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Information in this chapter was obtained from published articles identified in a Medline search conducted in March 2008 using the search term allergic rhinitis.

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Rhinitis is a misunderstood and commonly trivialized problem despite its high prevalence. The defining symptoms of rhinitis are well known (“it’s just a runny nose”), including nasal congestion, mucoid discharge, pruritus, and sneezing. What are less well known are the spectrum of secondary symptoms such as fatigue, sleep disturbance, cognitive and motor impairment, mood changes, and somnolence that often accompany nasal symptoms.1 Cumulatively, these contribute to potentially serious and detrimental effects on quality of life, functionality, and productivity.

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Approximately 40 million Americans have allergic rhinitis, another 17 million individuals are estimated to have nonallergic rhinitis, and 10 million suffer from mixed allergic and nonallergic conditions.2 Global epidemiology studies have found similar proportions throughout the world. This makes rhinitis one of the most common of chronic human diseases and the most prevalent chronic disease of childhood.

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Billions of dollars are spent each year on office visits and medications, while indirect costs such as decreased productivity in the workplace and at school and poor quality of life add untold dollars to the cost. Thus, what seems like a relatively innocuous disease has far-reaching impact.

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More than a dozen forms of rhinitis are recognized in the “Global Resource in Allergy” consensus document, published by the World Allergy Organization. Rhinitis is classified by etiology and temporal criteria. The three most common types are allergic, nonallergic, and infectious. Infectious rhinitis, often manifested as the “common cold,” and acute sinusitis typically occur together, as they share the same mucosal tissue. For this reason, infectious rhinitis and acute sinusitis have been retermed “acute rhinosinusitis,”3 and these conditions are addressed in Chapter 38 of this textbook.

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Allergic and nonallergic rhinitis are each further subdivided into “intermittent” and “persistent” conditions. Intermittent rhinitis is considered acute or occasional rhinitis with symptoms lasting fewer than 4 days per week or for fewer than 4 weeks. Patients with persistent rhinitis have symptoms for more than 4 days per week or for more than 4 weeks.4 These conditions were formerly termed “seasonal” and “perennial,” which were helpful terms for allergic rhinitis but nonsensical for nonallergic rhinitis.

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Additionally, the newer classification scheme accounts for individuals who have symptoms intermittently from allergens that are traditionally perennial. For example, cats produce “perennial” allergens, but if a woman does not have a cat in her home and only gets symptoms when she visits friends or relatives who have cats, then she has intermittent allergic rhinitis secondary to cat allergens.

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Severity classification of rhinitis is relatively straightforward from a qualitative standpoint:

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  • • Patients with mild rhinitis have normal sleep, no impairment of daily activities, normal work and school, and no troublesome symptoms.
  • • Patients with moderate-to-severe rhinitis have one or more of the ...

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