Introduction

Allergic rhinitis is a complex disease influenced by various factors, including genetics, environment, weather conditions, and age. It involves inflammation of the nasal mucosa upon contact with allergens. When an allergic individual inhales allergens like pollen, animal dander, mites, or mold, an abnormal immune reaction occurs in the nasal mucosa. This reaction initiates a sensitization response in the body, leading to the production of specific antibodies called IgE for the allergen. Consequently, the local reaction mimics respiratory symptoms similar to a common cold.

In addition to its standalone occurrence, allergic rhinitis often coexists with other diseases. These diseases either share the same underlying pathophysiology (such as atopic dermatitis or asthma) or are connected anatomically (as seen in conjunctivitis, middle ear problems, or sleep issues).

Allergic rhinitis is a prevalent chronic condition worldwide, affecting a significant portion of the global population. It impacts up to 25 percent of children and over 40 percent of adults, with these numbers expected to rise due to climate change. Global warming and exposure to environmental pollutants play a crucial role in the development and worsening of respiratory conditions, particularly allergic rhinitis and asthma.

Pollutants damage the nasal mucosa, facilitating the entry of allergens and increasing hypersensitivity to them. Simultaneously, the rising concentration of CO2 and temperature stimulates more vigorous and accelerated plant growth, resulting in higher levels of allergenic pollens and increased flowering duration. Productivity and maximum plant height were positively affected by daytime and soil temperatures as well as enhanced CO2, increasing 60% and 115% for the suburban and urban sites, respectively, relative to the rural site.

Although the biological mechanisms underlying allergies are complex and multifactorial, it remains important to prioritize primary prevention practices to minimize sensitization risks. These practices include avoiding exposure to allergens and substances that trigger sensitivity, as well as quitting smoking and shielding children from secondhand smoke.

Symptoms and impact on quality of life in Allergic Rhinitis

The predominant symptoms of allergic rhinitis primarily affect the respiratory system, causing nasal congestion, sneezing, itching, a runny or stuffy nose. These symptoms are often accompanied by coughing, sore throat, watery eyes, headaches, and excessive fatigue. Secondary or recurring symptoms may include nasal obstruction, leading to snoring and disrupted sleep, as well as loss of smell and taste, and even hearing difficulties. Allergic rhinitis can greatly contribute to daytime fatigue, irritability, and drowsiness, significantly impacting overall quality of life.

From a clinical standpoint, allergic rhinitis is categorized based on the frequency and severity of symptoms. It is classified as intermittent when symptoms occur less than four days per week or for fewer than four weeks in a year. On the other hand, persistent allergic rhinitis is diagnosed when symptoms last more than four days per week and persist for more than four weeks in a year. The severity of symptoms is determined by the extent of “sleep disturbance“:

• Mild allergic rhinitis manifests with typical cold-like respiratory symptoms without disrupting sleep.
• Moderate-severe allergic rhinitis is characterized by more pronounced and bothersome respiratory symptoms, accompanied by sleep disturbances and limitations in daily activities.

While allergic rhinitis is not life-threatening, it can significantly impact social interactions and impair academic or work performance. Recognizing this, guidelines for managing allergic rhinitis emphasize the importance of placing the patient at the center of the diagnostic process.

An accurate diagnosis requires active involvement from the patient in assessing symptoms and their impact on daily life. Patients now have access to tools such as: 

• Questionnaires that measure disease progression and coexisting conditions. 
• Additionally, various allergy apps and diaries utilizing new technology and communication systems are available to help record and track symptoms. 

This enables patients to provide firsthand information without the need for interpretation by doctors or others. It is crucial for patients to describe their overall well-being, encompassing physical, emotional-psychological, social, and environmental aspects, to aid physicians in making an accurate diagnosis and classifying the disease appropriately.

Diagnosing Allergic Rhinitis: from symptoms to molecules or from molecules to symptoms?

It appears that only half of patients with allergic rhinitis seek medical attention, while the others underestimate the condition or attempt self-management, possibly due to a lack of confidence in treatment outcomes. However, those who turn to a physician for a specific diagnostic approach benefit from precision diagnosis, secondary prevention, and personalized treatment.

An accurate diagnosis is crucial because neglecting allergic rhinitis not only exacerbates the clinical presentation, but also increases the likelihood of coexisting conditions such as allergic conjunctivitis and atopic dermatitis. These conditions share the same underlying cause as allergic rhinitis, involving the production of allergen-specific IgE antibodies.

Secondary prevention is equally significant since allergic rhinitis serves as a risk factor for developing asthma. Epidemiological studies indicate that over 80% of asthmatics have rhinitis, and 10-40% of patients with allergic rhinitis have asthma.

Currently, the most common diagnostic approach for allergies follows a “from symptoms to molecules” path. It begins by evaluating the patient’s symptoms, followed by allergy skin tests (prick tests) that assess reactions to 20 to 100 respiratory and food allergens. Specific IgE testing, which measures the level of IgE antibodies circulating in the blood, completes the process.

Alternatively, the physician may choose the reverse “molecules to symptoms” route, which directly involves determining IgE levels. This approach is used when prick tests cannot be performed due to the presence of atopic dermatitis, in elderly individuals with skin issues, or in patients with suspected complex poly-sensitization.

Conclusion

Taking control of allergic rhinitis is paramount for enhancing quality of life and preventing the coexistence of other allergic conditions. The initial step involves self-assessment by asking simple questions regarding symptoms: Is there a runny nose, sneezing, or itching? Are the eyes watery or red? Are there any hearing issues, difficulties with concentration, sleep problems, or excessive fatigue during daily activities? Questionnaires and modern communication technologies can assist patients in this initial phase.

The next step is to collaborate with a physician and embark on the diagnostic journey. This process leads to personalized treatment aimed at alleviating symptoms, reducing the frequency and intensity of allergy episodes, and preserving the overall health of the respiratory system.

True to its core values, the Menarini Group has been committed to people care and enhancing their quality of life for over 130 years. Allergology is among the specialized therapeutic areas that the Group focuses on, and driven by its innate caring nature, it continually strives to raise awareness about allergic rhinitis and its associated risks. The Group consistently places the patient first, exemplifying its commitment to compassionate care.