Information in this chapter was obtained from published articles
identified in a Medline search conducted in March 2008 using the
search term allergic rhinitis.
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.
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.
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.
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.
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
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.
Severity classification of rhinitis is relatively straightforward
from a qualitative standpoint:
- • Patients with mild rhinitis have normal sleep,
no impairment of daily activities, normal work and school, and no
- • Patients with moderate-to-severe rhinitis have
one or more of the ...