immunotherapy (subcutaneous or sublingual) | Severe symptoms despite treatment, defined allergen | Changes the course of disease | 3–5 years; risk of allergic reaction |
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Sources
- Joint Task Force on Practice Parameters (AAAAI/ACAAI), 2020 — Rhinitis 2020: a practice parameter update
- ARIA (Allergic Rhinitis and its Impact on Asthma), 2019–2020 — Guidelines for the pharmacological treatment of allergic rhinitis
- Goroll AH, Mulley AG. Primary Care Medicine, 8th edition (2020) — Management of allergic rhinitis
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.