Allergic rhinitis: Age & Duration
Seasonal allergic rhinitis (hay fever) affects 10-15% of people in the UK, and millions of patients rely on OTC medicines for treatment. The symptoms of allergic rhinitis occur after an inflammatory response involving the release of histamine, which is initiated by allergens being deposited on the nasal mucosa. Allergens responsible for seasonal allergic rhinitis include grass pollens, tree pollens and fungal mould spores. Perennial allergic rhinitis occurs when symptoms are present all year round and is commonly caused by the house dust mite, animal dander and feathers. Some patients may suffer from perennial rhinitis, which becomes worse in the summer months.
Age
Symptoms of allergic rhinitis may start at any age, although its onset is more common in children and young adults (the condition is most common in those in their twenties and thirties). There is frequently a family history of atopy in allergic rhinitis sufferers. Thus, children of allergic rhinitis sufferers are more likely to have the condition. The condition often improves or resolves as the child gets older. The age of the patient must be taken into account if any medication is to be recommended. Young adults who may be taking examinations should be borne in mind, because treatment that may cause drowsiness is best avoided in these patients.
Duration
Sufferers will often present with seasonal rhinitis as soon as the pollen count becomes high. Symptoms may start in April when tree pollens appear and the hay fever season may start 1 month earlier in the south than in the north of England. Hay fever peaks between the months of May and July, when grass pollen levels are highest and spells of good weather commonly cause patients to seek the pharmacist’s advice. Anyone presenting with a summer cold, perhaps of several weeks’ duration, may be suffering from hay fever. Fungal spores are also a cause and are present slightly later, often until September.
People can suffer from what they think are mild cold symptoms for a long period, without knowing they have perennial rhinitis.
A useful classification of allergic rhinitis is:
Intermittent. Occurs less than 4 days/week or for less than 4 weeks
Persistent. Occurs more than 4 days/week and for more than 4 weeks
Mild. All of the following – normal sleep; normal daily activities, sport, leisure; normal work and school; symptoms not troublesome
Moderate. One or more of the following – abnormal sleep; impairment of daily activities, sport, leisure; problems caused at work or school; troublesome symptoms
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