Rhinitis is an inflammatory process of the internal wall or mucosa of the nose and when it is of allergic origin it is characterized because the symptoms are triggered only after exposure to the allergen to which the individual is sensitized, unlike what happens with rhinitis of other origins, such as rhinitis of infectious origin.
Allergic rhinitis appears when the reason for the inflammatory process is the result of a hypersensitivity reaction to an environmental agent called allergen, such as: pollens, epithelia, mites, fungi, etc. Allergic rhinitis generates an annoying congestion and itching in the nose and among its most frequent causes are environmental allergens that can take different forms:
- Pollens
- Dust mites
- Fungi
- Remains of animal skin and fur
- Allergens present in multiple occupational settings
In the latter case, when allergic rhinitis is caused by allergens present in the workplace, it is known as occupational rhinitis and can occur in multiple occupational settings due to exposure to organic substances (such as flour, plants, animals), as well as exposure to chemical agents (cleaning products, hair dye components, resins used in artificial nails, paints, welding fumes, metals, fiberglass, etc.).
Symptoms and diagnosis
Dr. Inmaculada Herrera Mozo, a specialist in adult allergology and work-related allergies, points out that the characteristic symptoms of allergic rhinitis are an itchy nose, very liquid mucus called watery mucus or hydrorhea, sneezing, usually in bouts, and often nasal congestion that can cause a sensation of dyspnea (choking), accompanied by a certain respiratory insufficiency.
Regarding the diagnosis, the doctor explains that an examination of the nasal mucosa, an exhaustive review of the clinical history and an immunological study that establishes the allergens to which the patient is sensitized should be carried out.
The immunological study consists of performing epidermal skin tests called Prick tests and the study of specific antibodies in the blood against the suspected allergens. The allergens that are analyzed in the immunological study must be determined individually for each patient based on the data obtained in the clinical history and it is important to “adapt” the study to each specific case in order to obtain the most accurate diagnosis possible.
Sometimes, for a correct diagnosis of rhinitis, functional tests including nasal permeability study (rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow), and nasal inflammation (study of nasal secretions) are also needed, which will be performed in collaboration with Otolaryngology Units.
Rhinitis or cold?
Both in allergic rhinitis and in rhinitis due to a cold or cold (viral infectious origin) nasal symptoms will appear in the form of mucus, congestion and sneezing. The main differences are in the characteristics of the mucus, which will always be very liquid in allergic rhinitis (watery), while in rhinitis due to a cold it will be thicker and sometimes yellowish or greenish in color, also the presence of nasal itching which will be very intense in allergic rhinitis and mild or absent in infectious rhinitis, and in the duration of the symptoms, which in the case of allergic rhinitis will last for the whole period of environmental presence of the allergen (e.g. the spring period), whereas in infectious rhinitis the symptoms usually subside in about 10 days.
In addition, in allergic rhinitis ocular symptoms may appear (itching and tearing) which will not appear in catarrhal rhinitis, and in a catarrhal process general symptoms will appear (malaise, fever, tiredness, muscle or joint pain), which will not appear in an allergic process.
What are the treatment options?
Treatments for allergic rhinitis are divided into two groups:
- Symptomatic treatments: aimed at symptom control. They are based on antihistamines and corticosteroids for both topical nasal administration (sprays) and oral administration (tablets).
- Etiological treatments (treatment of the cause of the symptoms): aimed at controlling hypersensitivity to the allergens causing rhinitis.
We have specific immunotherapy for both oral and subcutaneous administration, and biological treatments for specific cases of severe rhinitis.
As the specialist reminds us, early diagnosis is important for early initiation of the most appropriate treatment in each case, since allergic rhinitis that is not correctly diagnosed and treated can eventually lead to bronchial pathology in the form of asthma. In addition, multiple epidemiological, pathophysiological and therapeutic studies establish the higher prevalence of asthma in patients with allergic rhinitis compared to the general population, with a temporal relationship in which rhinitis usually precedes the development of asthma.
The evolution from rhinitis to asthma is frequent when the disease is caused by occupational agents. Several studies establish that symptoms of occupational rhinitis precede those of occupational asthma in between 20% and 78% of patients, on the basis of which the accurate and early identification of occupational rhinitis is of great importance. A typical example of an occupational disease in which rhinitis is the “antechamber” of asthma occurs in bakery workers who develop flour allergy.