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.

How common is allergic rhinitis?

Allergic rhinitis is one of the most common chronic diseases. According to the international ARIA guidelines (Allergic Rhinitis and its Impact on Asthma), it affects about 500 million people worldwide. In Brazil, the ISAAC study (International Study of Asthma and Allergies in Childhood), in its phase 3, found allergic rhinoconjunctivitis in the past year in 8.9% to 28.5% of adolescents aged 13 to 14 and in 10.3% to 17.4% of children aged 6 to 7, with variation according to the region of the country. These figures help explain why persistent sneezing, runny nose, and a stuffy nose are among the most common complaints in the office.

Rhinitis and asthma: the united airway

The nose and the bronchi are part of the same respiratory tract, which is why rhinitis and asthma tend to go hand in hand, a concept known as the united airway. The very name of the international guidelines, ARIA (allergic rhinitis and its impact on asthma), reflects this connection. Most people with asthma also have rhinitis, and poorly controlled rhinitis can make asthma harder to control. Assessing and treating the nose is therefore part of caring for the entire respiratory tract, not just nasal comfort.

Most common symptoms

Bouts of sneezing, a watery runny nose, nasal and eye itching, nasal congestion, and a reduced sense of smell are typical manifestations that vary in intensity and frequency. Symptoms may appear in flare-ups, linked to a specific allergen (such as pollen at certain times of year), or be present throughout almost the entire year (as in dust mite allergy).

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. Under the ARIA guidelines, rhinitis is classified by duration (intermittent or persistent) and by severity (mild or moderate-to-severe), which directly guides the choice of treatment. Distinguishing allergic rhinitis from other phenotypes, such as non-allergic rhinitis or local allergic rhinitis, is essential to define the best approach.

Medical treatment

The treatment plan integrates reduced exposure to allergens and irritants, environmental hygiene, nasal hygiene, and evidence-based pharmacotherapy. A daily nasal rinse with isotonic saline solution 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 benefit that is sustained after it ends. International and Brazilian guidelines recommend it 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. In children with grass-pollen rhinoconjunctivitis, a five-year controlled trial (the GAP study) showed that sublingual immunotherapy reduced asthma symptoms and the need for asthma medication during follow-up, reinforcing its role in modifying the disease.

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 favor 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 current therapies, help achieve better control and reduce recurrences by aligning science and personalized care.

Scheduling an evaluation with Dr. José Eduardo Marcondes in Morumbi or Itaim (São Paulo) or in Alphaville (Barueri) 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.

Dr. José Eduardo Merighe Marcondes is a PHYSICIAN and otolaryngologist (ENT) (CRM SP 107711 | RQE 43840), working in rhinology and nasal surgery, seeing patients in Morumbi and Itaim (São Paulo) and in Alphaville (Barueri). If it makes sense for you, schedule an evaluation so we can talk about your case.

This content is informational and does not replace a medical consultation.

References

1. Solé D, Camelo-Nunes IC, Wandalsen GF, Rosário Filho NA, Naspitz CK; Brazilian ISAAC’s Group. Prevalence of rhinitis among Brazilian schoolchildren: ISAAC phase 3 results. Rhinology. 2007;45(2):122-128.
2. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update. Allergy. 2008;63(Suppl 86):8-160.
3. Bousquet J, Schünemann HJ, Togias A, et al. Next-generation ARIA guidelines for allergic rhinitis based on GRADE and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70-80.
4. Valovirta E, Petersen TH, Piotrowska T, et al. Results from the 5-year SQ grass sublingual immunotherapy tablet asthma prevention (GAP) trial in children with grass pollen allergy. J Allergy Clin Immunol. 2018;141(2):529-538.