Allergic Rhinitis: Causes, Symptoms, Diagnosis and Treatment
Allergic rhinitis, commonly known as hay fever, is one of the most common allergic conditions worldwide. It occurs when the immune system overreacts to harmless airborne substances (allergens), causing inflammation inside the nose.
Although allergic rhinitis is not life-threatening, it can significantly affect sleep, work productivity, school performance, and overall quality of life. It is also closely linked with asthma, sinusitis, ear problems, and recurrent nasal congestion.
This guide explains the causes, symptoms, diagnosis, and evidence-based treatment options for allergic rhinitis.
What Is Allergic Rhinitis?
Allergic rhinitis is an allergic reaction that occurs when the immune system produces IgE antibodies against inhaled allergens.
When exposed to these allergens, the body releases histamine and other inflammatory chemicals, causing symptoms such as sneezing, nasal congestion, itching, and a runny nose.
Types of Allergic Rhinitis
Seasonal Allergic Rhinitis
Occurs during certain times of the year.
Common triggers include:
- Tree pollen
- Grass pollen
- Weed pollen
Symptoms are usually worse during spring and early summer.
Perennial Allergic Rhinitis
Occurs throughout the year.
Common triggers include:
- Dust mites
- Pet dander
- Mold spores
- Cockroach allergens
Common Symptoms
Symptoms may include:
- Frequent sneezing
- Runny nose
- Stuffy nose
- Itchy nose
- Itchy eyes
- Watery eyes
- Red eyes
- Itchy throat
- Ear pressure
- Reduced sense of smell
- Postnasal drip
- Chronic cough
- Fatigue due to poor sleep
What Causes Allergic Rhinitis?
The condition develops when genetically susceptible people inhale allergens.
Common triggers include:
Pollen
- Trees
- Grasses
- Weeds
Dust Mites
Tiny organisms living in:
- Mattresses
- Pillows
- Carpets
- Upholstered furniture
Pet Dander
Proteins found in:
- Cats
- Dogs
- Rabbits
- Horses
Mold
Mold spores commonly grow in:
- Bathrooms
- Basements
- Damp buildings
Cockroach Allergens
A common trigger in urban environments.
Risk Factors
You are more likely to develop allergic rhinitis if you:
- Have asthma
- Have eczema
- Have a family history of allergies
- Are exposed to tobacco smoke
- Live in polluted areas
- Have other allergic conditions
Complications
Untreated allergic rhinitis may contribute to:
- Chronic sinusitis
- Nasal polyps
- Ear infections
- Eustachian tube dysfunction
- Hearing problems
- Snoring
- Poor sleep
- Asthma flare-ups
- Reduced quality of life
Can Allergic Rhinitis Cause Other Symptoms?
Yes. Many people are surprised that allergies can affect more than just the nose.
Allergic rhinitis may contribute to:
- Blocked ears
- Ringing in the ears (occasionally)
- Sore throat from postnasal drip
- Loss of smell
- Hoarseness
- Chronic cough
- Bad breath
- Headaches
- Fatigue
Allergic Rhinitis as a Medication Side Effect
Some medications may worsen nasal congestion or allergy-like symptoms.
Beta Blockers
Examples include:
- Propranolol
- Atenolol
- Metoprolol
They may worsen allergic symptoms in some individuals and reduce the effectiveness of emergency epinephrine used to treat severe allergic reactions.
Aspirin and NSAIDs
Some people develop worsening nasal symptoms after taking:
- Aspirin
- Ibuprofen
- Naproxen
This is particularly common in people with aspirin-exacerbated respiratory disease (AERD).
Decongestant Nasal Sprays
Examples include:
- Oxymetazoline
- Xylometazoline
Using these sprays for more than 3–5 days may cause rebound congestion (rhinitis medicamentosa), where nasal blockage becomes worse after the medication wears off.
How Is Allergic Rhinitis Diagnosed?
Diagnosis usually includes:
- Medical history
- Symptom review
- Physical examination
Additional tests may include:
- Skin prick allergy testing
- Blood tests for allergen-specific IgE antibodies
- Nasal endoscopy (selected cases)
- Sinus CT scan if chronic sinusitis is suspected
How Is Allergic Rhinitis Treated?
Treatment focuses on avoiding allergens and controlling inflammation.
Allergen Avoidance
Depending on your trigger, helpful measures include:
- Keeping windows closed during high pollen seasons
- Showering after spending time outdoors
- Washing bedding weekly in hot water
- Using dust mite-proof mattress and pillow covers
- Keeping indoor humidity below 50%
- Using HEPA air filters
- Limiting exposure to pets if allergic
Saline Nasal Irrigation
Daily saline rinses help remove allergens and reduce congestion.
Intranasal Corticosteroids (Most Effective Treatment)
Examples include:
- Fluticasone
- Budesonide
- Mometasone
These medications reduce inflammation and are considered the first-line treatment for moderate to severe allergic rhinitis.
Antihistamines
Examples include:
Second-generation (preferred)
- Cetirizine
- Loratadine
- Fexofenadine
- Desloratadine
These cause less drowsiness than older antihistamines.
First-generation
- Diphenhydramine
- Chlorphenamine
These may cause significant drowsiness and are generally not recommended for regular daytime use.
Leukotriene Receptor Antagonists
Example:
- Montelukast
May be useful in selected patients, particularly those with asthma, but potential neuropsychiatric side effects should be discussed with a healthcare provider.
Allergy Immunotherapy
Allergy shots or sublingual tablets gradually reduce sensitivity to allergens and may provide long-term improvement in selected patients.
Supplements That May Help
Vitamin D
Low vitamin D levels have been associated with allergic diseases in some studies. Supplementation may be beneficial if a deficiency is present, although it is not considered a primary treatment for allergic rhinitis.
Probiotics
Certain probiotic strains may help regulate the immune system, but studies show mixed results. Current evidence is insufficient to recommend probiotics routinely for allergic rhinitis.
Quercetin
Quercetin is a plant flavonoid that has shown antihistamine and anti-inflammatory effects in laboratory studies.
Human studies are limited, so evidence remains insufficient for routine use.
Butterbur (Petasites hybridus)
Some studies suggest butterbur may relieve seasonal allergy symptoms similarly to certain antihistamines.
Only use products certified free of pyrrolizidine alkaloids (PA-free), as untreated products may cause serious liver damage.
Vitamin C
Vitamin C has mild natural antihistamine properties and supports immune function, but evidence for significant improvement in allergy symptoms is limited.
Supplements with Limited or No Evidence
The following supplements are sometimes promoted for allergies, but current evidence is weak or inconsistent:
- Zinc
- Echinacea
- Elderberry
- Spirulina (promising but more research is needed)
- Homeopathic remedies
Amazon Recommendations
Allergy Relief
HEPA Air Purifiers
Bedding Protection
Allergic Rhinitis in Children
Allergic rhinitis is common in children and occurs when the immune system overreacts to allergens such as pollen, dust mites, pet dander, or mold. Symptoms may be seasonal, such as during spring and summer, or occur year-round if triggered by indoor allergens.
Although allergic rhinitis is not usually serious, it can interfere with sleep, concentration, school performance, and daily activities if left untreated.
Symptoms
Children with allergic rhinitis may experience:
- Frequent sneezing
- A runny or blocked nose
- An itchy nose, eyes, ears, or throat
- Watery, red eyes
- Mouth breathing due to nasal congestion
- Snoring or restless sleep
- An “allergic salute” (frequent rubbing of the nose upward)
- Dark circles under the eyes (“allergic shiners”)
- Reduced sense of smell
Some children may also develop ear pressure, recurrent ear infections, or sinus infections because ongoing nasal inflammation can affect the Eustachian tubes and sinuses.
Treatment
Treatment focuses on reducing exposure to allergens and relieving symptoms.
Parents can help by:
- Keeping windows closed during high pollen seasons.
- Showering and changing clothes after outdoor activities.
- Washing bedding weekly in hot water to reduce dust mites.
- Using dust mite-proof covers for pillows and mattresses when appropriate.
- Keeping pets out of the child’s bedroom if pet allergies are suspected.
- Rinsing the nose with sterile saline nasal spray to help remove allergens and relieve congestion.
If symptoms are persistent or moderate to severe, a healthcare professional may recommend:
- Intranasal corticosteroid sprays, which are the most effective treatment for nasal symptoms.
- Non-drowsy oral antihistamines, particularly for sneezing and itching.
- Antihistamine nasal sprays or eye drops if needed.
Always use medications according to the child’s age and the product instructions or a healthcare provider’s advice.
When Should You See a Doctor?
Arrange a medical evaluation if your child:
- Has symptoms lasting several weeks or recurring every year.
- Has difficulty sleeping because of nasal congestion.
- Frequently develops ear infections or sinus infections.
- Has asthma symptoms such as wheezing or persistent coughing.
- Does not improve with over-the-counter treatments.
- Has symptoms affecting school performance or daily activities.
💡 Pharmacist’s Tip
If your child has frequent sneezing, a blocked or runny nose, and itchy eyes without a fever, allergies may be the cause rather than a cold. Intranasal corticosteroid sprays are generally the most effective treatment for persistent allergic rhinitis, while non-drowsy antihistamines can help relieve sneezing and itching. Reducing exposure to allergens and using saline nasal sprays can also help control symptoms.
Is allergic rhinitis the same as a cold?
No. A cold is caused by a viral infection and usually resolves within one to two weeks. Allergic rhinitis is triggered by allergens and may persist for weeks or months while exposure continues.
Can allergies cause blocked ears?
Yes. Allergies can cause swelling around the Eustachian tubes, leading to ear pressure, popping, and temporary hearing changes.
Can allergies cause loss of smell?
Yes. Persistent nasal inflammation and congestion can reduce the sense of smell, particularly if symptoms are severe or prolonged.
Can allergic rhinitis lead to sinus infections?
Yes. Chronic nasal inflammation can impair sinus drainage, increasing the risk of acute or chronic sinusitis.
What is the best treatment for allergic rhinitis?
Intranasal corticosteroid sprays are generally considered the most effective treatment for moderate to severe allergic rhinitis. Saline nasal irrigation and second-generation antihistamines are also commonly recommended.
Can allergic rhinitis be cured?
There is no permanent cure, but symptoms can often be well controlled with allergen avoidance, medications, and allergy immunotherapy.
Can children develop allergic rhinitis?
Yes. Allergic rhinitis is one of the most common allergic conditions in children. Symptoms often begin during childhood and may include frequent sneezing, a runny or blocked nose, itchy eyes, and nasal congestion. Early diagnosis and appropriate treatment can improve sleep, concentration, and quality of life.
How can I tell if my child has allergies or a cold?
A common cold usually lasts 7 to 10 days and may cause fever, sore throat, and body aches. Allergic rhinitis often causes itchy eyes, frequent sneezing, and a clear runny nose without a fever. Symptoms may last for weeks or recur during certain seasons or after exposure to allergens such as pollen, dust mites, or pet dander.
Can allergic rhinitis affect my child’s sleep?
Yes. Persistent nasal congestion can make it difficult for children to breathe through their nose, leading to snoring, restless sleep, daytime tiredness, and difficulty concentrating at school. Effective allergy treatment often improves sleep quality and daytime functioning.
Clinical Considerations
Allergic rhinitis is an IgE-mediated inflammatory disorder that often coexists with asthma, eczema, chronic sinusitis, and Eustachian tube dysfunction. Intranasal corticosteroids remain the cornerstone of treatment due to their superior effectiveness in controlling nasal inflammation. Patients with persistent symptoms despite appropriate therapy should be evaluated for chronic sinusitis, nasal polyps, structural nasal abnormalities, or alternative diagnoses.
Related Guides
- Why Is My Nose Always Blocked?
- Why Do I Get Frequent Nosebleeds?
- Chronic Sinusitis: Causes, Symptoms and Treatment (future pillar)
- Why Have I Lost My Sense of Smell?
- Why Does My Ear Feel Blocked or Like There’s Water in It?
- Why Do I Have a Chronic Sore Throat?
- Asthma: Causes, Symptoms and Treatment (future pillar)
References
- Allergic Rhinitis and its Impact on Asthma (ARIA). International Guidelines for Allergic Rhinitis.
- American Academy of Allergy, Asthma & Immunology (AAAAI). Allergic Rhinitis.
- American College of Allergy, Asthma & Immunology (ACAAI). Hay Fever (Allergic Rhinitis).
- Mayo Clinic. Hay Fever (Allergic Rhinitis).
- UpToDate. Allergic Rhinitis: Clinical Manifestations, Diagnosis and Treatment.
- National Institute of Allergy and Infectious Diseases (NIAID). Allergic Diseases.