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Allergic rhinitis - Prognosis

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of common nasal allergies.

Alternative Names

Hay fever; Nasal congestion - allergies

Prognosis:

Seasonal allergic rhinitis tends to diminish as a person ages. The earlier the symptoms start, the greater the chances for improvement. People who develop hay fever in early childhood tend not to have the allergy in adulthood. In some cases, allergies go into remission for years and then return later in life. People who develop allergies after age 20, however, tend to continue to have hay fever at least into middle age.

People with allergic rhinitis may be at higher risk for other allergies, including potentially serious food or latex allergies.

Quality of Life

Although allergic rhinitis is not considered a serious condition, it nonetheless can interfere with many important aspects of life. Surveys of nasal allergy sufferers report that symptoms such as feeling tired (80%), miserable (65%), or irritable (62%) are present in one half to three quarters of patients. Interference with work performance is present in around 50% of allergy sufferers.

People with allergic rhinitis, particularly those with perennial allergic rhinitis, may experience sleep disorders and daytime fatigue. Often they attribute this to medication, but studies suggest congestion may be the culprit in these symptoms. Patients who have severe allergic rhinitis tend to have worse sleep problems than those with mild allergic rhinitis.

Higher Risk for Asthma, Eczema, Nasal Polyps

Asthma and allergies often coexist, and the allergic response plays a strong role in childhood asthma. About 70 - 85% of children with asthma also have allergies. Aggressive treatment of allergies in children with asthma can lower the risk for asthma attacks. Treating allergies in children may also help prevent the onset of asthma. Patients with allergies also have a higher risk for eczema and nasal polyps.

Chronic Swelling in the Nasal Passages (Turbinate Hypertrophy)

Any chronic rhinitis, whether allergic or nonallergic, can cause swelling in the turbinate, which may become persistent (turbinate hypertrophy). The turbinate is a tiny shelf-like bony structure that protrudes in the nasal passageways. It helps warm, humidify, and clean the air that passes over it. If turbinate hypertrophy develops, it causes persistent nasal congestion and, sometimes, pressure and headache in the middle of the face and forehead. This condition may require surgery.

Complications of Chronic Rhinitis in Children

  • Children with severe allergies may have a higher risk for behavioral problems than those without allergies.
  • Some research suggests that allergic rhinitis is responsible for 2 million missed school days each year.
  • Chronic nasal obstruction from year-round allergies can affect a child's appearance. If a child can only breathe through the mouth, the continual force of air passing through the oral cavity can cause changes in facial development. Such changes may include an elongated face and an overbite from teeth coming in at an abnormal angle.
  • Chronic rhinitis can cause headaches and also affect a child's sleep, concentration, hearing, appetite, and growth.
Middle ear infection

Associations with Other Disorders

Depression. During allergy season, patients with allergies are more likely to experience mood changes, including sadness, lethargy, and mental fatigue, than at other times. Some evidence suggests that specific immune factors in the allergic response can cause depressive symptoms. Other research indicates that both may have a common cause.

Resources

References

Al Sayyad JJ, Fedorowicz Z, Alhashimi D, Jamal A. Topical nasal steroids for intermittent and persistent allergic rhinitis in children. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD003163.

Bahls C. In the clinic. Allergic rhinitis. Ann Intern Med. 2007 Apr 3;146(7):ITC4-1-ITC4-16.

Bielory L. Ocular toxicity of systemic asthma and allergy treatments. Curr Allergy Asthma Rep. 2006 Jul;6(4):299-305.

Blaiss MS. Safety considerations of intranasal corticosteroids for the treatment of allergic rhinitis. Allergy Asthma Proc. 2007 Mar-Apr;28(2):145-52.

Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001936.

Ernst P, Baltzan M, DeschĂȘnes J, Suissa S. Low-dose inhaled and nasal corticosteroid use and the risk of cataracts. Eur Respir J. 2006 Jun;27(6):1168-74. Epub 2006 Feb 15.

Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008 Jan;121(1):183-91.

Saleh HA, Durham SR. Perennial rhinitis. BMJ. 2007 Sep 8;335(7618):502-7.

Scow DT, Luttermoser GK, Dickerson KS. Leukotriene inhibitors in the treatment of allergy and asthma. Am Fam Physician. 2007 Jan 1;75(1):65-70.

Sheikh A, Hurwitz B, Shehata Y. House dust mite avoidance measures for perennial allergic rhinitis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001563.

Smits WL, Giese JK, Letz KL, Inglefield JT, Schlie AR. Safety of rush immunotherapy using a modified schedule: a cumulative experience of 893 patients receiving multiple aeroallergens. Allergy Asthma Proc. 2007 May-Jun;28(3):305-12.

  • Reviewed last on: 4/20/2008
  • Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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