Allergic rhinitis
Allergic rhinitis is not just a "sensitivity". It is inflammation of the lining of the nose, which starts when the immune system reacts to something harmless: pollen, dust mites, pet hair, mold. The diagnosis is made clinically, from your history and the examination. You do not need an allergy test to start treatment, it is needed to answer specific questions.
Allergic or non-allergic rhinitis?
The distinction is made mainly from the symptoms, and it changes the treatment.
The allergic form itches. Sneezing fits, itching in the nose, eyes or roof of the mouth, a clear watery runny nose, red watery eyes.
The non-allergic form does not itch. The nose blocks up and runs with cold air, strong smells, sudden temperature changes or humidity, while allergy testing comes back negative. Antihistamines do little here, and that is often the first clue that gives it away.
Seasonal or year-round allergic rhinitis?
The seasonal form (hay fever) is caused by pollen and appears in specific weeks, depending on the plant. In Greece the heaviest period is spring, with grass and olive tree pollen.
The year-round form is caused mainly by house dust mites, pets or mold in the home. Symptoms are present all year, often worse in the morning and in bed, and precisely because they have no season, many people do not put them down to allergy. It is one of the most common causes of a nose that never fully clears.
How does it show in children?
Children rarely describe itching. They show other signs: constantly rubbing the nose upwards with the palm, an open mouth, dark circles under the eyes, coughing at night, restless sleep. A permanently stuffy nose in a child is not harmless, because it contributes to mouth breathing and to fluid behind the eardrum. στο υγρό πίσω από το τύμπανο.
What happens at the appointment?
We start with your history, because the diagnosis rests on it: when the symptoms appear, whether they are seasonal, what there is at home and at work, which medicines you have tried, at what dose and for how long.
Nasal endoscopy
It shows the condition of the nasal lining and the turbinates, but above all it rules out conditions that look like allergy without being allergy: nasal polyps, a structural blockage, signs of established sinusitisWhen symptoms do not improve despite the right treatment, the answer is usually found here.
When is an allergy test needed?
The test is not the first step and not everyone needs it. It comes in when treatment is not working, when the diagnosis is uncertain, when identifying the allergen will genuinely change the treatment or when allergy shots or tablets (immunotherapy) are being considered. It is done with skin prick tests or by measuring specific IgE in the blood.
A positive result means sensitization, not automatically that this allergen is the culprit. It is always read alongside your history, because if the symptoms do not match the timing of exposure, the finding does not change the plan.
What is not needed?
A CT scan of the sinuses does not confirm allergic rhinitis, because there is no imaging finding that characterizes it. It is requested when another condition is suspected, such as chronic sinusitis or nasal polyps, and not for the allergy itself.
Treatment
Nasal steroid sprays
They are the first choice and the treatment with the strongest evidence, because they cover all 4 main symptoms, including the stuffiness that antihistamines leave almost untouched.
2 things decide whether they will work.
Time. The full effect does not come on the first day, it takes regular use over days to weeks. Most people who say "it didn't work for me" stopped after 3 days. If you have a known seasonal allergy, ideally start a few days before the season begins.
Technique. Aim the spray outwards, away from the nasal septum, using the hand on the opposite side, without sniffing hard. The blood that many people notice is not a side effect of the medicine, it happens because the spray hits the same spot on the septum every day. This is corrected within a minute, once someone shows you how.
Antihistamines
Second-generation antihistamine tablets, which do not cause drowsiness, are suitable when sneezing and itching are the main problem. They work quickly and are useful for symptoms that come and go, but they fall short on stuffiness. They are also available as a nasal spray, which works even faster.
What is not first-line treatment
Leukotriene receptor antagonists (such as montelukast) are not recommended as initial treatment for allergic rhinitis, because they are less effective than the options above. They still have a place in selected cases, especially when there is also asthma.
Decongestant nasal sprays open the nose impressively and should not be used for more than a few days, because after that they have the opposite effect.
There is no recommendation for herbs and supplements, because the evidence is not sufficient.
Immunotherapy (allergy shots or tablets)
It is the only treatment that does not stop at the symptoms but acts on the mechanism itself. It is given under the tongue or as injections under the skin, using the allergen itself in controlled doses, so that the reaction gradually decreases.
It is offered when symptoms are not adequately controlled with medication, avoidance or both, or when the patient prefers this route. It requires confirmed sensitization that matches your history, as well as an assessment for asthma before starting.
There are 2 points worth knowing from the start.
Duration: or the effect to last, treatment takes at least 3 years.
Benefit: beyond relief, it can limit the development of new sensitizations, reduce the risk of developing allergic asthma and keep working even after it is stopped.
Allergic rhinitis and asthma
The lining of the nose and the airways in the lungs is the same tissue, and inflammation rarely stays in one area. A large proportion of people with asthma also have allergic rhinitis, and a poorly controlled nose makes asthma harder to control. That is why we always ask about coughing at night, shortness of breath during exercise and tightness in the chest.
Frequently asked questions
Not necessarily. The test shows sensitization, meaning that antibodies are present. The allergen considered responsible is the one that matches the timing of your own symptoms, which is why the result is never read on its own.
At the recommended doses they have a good safety profile, because they act locally with minimal absorption into the body. The most common complaints are local, dryness and minor nosebleeds, and they usually go away once the spraying technique is corrected.
Symptoms change over the years and in some people they fade. The only treatment that has been shown to change the course of the condition, and not just how you feel day to day, is immunotherapy.
Changes in your surroundings help, especially with dust mites and pets, but they are rarely enough on their own. They work as an addition to treatment, not as a substitute for it.
First the inflammation is brought under control, and then we assess what remains. Surgery corrects the structural partit does not cure the allergy, so the order matters, so that you know exactly what you will gain from each.
Yes. Air pollution irritates the already inflamed lining of the nose and makes symptoms worse, without being an allergen itself. The same applies to cigarette smoke.
When should you not wait?
Immediately
Shortness of breath, wheezing or tightness in the chest
Allergic rhinitis does not make breathing from the chest difficult. When symptoms like these are added, you need to be assessed right away
Soon
Symptoms that stay on one side, especially with blood
Allergy affects both sides. Persistent one-sided symptoms with bloody discharge need an endoscopy without waiting
Soon
Clear watery discharge from one nostril only
When clear fluid drips from one side only, especially when bending forward or after an injury to the nose, it should not be put down to allergy before it has been investigated
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγές: Seidman MD et al., Clinical Practice Guideline: Allergic Rhinitis, AAO-HNSF, 2015. Gurgel RK et al., Clinical Practice Guideline: Immunotherapy for Inhalant Allergy, AAO-HNSF, 2024.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
