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Allergic Rhinitis

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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.

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