What is allergic rhinitis?
Allergic rhinitis, often referred to as "hay fever," is a chronic inflammatory disease of the nasal mucosa caused by the immune system's reaction to harmless substances known as allergens. It is one of the most common chronic conditions, affecting millions of people worldwide. The main symptoms include:
- Nasal congestion
- Profuse watery nasal discharge (runny nose)
- Sneezing
- Itching in the nose, eyes, or throat
- Tearing (watery eyes)
These symptoms can significantly impair quality of life, affecting sleep, productivity, and overall well-being. Understanding the mechanisms of development and modern treatment approaches is key to effectively managing the disease.
Mechanisms of development: the role of type 2 inflammation
At the core of allergic rhinitis, as well as many other chronic airway diseases (such as asthma), often lies what is known as type 2 inflammation [1]. This type of inflammatory response is characterized by the activation of specific immune cells and the production of specific cytokines.
Key markers indicating the presence of type 2 inflammation include:
- Elevated blood eosinophil levels [1, 8]
- Increased fractional exhaled nitric oxide (FeNO) [1]
- High levels of total serum immunoglobulin E (IgE) [1, 8]
These markers provide valuable information regarding disease progression, the risk of exacerbations, and potential response to treatment, although their stability still requires further research [1]. Understanding these mechanisms allows for the application of more targeted and personalized therapeutic strategies.
Diagnosis and identification of triggers
Effective treatment of allergic rhinitis begins with accurate diagnosis and the identification of specific allergens causing the reaction. This process involves several important steps:
- Detailed medical history: The physician asks questions about symptoms, their duration, seasonality, association with specific locations or substances, and family history of allergic diseases [4].
- Identification of potential irritants and allergens: It is important to determine which environmental factors (pollen, dust mites, pet dander, mold, certain foods) may be triggering the symptoms [4].
- Allergy testing: Skin prick tests or blood tests for specific IgE antibodies help confirm sensitivity to particular allergens. In some cases, especially with chronic skin manifestations, patch testing may be used to identify contact allergens [4].
A comprehensive approach to diagnosis, which includes not only pharmacological treatment but also recommendations for lifestyle changes and avoidance of causative factors, is the foundation of successful allergy management [4].
Modern approaches to treating allergic rhinitis
Managing allergic rhinitis involves a multifaceted approach aimed at alleviating symptoms and improving quality of life. The main treatment strategies include:
- Allergen avoidance: This is the first and often the most effective step. It may include using air purifiers, hypoallergenic bedding, limiting contact with pets, or staying indoors during periods of high pollen concentration.
- Pharmacotherapy:
- Antihistamines: Available in the form of tablets, nasal sprays, and eye drops. They block the action of histamine, reducing itching, sneezing, and runny nose [5].
- Nasal corticosteroids: Effectively reduce inflammation in the nose, relieving congestion, runny nose, and sneezing. They are considered the cornerstone in the treatment of moderate to severe allergic rhinitis [5].
- Decongestants: May be used for a short time to relieve severe nasal congestion, but their long-term use is not recommended due to the risk of developing rhinitis medicamentosa.
- Allergen-specific immunotherapy (AIT): A method aimed at "retraining" the immune system by gradually reducing its sensitivity to an allergen. It is performed through regular administration of small doses of the allergen (injections or sublingual tablets/drops).
It is important to note that treatment should be tailored to the individual needs of the patient, and each new therapeutic method may complement or overlap with the previous one to achieve the best result [4].
Personalized therapy and biological drugs
In the era of personalized medicine, increasing attention is being paid to an individualized approach to treating allergic diseases. This includes refining clinical markers in combination with molecular and cellular phenotyping to improve treatment outcomes [1].
For patients with severe forms of allergic rhinitis, especially when combined with asthma, biological drugs may be recommended. These innovative medications target specific molecules involved in type 2 inflammation, such as:
- Interleukin-4 (IL-4) and interleukin-13 (IL-13) [1]
- Interleukin-5 (IL-5) [1]
Biological drugs have shown potential in treatment, although their efficacy may vary among different patients [1]. In some cases, in the presence of type 2 inflammation, even corticosteroid therapy can be beneficial, despite general concerns regarding its use [1]. These approaches underscore the importance of accurate diagnosis and the selection of therapy based on the individual characteristics of the patient's immune response.
Managing allergies in children and in special conditions
Allergy and asthma are among the most common chronic non-communicable diseases in children, requiring special attention and, if necessary, adaptation of the standard treatment plan [5].
When managing childhood allergies, it is important to:
- Optimal disease control: One should strive for maximum control of allergic, asthmatic, and immunodeficient conditions in children in accordance with standard treatment recommendations [5].
- Safety of standard medications: There is no evidence that widely used allergy and asthma medications, such as antihistamines, corticosteroids, and bronchodilators, increase the risk of severe respiratory viral disease [5]. This is especially relevant during epidemic periods when parents may be concerned about using these agents.
- Telemedicine: In conditions where an in-person visit to a doctor is difficult (e.g., during epidemics), telemedicine becomes an important tool for connecting with the attending physician and receiving consultations [5].
Maintaining optimal control over allergic rhinitis in children helps prevent complications and improve their overall health and development.
Sources
- [1] Type 2 inflammation, a common denominator in chronic airway disease? https://pubmed.ncbi.nlm.nih.gov/40104899/
- [4] Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. https://pubmed.ncbi.nlm.nih.gov/32776537/
- [5] Managing childhood allergies and immunodeficiencies during respiratory virus epidemics - The 2020 COVID-19 pandemic: A statement from the EAACI-section on pediatrics. https://pubmed.ncbi.nlm.nih.gov/32319129/
- [8] Pediatric angioedema without urticaria: A rare presentation of autoimmune thyroid disease with complete remission on levothyroxine therapy. https://pubmed.ncbi.nlm.nih.gov/40965010/
The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult with a qualified medical professional for diagnosis and treatment prescription.