History and progression of allergic rhinitis:  4-year-old patient presents with symptoms of nasal congestion, rhinorrhea, snoring, and frequent throat clearing.  Parents report the child is in preschool and is exposed to many other children.  She has history of eczema starting at 12 months old and has had questionable food allergies.  Physical exam shows dark, puffy, lower eyelids, nasal crease, and mouth-breathing.  She also has a history of middle ear effusions for which she has had tympanostomy tubes.

Differential diagnosis in children include recurrent acute infectious rhinitis, chronic rhinosinusitis, and adenoid hypertrophy.  Allergic rhinitis is less common in young children less than 2 years old though clinically significant sensitization to indoor allergens may occur.  The most common indoor allergens include dust mites, pet danders, cockroaches, molds.  Sensitization to outdoor allergens is more common in children older than 4–6 years as it may take several seasons to get enough exposure.  Typically allergies peak in the early school and early adult years.  Older adults are less likely to develop new allergies.  

Atopic dermatitis is often the first step in the allergic march in which the child goes on to develop allergic rhinitis and asthma. Environmental controls should be emphasized.  Testing can define the causative allergens and could allow definitive immunotherapy if environmental controls and medications are not effective.  Immunotherapy can prevent the development of asthma.

Seasonal allergic rhinitis:  19-year-old male presents cough, causing awakenings at night and drowsiness during the day.  He also complains of chronic rhinorrhea and congestion that is worse at night.  His nasal congestion contributes to his difficulty sleeping. His schoolwork is suffering as is his social life.  He is worse in the spring and fall.  On physical exam, the patient’s eyes are injected and chemotic.  They area also itchy and watery.  Turbinates are congested and bluish. Family history includes sibling with asthma and eczema.  Mother with allergic rhinitis.

Seasonal symptoms are symptoms that occur a certain time of the year.  Typically, allergies to pollen usually present between March – September.  Though pollination periods are different in different geographical areas, usually tree pollens from March to mid-May, grass pollens from mid-May to July. Weed pollens from the end of June to early September.  

Patients with episodic symptoms may be more aware of the disability from them.  Based on the WHO classification, his symptoms would be regarded as moderate-severe since they cause sleep disturbance and difficulty with daily activities.Treatment with avoidance measures such as washing hair before bed, wearing allergy masks, and using air conditioning in the car may be helpful.  Non-sedating antihistamines can be used.  Steroid sprays should be used daily.  Topical antihistamine eye drops and nasal spray can also be effective.  Requirement for testing and immunotherapy is required if patient does not respond to medical management as symptoms are affecting his sleep and daily function.