Key Points
Î Allergic rhinitis (AR) is one of the most common diseases affecting
adults. In the United States today it is the most common chronic
disease in children and the fifth most common disease overall.
Î AR is estimated to affect nearly one in every six Americans and
generates $2 to $5 billion dollars in direct health expenditures
annually.
Î Many diagnostic tests and treatments are used in managing patients
with this disorder, yet there is considerable variation in their use.
Definitions
Î AR is defined as an immunoglobulin E (IgE)-mediated inflammatory
response of the nasal mucous membranes after exposure to inhaled
allergens. Symptoms include rhinorrhea (anterior or postnasal drip),
nasal congestion, nasal itching, and sneezing. AR can be seasonal,
perennial, or episodic with symptoms being intermittent or persistent.
Î AR may be classified by
• the temporal pattern of exposure to a triggering allergen as:
▶ seasonal, (e.g., pollens) or
▶ perennial / year round, (e.g., dust mites) or
▶ episodic (environmental from exposures not normally encountered in the
patient's environment, e.g., visiting a home with pets)
• frequency of symptoms
▶ intermittent (<4 days/week or <4 weeks/year) or
▶ persistent (>4 days/week and >4 weeks/year)
Note: is classification of symptom equency has limitations. For example, the patient who
has symptoms 3 days/week year round would be classifiedas "intermittent" even though he or
she would more closely resemble a "persistent" patient. It may be best for the patient and the
provider to determine which equency category is most appropriate and would best guide the
treatment plan. Based on these definitions, it is possible that a patient may have intermittent
symptoms with perennial AR or persistent symptoms with seasonal AR.
• severity of symptoms
▶ mild (when symptoms are present but are not interfering with quality of life) or
▶ more severe (when symptoms are bad enough to interfere with quality of life)
Î Although the FDA uses "seasonal" or "perennial" when approving new
medications for AR, classifying a patient's symptoms by frequency and
severity allows for more appropriate treatment selection.
