• Most common: birch, oak, maple, cedar, olive, and elm

• Vary geographically

• Highest in late spring through fall

• Year-round in warmer climates

• Most common: Kentucky bluegrass, orchard, redtop, timothy, vernal, Bermuda, perennial rye

• Cross-sensitivity common

• Vary geographically

• Highest in late summer and fall

• Year-round in warmer climates

• Short ragweed is most common

• Other common: western ragweed, pigweed, sage, mugwort, yellow dock

• Vary geographically

• Aspergillus and Penicillium found indoor and outdoor

• Alternaria and Cladosporium in dry, windy conditions

• Thrive in warmer temperatures and high humidity

• Found in carpets, upholstered furniture, pillows, mattresses, bedding, stuffed toys

• Common: Dermatophagoides farinae and Dermatophagoides pteronvssinus

• Can occur with most furry animals and birds

• Also common cause of asthma

severe symptoms if his or her symptoms impact sleep, daily activities, work, school, sports or leisure, as well as if troublesome symptoms exist.

When classifying a patient’s allergic rhinitis, both duration and severity need to be considered. A patient with symptoms lasting for six weeks that interfere with normal activities would be diagnosed with moderate to severe persistent allergic rhinitis. Ten percent of patients can be classified with mild intermittent rhinitis, 14 percent with mild persistent rhinitis, 17 percent with moderate to severe intermittent rhinitis and 59 percent with moderate to severe persistent rhinitis.

Weed

Outdoor molds

Persistent

Dust mites

Cockroaches and rodents

The Allergic Rhinitis and its Impact on Asthma (ARIA) classifications for allergic rhinitis—intermittent and persistent—have replaced the traditional nomenclature of seasonal and perennial. These newer classifications utilize duration, symptoms and quality of life parameters to subdivide patients. A patient with intermittent allergic

rhinitis exhibits symptoms less than four days per week or for less than four weeks. A patient with persistent allergic rhinitis exhibits symptoms more than four days per week or for more than four weeks. Patients are further subdivided as having mild or moderate to severe symptoms. A patient is diagnosed with mild symptoms if his symptoms do not impact sleep, daily activities, work, school, sports or leisure. A patient is diagnosed with moderate to

PATIENT CASE

Tom Hall, a 25-year-old male, comes into the pharmacy complaining of nasal congestion, sneezing and nasal itching. He says that “he just can’t take this any longer” because the symptoms have lasted for 7 weeks, occurring nearly every day of the week. The symptoms are so bothersome that he is unable to function at work. To make matters worse, he is unable to sleep at night due to the symptoms. At first he thought he had developed a cold, but now that the symptoms have persisted for nearly two months, he feels he should seek help. How should Mr. Hall’s symptoms be categorized?

Mr. Hall’s symptoms would be considered to be persistent moderate to severe. His symptoms are considered persistent because they occur almost every day. And his symptoms are considered to be moderate to severe because they interfere with his ability to do work and to sleep.

Common symptoms exhibited by patients with allergic rhinitis include clear nasal discharge, sneezing, nasal congestion, itching of the nose and eyes, and postnasal drip. Nasal congestion may make it hard for the person to breath through the nose, making him or her a chronic mouth breather. The nasal congestion may also lead to a decrease in the sense of taste and smell. Some patients may also develop a cough due to the presence of postnasal drip. Patients who experience itching of the eyes often have tearing and develop