Question 1

How is allergic rhinitis distinguished from non-allergic rhinitis?

Accepted Answer

Allergic rhinitis typically presents with sneezing, itchy nose, clear rhinorrhoea, and nasal congestion triggered by allergen exposure (pollen, dust mites, animal dander). Non-allergic rhinitis has similar symptoms but no identifiable allergen trigger, often with negative skin-prick tests or serum-specific IgE. Key clues for non-allergic: older age onset, no seasonal pattern, no ocular symptoms, triggers include weather changes, irritants, or strong odours.

Question 2

When should allergen immunotherapy be considered?

Accepted Answer

Immunotherapy (subcutaneous or sublingual) is indicated for moderate-severe persistent allergic rhinitis not adequately controlled with pharmacotherapy, patients who wish to avoid long-term medication, or when symptoms significantly impair quality of life. It is most effective for pollen and dust mite allergy. Treatment duration is typically 3 years.

Question 3

Should patients with allergic rhinitis be routinely referred for allergy testing?

Accepted Answer

Referral for skin-prick testing or serum-specific IgE is recommended when: diagnosis is uncertain, symptoms are severe or persistent despite medical therapy, or immunotherapy is being considered. Routine testing for mild intermittent symptoms controlled on medication is not necessary.

Question 4

What is the link between allergic rhinitis and asthma?

Accepted Answer

ARIA guidelines emphasise that allergic rhinitis and asthma are manifestations of the same allergic airway disease ('united airway disease'). Up to 40% of patients with allergic rhinitis have asthma, and treating allergic rhinitis improves asthma control. All patients with allergic rhinitis should be asked about asthma symptoms, and vice versa.