Counseling Patients About Allergic Rhinitis

INTRODUCTION

Allergic rhinitis is a global health concern affecting at least 10 percent to 25 percent of the population. From the 1960s to 1990s, a 100 percent increase in the incidence of allergic rhinitis in developed nations has led some researchers to pronounce it an epidemic. Millions of Americans suffer from allergic rhinitis. The most recent U.S. estimates establish that 10 percent to 30 percent of adults and 40 percent of children have allergic rhinitis. These estimates may be low because many patients self-medicate with nonprescription medications and herbal remedies, rather than seeking medical attention.

Although symptoms are not typically severe, they change the quality of life of patients, affecting work productivity and school performance. In the Allergies in America survey, 85 percent of individuals reported that allergic rhinitis altered their quality of life during allergy season. More than 40 percent stated that their nasal symptoms interfered with their work performance. Allergic rhinitis is estimated to account for 100 million days of lost work per year. Allergic rhinitis is responsible for 1. 5 million missed school days per year, and and symptoms are associated with decreased learning in children due to sleep disturbances, fatigue and irritability.

Indirect costs of allergic rhinitis add up to nearly $4 billion per year. Allergic rhinitis is also responsible for $5.9 billion annually in direct healthcare costs and 16. 7 million physician office visits.

Allergic rhinitis is also a known risk factor for asthma. The DREAMS study found asthma was present in nearly 25 percent of rhinitis patients, compared with 2 percent of the general population. Patients who have both indoor and outdoor allergies are more likely to develop asthma than people who only have indoor or outdoor allergies. Individuals with moderate or severe persistent rhinitis are more likely to develop asthma than those with mild or intermittent rhinitis.

PATHOPHYSIOLOGY

Allergy rhinitis symptoms occur due to an overproduction of immune globulin-E (IgE) resulting from a response to an environmental allergen. During the early- and late-phase responses to an allergen in these Type 1 allergic reactions, various inflammatory mediators are produced and released, along with activation and recruitment of cells to the involved mucosa.

In this type of reaction, the allergen is inhaled through the nose. Within minutes, the allergen interacts with T

TABLE 1

Causes of drug-induced rhinitis

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ACE inhibitors
Aspirin
Beta-blockers
Chlorpromazine
Conjugated estrogen
Guanethidine
Methyldopa
NSAIDs
Oral contraceptives
Phentolamine
Prazosin
Reserpine

cell and B cell lymphocytes, resulting in production of IgE antibodies. This leads to a series of events that result in nasal itching and sneezing. The blood vessels in the mucosal glands also dilate, leading to sinus and nasal congestion.

After several exposures, airways become hypersensitive and nasal symptoms worsen. Tissue inflammation may last several weeks in intermittent allergy sufferers or become chronic in the case of persistent allergic rhinitis. When patients are repeatedly exposed to an allergen, the amount of allergen neces-

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