Allergic Rhinitis – causes, symptoms, diagnosis, treatment, pathology

By Adem Lewis / in , , , , , , , , , , /

“Rhin” refers to the nose and “itis”
refers to inflammation, so rhinitis is nasal inflammation. Allergic rhinitis is also called hay fever,
because it’s typically caused by allergens like hay, as well as pollen, dust, animal
hair, or mold spores. Since the main trigger is pollinating plants,
allergic rhinitis will flare up at specific times of the year. Allergic rhinitis is a type 1 hypersensitivity
reaction, which is a type of allergic reaction that starts with exposure to an environmental
allergen. So – let’s say that a bit of pollen enters
the nose. It can get picked up by a dendritic cell which
is a type of immune cell that gobbles up foreign particles and presents it to a nearby lymphocyte
called a T cell. If that T cell gets activated, it kicks into
action, producing cytokines which helps to get other immune cells involved. The exact type of T cell determines the type
of immune response, and in allergic rhinitis there’s a bit of a T cell imbalance. There are too many T cells that, when activated,
stimulate B cells, another group of lymphocytes, to produce IgE antibodies. Those IgE antibodies get released into the
bloodstream and bind to mast cells, which are immune cells in the tissue that carry
within themselves a load histamine. Once bound by IgE the mast cells are “primed”,
meaning if pollen enters the body again in the future, those mast cells degranulate and
release their histamine into the local tissue. The histamine causes blood capillaries to
dilate and become leaky which brings more fluid and immune cells to the area where the
mast cells are located. Because the eyes and nose are portals of entry
for infections, there are lots of mast cells around those areas for extra protection. So those IgE-primed mast cells release their
histamine, which causes nearby capillaries to dilate – flooding the facial tissues with
fluid. Interestingly, there’s evidence that early
exposure to allergens might protect against type 1 hypersensitivity. For example, children who grew up on farms
and have pets at an early age typically have lower rates of allergic rhinitis. It’s thought that a combination of genetic
factors and environmental factors like these contribute to which type of T cell group is
most common and thereby influences the overall immune response. The symptoms of allergic rhinitis are related
to the excess fluid in the facial tissues. It causes nasal congestion, and red, itchy,
swollen eyes with frequent bouts of sneezing. Symptoms can begin just minutes after exposure
to allergens, and can persist for weeks at a time, affecting the ability to concentrate
and sleep, as well as attend work or school. The diagnosis of allergic rhinitis is generally
based on simply the way the skin looks, and when possible, it’s helpful to identify
the allergic trigger so that a person can avoid them in the future. One way to identify an allergic trigger is
with SKIN-PRICK test where small drops of allergens are placed on the skin and then
pricked into the skin with a tool; again, to see if there’s evidence of an allergy
like raised bumps or weals – otherwise known as itchy red skin. These tests can test for many allergens at
once, but they can sometimes have low sensitivity and low specificity. In other words, sometimes a person might have
no allergic reaction on the skin test, but have a localized allergic reaction affecting
the nasal cavity and eyes – that’s low sensitivity. Other times a person might have a skin reaction
to something, even though they don’t normally have symptoms when they encounter that allergen
in their everyday life – and that’d be low specificity. Typically, the best thing for allergic rhinitis
is to simply avoid the triggering allergen if possible. If there are symptoms, antihistamine medications
can be used to suppress the effect of mast cell degranulation. Nasal irrigation can flush out the sinuses,
reducing the congestive symptoms of allergic rhinitis. In some situations, it’s also possible to
rewire the body’s immune response to an allergen by exposing it to micro-doses and
slowly ramping up to a full dose of the allergen. This gradually boosts tolerance to the allergen
by reducing the immune system’s tendency to produce IgE each time. Alright, as a quick recap – allergic rhinitis
is a type 1 hypersensitivity reaction which results in inflammation of eyes and nose. Airborne allergens like pollen, dust, animal
hair, or mold spores cause mast cells in the tissues to release histamine, causing the
eyes and nose to get inflamed and watery. Avoiding allergens is the best approach, but
it’s also possible to use antihistamines, and in severe cases try desensitization to
reduce or eliminate the symptoms.

41 thoughts on “Allergic Rhinitis – causes, symptoms, diagnosis, treatment, pathology

  1. Hi Folks! We're re-releasing this video to correct an error in our diagnosis section. A previous version of this video discussed the use of a patch test which is specific for Type IV hypersensitivity reactions, not type 1 hypersensitivity reactions.

  2. Thanks guys!
    I have a question, In case of using antihistamine and it's not really the person is using nasal drops frequently..and he's almost lost ability to smell..what's the solution to that?

  3. I'm 20 years old , I was diagnosed with Rhinitis (that's what the ENT doctor said i have )at the age of 15 years old but i had it way before probably when i was 6/8 years old , I was told that If i wanted surgery i had to wait until i turned 18 years old but i didn't do it. Mine is really unpredictable especially under sun rays really hot and when the temperature is really cold. however mine is always crystal clear. I always carry with me packets of tissues when I'm outside. I used to use Ocean spray but then tried haysan spray and now i want to try others to see what best works for me.

  4. That most effective explanation for Allergic Rhinitis, and this diagram is so helpful for memorizing quickly and understanding very well. THNKS

  5. I dont agree! It is not caused by outside factors. Outside factors just triggers it but it is not the ROOT CAUSE. Root cause is internal, in the immune system itself.

  6. i cant tolerate any fragrance ,dust… i cant even touch the clothes inside my wardrobe as i feel that specific cloth smell and the i sneeze. i cant even tolerate air, a running fan. if someone passes by me, i feel that too as my nostril feels the air and i start sneezing… if i am sitting, then standing or walking will also trigger my nose as one of my nostrils is too sensitive that time. i cant even move then due to the feel of air on my nostril. i cant even wash my face, as my nostril feels water being poured on it and i sneeze then. i cant take anything being cooked in the kitchen as spices and that aroma makes me sneeze. i cant even press washed clothes as i feel surf fragrance from them when they being pressed. i cant even tolerate if something is being moved (any blanket, cloth) around my surrounding or someone being passed by or me mysellf if moves… what is this all? PUTTING RUMAL (handkerchief) DOES NOT WORK IN MY CASE until and unless i make a ball of that cloth and keep on pressing it on my nose with full force so that i cant breath throuth it +it has no contact with the environment… what is this all?

  7. I want to let you know that i have had those symptoms for a VERY long time i have seen a doctor and there sending me for a skin prick test and the suggested it might be rhinitis thx!!!!!!

  8. Incredible no cure for allergies but there's a cure for deadly diseases like hep c and HIV. This is a simple reaction by the body yet they push all these shitty allergy pills and sprays that don't do shit. Allergies have ruined my quality of life and gets worse with age

  9. I have grow up in farm with cats and dogs as pet but after 20 years, One day, i just suddenly sneeze in my boarding house and that sneeze always happen every day. BEFORE I go to bed and after I wake up. SOMETIMES I SNEEZE IN AFTERNOON WHEN I INHALE SOME PERFUME or JUST A RANDOM SNEEZING. Tbh, this is very annoying and to tell you that in my place, having check up in a doctor is fcking expensive and I am just a broke student. THIS IS WHY NO MATTER HOW I WANT THIS TO END, I STILL NEED A JOB AND SAVE uP SO I CAN FINALLY CHECK THIS STUPID ALLERGY. I DONT REALLY UNDERSTAND WHY I GOT THIS BUT ITS SUPER ANNOYING. SOMETIMES I COULDN'T SLEEP ECAUSE I COULDNT STOP SNEEZING. I really hate this.

  10. Vaccine cause us to have all these symptoms Rrrrrrrrrrrrrrrrrrrrrrr. Two words COLLOIDAL SILVER. Add MARIJUANA TO THE MIX YOUR ON YOUR WAY TO RECOVERY

  11. I’m so tired of this 😭 I was diagnosed with allergic rhinitis at the age of 13. I’m 23 now. I’ve struggled with breathing since then. I’ve tried everything. I don’t have the same symptoms as other do though. I don’t get the constant sneezing or itching. It’s rare when I do. But i do have excessive post nasal drip. I choke all the time because of it. The nasal drip piles up deep in my throat causing me to hack it out all the time. I’m so tired I just want to be able to breathe 🙁 my nostrils are inflamed every single day of the year. I’m currently on montelukast, Flonase, and Allegra-D. It doesn’t help though. It’s so hard to take a deep breath and my chest feels super tight. Someone help 😭

  12. I always sneeze specially when cleaning the house, and now I have difficulty in breathing when sleeping or even laying. I feel like there's something hinder my Nose so I breath with my mouth but I learnerd that it is not good. Maybe I have an allergic rhinitis.

  13. I've been suffering allergic rhinitis since i was a child and now i am 19 and its been insanely difficult. I wouldn't wish on my worst enemy to suffer this. I have been doing so much research on this I might as well write a paper on it. However there is barely any information on the internet that is any help. The only advice you hear is taking nasal sprays and steroids etc but I have tried them to no avail. I even had an operation to remove tonsils but nothing changed. But during my recent research, I began reading about how allergies could be caused by missing bacteria species in the gut. It makes sense when you realise that 80% of the immune system lies in the gut. Allergies only started rising sharply when people became cleaner and urbanisation took place around the world. People and their immune systems are much less exposed to environmental bacteria and organisms than before. It is no shock to hear that children raised in farms are significantly less likely to have allergies than children raised in cities. Since discovering this, I tried to embrace nature more and add natural bacteria into my environment. So far my symptoms have been gradually decreasing little by little but still severely impact me daily. Moving to farm living for a year or two may largely improve my symptoms. I just hope one day I can find an end to this crippling condition.

  14. I have been suffering with sinus problems for 12 years . However 18 months ago it spiralled , effecting my chest , so went onto inhalers . I have flu like symtoms aching all over . Throbbing sensation in and around my nose /eye area. Cannot breath through my nose while sleeping ,so my mouth is so dry. I sleep on 5 pillows other wise I cough because of post nasal drip. I am trying to clear my throat all of the time. Been to chest specialist, allergist no diagnosis. But on a letter it did say suspected non allergic rhinitis. Had a ct scan shows my sinuses are blocked. Also I have a deviated septum. Been told that I could have sinus op plus have my deviated septum corrected. However it is only 50 50 chance of symtoms going away. Tried everything on offer basically ,steroids , nasal sprays, anti histamines, sterimar spray, doses of antibiotics. The last treatment was homeopathic medicine that I thought was going to work but after three or four months I carried on having symtoms . So now I am trying to make a decision on having the op. Which I am really scared to have . Just find it so hard to carry on working as I feel so tired every day .

  15. It is very difficult when you're suffering. Hope this can help. I was given the following by my doctor.
    1)Prednisolone:> 20mg for 3days, 15mg for 6days and 5mg for 10days
    2) Cetirizine Hydrochloride 10mg one daily month
    3) Salbutamol 5mg 1 tab 2x daily for 6days
    4)Doxcycyline 100mg one daily 6wks (this was also for my skin)
    I am only on the meds 6days now and I can breathe…….it feels amazing. No coughing, choking, vomiting, runny nose, sneezing etc. I can be in a room with the AC or fan on and don't have to hurry out. Thank you Jesus.


    This is incorrect. It is animal DANDER that causes reactions — NOT animal hair.

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