Allergic Rhinitis: Symptoms and Treatment

What is allergic rhinitis?

Allergic rhinitis is an inflammation of the nasal lining triggered by allergens such as dust mites, pollen, fungi, and animal dander, mediated by IgE and associated with type 2 (T2) immune responses. Its impact goes beyond the nose, affecting sleep, productivity, and cognitive performance, and frequently coexisting with asthma or conjunctivitis.

Most common symptoms

Bouts of sneezing, watery runny nose, nasal and eye itching, nasal congestion, and a reduced sense of smell are typical manifestations that vary in intensity and frequency. The condition is classified as intermittent or persistent and as mild or moderate-to-severe, which guides the therapeutic choice.

Accurate diagnosis

Diagnosis is based on a detailed clinical history, an ENT examination, and, when indicated, confirmation of allergic sensitization through skin tests or specific IgE. Distinguishing allergic rhinitis from other phenotypes, such as non-allergic rhinitis or local allergic rhinitis, is essential to define the best treatment.

Medical treatment

The treatment plan integrates reduced exposure to allergens and irritants, environmental hygiene, nasal hygiene, and evidence-based pharmacotherapy. Isotonic saline solution as a daily nasal rinse helps control secretions and improves the effectiveness of intranasal sprays. Second-generation antihistamines and intranasal corticosteroids are the mainstays of treatment, and leukotriene antagonists may be added depending on the clinical picture. Decongestants have restricted, short-term use, always under medical guidance, to avoid rebound effects and adverse events.

Allergen immunotherapy

Specific allergen immunotherapy, given subcutaneously or sublingually, is the only treatment capable of modifying the natural course of rhinitis, inducing tolerance and a sustained benefit after it ends. International and Brazilian guidelines recommend immunotherapy as an adjunct in selected cases, especially when symptoms persist despite standard treatment or when there is a wish to reduce the medication burden. Courses of three to four years show consistent improvement in symptoms and quality of life, with a good safety profile under appropriate protocols.

When to consider biologics and surgery

In specific situations with intense type 2 inflammation or comorbidities, biologic therapies such as anti-IgE and IL-4/13 modulators are being studied and may be considered in selected cases, always by a specialist. Nasal surgical procedures can be useful in refractory nasal obstruction caused by associated structural changes, such as a deviated septum or turbinate hypertrophy, complementing clinical management.

Personalized plan and follow-up

The choice between sprays, tablets, and immunotherapy should consider the patient’s preferences, lifestyle, and treatment goals to maximize adherence and results. Periodic reassessments make it possible to adjust doses, review spray application technique, and optimize control throughout the seasons of greatest exposure.

Care in São Paulo and Alphaville

Specialized ENT consultations, with access to accurate diagnosis and advanced therapies, raise the rate of control and reduce recurrences by aligning science and personalized care.

Scheduling an evaluation with Dr. José Eduardo Marcondes in São Paulo (Faria Lima and Morumbi) or Alphaville makes it possible to start a structured plan with environmental measures, modern pharmacotherapy and, when indicated, immunotherapy for sustained control.

Next steps

Patients with recurrent sneezing, chronic nasal congestion, a clear runny nose, and nasal or eye itching benefit from a specialized evaluation to confirm the phenotype and start targeted treatment. The earlier control is achieved, the greater the chance of reducing the impact on sleep, daily performance, and quality of life throughout the year.