Overview
Allergic rhinoconjunctivitis, also known as hay fever, involves symptoms such as nasal congestion, sneezing, itching, and watery eyes due to immunoglobulin E (IgE)-mediated hypersensitivity reactions to allergens like pollen, dust mites, and pet dander. 15Diagnosis
Symptom Assessment: Presence of typical symptoms like sneezing, nasal congestion, and ocular itching. 5
Allergy Testing: Skin prick tests or specific IgE blood tests to identify specific allergens. 5
Exclusion of Other Conditions: Rule out non-allergic rhinitis and other respiratory conditions through clinical evaluation and possibly imaging or other diagnostic tests. 5Management
First-Line Treatments:
- Nasal Corticosteroids: Regular use to reduce inflammation (e.g., fluticasone, mometasone). 5
- Antihistamines: Second-generation antihistamines for symptom relief (e.g., cetirizine, loratadine). 6
Adjunctive Treatments:
- Decongestants: Short-term use for nasal congestion.
- Leukotriene Receptor Antagonists: For moderate to severe symptoms (e.g., montelukast). 5
Immunotherapy: Consider for patients with persistent symptoms despite optimal pharmacotherapy (subcutaneous or sublingual). 3Special Populations
Pregnancy: Maternal intake of vitamin C is inversely related to childhood allergic conditions; ensure adequate dietary intake of fruits and vegetables. 2
Pediatrics: Use of second-generation antihistamines is common; monitor for safety profiles, including rare serious adverse reactions like epilepsy with levocetirizine. 6
Elderly: Management strategies similar to adults, with consideration for polypharmacy and comorbid conditions affecting treatment choices. 5Key Recommendations
Educate Physicians: Enhance allergy and immunology training in internal medicine residency programs to improve knowledge and clinical competency in managing allergic rhinoconjunctivitis, asthma, and anaphylaxis. (Evidence: Moderate 5)
Utilize Electronic Consultations: Implement e-consults to expedite care and reduce wait times for allergy/immunology consultations, especially in settings where in-person visits are limited. (Evidence: Moderate 4)
Promote Public Awareness: Engage in media advocacy to raise awareness about allergic conditions, emphasizing key points early in communications to maximize impact. (Evidence: Expert opinion 1)References
1 Conway AE, Gupta E, Verdi M, Berger WE, Anagnostou A, Abrams EM et al.. A Media Advocacy Toolkit for the Allergist-Immunologist. The journal of allergy and clinical immunology. In practice 2024. link
2 Podolska K, Mazankova D, Goboova M, Vano I. Ascorbic acid intake during pregnancy. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 2023. link
3 Bright D, Pollart SM, Franko J. Allergy immunotherapy: Who, what, when...and how safe?. The Journal of family practice 2019. link
4 Phadke NA, Wolfson AR, Mancini C, Fu X, Goldstein SA, Ngo J et al.. Electronic Consultations in Allergy/Immunology. The journal of allergy and clinical immunology. In practice 2019. link
5 Alpern M, Wang Q, Rothernberger M. Allergy, Asthma and Immunology Training in Internal Medicine Residents. Minnesota medicine 2017. link
6 Motola D, Donati M, Biagi C, Calamelli E, Cipriani F, Melis M et al.. Safety profile of H1-antihistamines in pediatrics: an analysis based on data from VigiBase. Pharmacoepidemiology and drug safety 2017. link
7 Stukus DR, Green T, Montandon SV, Wada KJ. Deficits in allergy knowledge among physicians at academic medical centers. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2015. link
8 Muche-Borowski C, Kopp M, Reese I, Sitter H, Werfel T, Schäfer T. Allergy prevention. Deutsches Arzteblatt international 2009. link