Evaluation and management of allergic rhinitis

Allergic rhinitis is a problematic disorder that is common. The practicing physician recognizes the majority of the overt clinical symptoms of sneezing, nasal itching, postnasal discharge, and eye symptoms but may not be attuned to the more subtle symptoms of lethargy, headache, and loss of productivity they create. Food sensitivities may complicate the evaluation and treatment of the sensitive patient, and frequently the idea of foods causing problems with rhinitis is ignored. For most patients, practical medications are beneficial in reducing symptoms without producing the side effects of sedation. The newer topical nasal steroids are becoming the first line of therapy, and nonsedating antihistamines are still useful because they have few side effects. Immunotherapy is recommended for treatment failures in the appropriate patient. Specialty referral then should be considered.