Allergic rhinitis

1) Department of Internal Medicine, Athena Villa dei Pini Clinic, Piedimonte Matese (CE);

2) Division of Internal Medicine, A.G.P. Piedimonte Matese (CE);

Definition and Epidemiology

Allergic rhinitis is a frequently encountered pathology, which consists in the inflammation of the nasal mucosa caused by exposure to certain substances.

ACTION MECHANISM

Allergic rhinitis is caused by an antigen-antibody reaction, during which inflammatory mediators cause vasodilation.

In the United States alone, there are over 50 million individuals suffering from allergic rhinitis, making it the most common chronic disease in adults and children.

The prevalence - that is, the total frequency of the world population affected by allergic rhinitis - is over 10%.

These estimates, however, are likely underestimated, as symptoms are underestimated by both the affected person and the physician himself.

Risk factors

Certain risk factors include environmental pollution, the presence of cases of allergies in family history, asthma, early exposure to domestic allergens (for example mites and animal dandruff), early weaning and finding of elevated IgE immunoglobulin values in the blood.

At risk are especially those who:

they live in highly polluted areas
have a family history of allergy
they were born during the pollen season.

Treatment

The disease control measures are based on "removal from" the allergen, although this goal is not easy to achieve, and on pharmacological treatment aimed at limiting the activity of histamine, mediator of the inflammation that underlies the process.

For this reason, in mild-moderate, intermittent and persistent allergic rhinitis, the latest generation antihistamines represent the first therapeutic option.

In recent times the chronobiology of rhinitis has been deepened, that is the research on the "incidence of symptoms over" 24 hours. Several clinical studies show that the symptoms associated with allergic rhinitis tend to concentrate in the early hours of the day, following a well-defined circadian rhythm.
These observations have led to a more careful consideration of the therapeutic approach to the disease, with the development of treatment strategies that favor the control of allergic rhinitis precisely in the morning. In particular, in adults it has been seen that drugs with a "prolonged half-life, like the active ingredient desloratadine, allow - albeit with a" single daily administration - to effectively control the symptoms associated with nasal obstruction, repeated sneezing and tearing.

The goal is achieved with a satisfactory safety profile, given that the new generation antihistamines do not induce those unwanted effects - primarily sleepiness and increased appetite - which often penalized the "old" antihistamines.

For further information: Drugs for the Treatment of Rhinitis (including the allergic form)

Classification and Symptoms

For further information: Symptoms Allergic Rhinitis

Allergic rhinitis is now divided into intermittent, persistent, mild and moderate-severe. These terms are progressively replacing the old definitions of seasonal and perennial allergic rhinitis.
Particularly:

intermittent allergic rhinitis: symptoms present for less than four days a week or less than four weeks a year;
persistent allergic rhinitis: symptoms present for more than four days a week and for more than four weeks a year;
mild allergic rhinitis: absence of related disorders, such as sleep problems and interference with school, professional and daily activities;
moderate-severe allergic rhinitis: sleep disturbances and / or interference with daily life.

On the clinical front, allergic rhinitis can present with symptoms of different intensity and duration. Generally, the subdivision of patients into blocker (which often stops the nose) e sneezer and runner (those who sneeze a lot and whose nose is often runny), according to the predominant symptoms:

in the blocker there are almost exclusively nasal obstructions, phlegm and only occasionally sneezing.
in sneezer and runner there are symptoms more easily connected to allergic rhinitis, such as sneezing, rhinorrhea, itching and nasal obstruction, which is often associated with conjunctivitis.