Allergic Rhinitis: Detailed Guide

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 10.10.2026

How does the allergic reaction develop?

In people prone to allergy, the immune system mistakenly treats substances that are actually harmless, such as pollen, house dust mites or animal dander, as dangerous and produces special antibodies (IgE) against them. This first stage is called sensitisation and does not yet cause symptoms. When the same substance is encountered again, cells in the nasal lining release various chemicals, histamine above all. By stimulating nerve endings, histamine causes itching and sneezing; by stimulating the mucus glands, it causes a watery discharge; and by widening the blood vessels, it causes swelling of the turbinates and blockage.

Sneezing, itching and runny nose start within minutes of contact with the allergen; hours later, inflammatory cells gather in the lining and blockage becomes the main problem. A nose that is constantly exposed to the allergen gradually becomes more sensitive, and a very small amount of allergen, or even cigarette smoke or perfume, can set off symptoms. Heredity plays an important part in the tendency to allergy; allergic rhinitis is more common in children whose mother or father has allergies.

Types of allergic rhinitis

Allergic rhinitis is grouped according to when symptoms occur and what triggers them. Doctors also assess how severe the condition is by looking at how often symptoms occur and how much they affect sleep and daily life; treatment is planned according to this assessment.

Seasonal allergic rhinitis

It is caused by pollen and recurs at the same time every year. Tree pollen is usually at its highest in late winter and early spring, grass pollen in late spring and early summer, and weed pollen in late summer and autumn; these periods can vary by region and from year to year. Pollen levels rise on windy, dry and sunny days and fall after rain. Bouts of sneezing, watery discharge and itchy eyes are prominent.

Year-round allergic rhinitis

It continues throughout the year because of indoor allergens such as house dust mites, pets, mould and cockroaches. Symptoms are milder but constant; blockage, postnasal drip and a reduced sense of smell are the main features. Sneezing and blockage that are worse on waking in the morning suggest a mite allergy. In many people, seasonal and year-round allergens play a part together.

Occupational allergic rhinitis

In some people the allergy develops to substances at work: flour in bakers, laboratory animals in laboratory workers, latex gloves in healthcare workers and wood dust in carpenters are examples. It is typical for symptoms to get worse on working days and to ease at weekends and on holidays. Because occupational rhinitis can appear before asthma caused by the same substance, measures to reduce contact with that substance at work are important.

Examination and assessment

Assessment starts with a detailed history: you will be asked in which season and surroundings your symptoms get worse, about your home and work environment and any pets, whether there is a family history of allergy and asthma, and about the medicines and nasal sprays you use. On examination the turbinates are usually swollen, pale or greyish and covered with watery mucus. Endoscopic examination with a thin camera also shows any accompanying deviated septum, enlarged turbinates, polyps or signs of sinusitis. A CT scan is usually not needed for the diagnosis.

In general, skin tests and blood tests measuring allergy-specific IgE antibodies are used to show which substance a person is allergic to. A positive result does not always mean that the substance is causing symptoms; the results are interpreted together with the history. In people whose nose runs constantly but whose allergy tests are negative, the cause may be non-allergic rhinitis, which is triggered by temperature changes or strong smells.

Links with asthma and sinusitis

The nose and the bronchi (the air passages of the lungs) are parts of the same airway. This is why allergic rhinitis and asthma often occur together: most people with asthma also have allergic rhinitis, and people with allergic rhinitis are more likely to develop asthma. When the nose is blocked, the cold, dry air breathed in through the mouth irritates the bronchi more; good control of nasal symptoms can also make asthma easier to control. If you have a cough, wheezing or chest tightness, mention this at your examination.

Swelling of the lining caused by allergic inflammation can narrow the small channels through which the sinuses drain into the nose and so pave the way for sinusitis; this is why, in recurrent sinusitis, the possibility of an underlying allergy is assessed. Allergic rhinitis can also cause itchy, watery eyes (allergic conjunctivitis), a cough due to postnasal drip and, by affecting the Eustachian tube, a feeling of fullness in the ear.

Allergic rhinitis in children

Allergic rhinitis is common in children and usually becomes noticeable at school age. Children may not be able to describe their symptoms; constantly rubbing the nose upwards with the palm of the hand, a horizontal crease across the bridge of the nose, dark circles under the eyes, frequent sniffing, sleeping with the mouth open and snoring are important signs. Disturbed sleep at night can lead to daytime tiredness, poor concentration and a drop in school performance.

Another common cause of nasal blockage in children is enlarged adenoids. The two conditions can be confused or can occur together; endoscopic examination helps to tell them apart. Rinsing the nose with saline and avoiding allergens are the basic measures; medicines are chosen from those suitable for the child’s age, on the doctor’s advice.

Allergic rhinitis in pregnancy

During pregnancy the nasal lining swells because of hormonal changes; nasal blockage is common even in women without allergies, and it usually clears up on its own after the birth. Existing allergic rhinitis may stay the same, get worse or improve during pregnancy. Rinsing the nose with saline, avoiding allergens, sleeping with the head slightly raised and staying away from cigarette smoke are measures that do not involve medicines. During this time, do not use any medicine, including over-the-counter nasal sprays, without consulting your doctor; any treatment needed is planned in a way that is suitable for pregnancy.

Measures at home

Avoiding allergens completely is often not possible, but reducing contact with them can ease symptoms in some people and lower the need for medicines. A single measure is usually not enough; combining several measures is more helpful.

House dust mites

Mites live mostly in mattresses and pillows. Using mite-proof mattress and pillow covers, washing sheets and duvet covers in hot water once a week, and cutting down on carpets, heavy curtains and soft toys in the bedroom all help. Dusting with a damp cloth, using a vacuum cleaner with a filter, airing the home every day and not letting the humidity in the home get high limit the growth of mites.

Pollen

During high-pollen periods, especially on windy and dry days, keeping the windows of your home and car closed, showering and changing your clothes when you come in from outside, not drying laundry outdoors, not staying outdoors for long periods and wearing sunglasses reduce contact with pollen.

Pets

Cat and dog allergens are found in skin flakes and saliva; they stay suspended in the air for a long time and stick to furniture and fabrics. Keeping the animal out of the bedroom and off sofas and beds, using an air purifier with a filter and leaving the animal’s care to a family member without allergies can reduce symptoms. Ending contact with the animal completely often brings clear relief; however, because allergens can remain in the home for some time, the effect may not be seen straight away. This is not an easy decision and is considered according to how severe the symptoms are.

Mould

Ventilating the bathroom and kitchen regularly, fixing water leaks and damp, cleaning mouldy areas, ventilating the room when drying laundry indoors and not overusing humidifiers reduce contact with mould. Not smoking in the home and avoiding strongly scented products also bring relief to a sensitive nose.

Treatment steps

Treatment is planned individually according to how often symptoms occur, how severe they are and which symptom is most prominent; your doctor decides which medicine to use and how. At every step, allergen avoidance and rinsing the nose with saline are part of the treatment.

• Mild, occasional symptoms: antihistamines in tablet or nasal spray form can be used when needed. Newer-generation antihistamines are less likely to cause drowsiness.
• Frequent or persistent symptoms: intranasal corticosteroid sprays are the main treatment and are effective for all nasal symptoms, blockage in particular; they are used regularly, not only when needed.
• Not enough relief with a single medicine: using intranasal corticosteroid and antihistamine sprays together is an option; anti-allergy eye drops can be added for eye symptoms.

Aiming the spray slightly towards the eye on the same side, rather than at the septum, helps the medicine spread better inside the nose and reduces side effects such as dryness and slight bleeding. In people with seasonal allergies, starting the treatment recommended by the doctor before the pollen season begins can give better control of symptoms. Decongestant nasal sprays can be used only for short-term relief; long-term use leads to medication-induced congestion.

Allergen immunotherapy is a long-term treatment that aims to get the immune system used to the substance causing the allergy by giving it under the tongue or under the skin at regular intervals, starting from very small amounts. In general, it is considered for selected people whose allergy has been confirmed by tests and who do not get enough relief from medicines or do not want to use medicines for a long time. What sets this method apart from medicines is that its effect can continue for some time after the treatment is completed.

If symptoms persist despite treatment, the way the medicines are being used is checked, the diagnosis is reconsidered, and the nose is assessed for an accompanying deviated septum, enlarged turbinates, polyps or sinusitis.

The role of surgery

Allergic rhinitis is not a disease treated with surgery; surgery does not cure the allergy. However, long-standing allergic inflammation can lead to permanent enlargement of the turbinates, and in many people a deviated septum, unrelated to the allergy, is also present. If blockage persists despite regular and correct medical treatment, the nasal airway can be widened with turbinate reduction and, if needed, septoplasty. In turbinate reduction the aim is not to remove the turbinates but to reduce their volume while preserving their function. These procedures make breathing easier and help sprays reach the inside of the nose better; allergy treatment continues for sneezing, itching and runny nose.

Quality of life and sleep

Allergic rhinitis is often dismissed as “just a cold”, yet blockage that gets worse at night can lead to mouth breathing, snoring and frequently interrupted sleep, and the person wakes up unrefreshed in the morning. During the day, tiredness, difficulty concentrating and reduced performance at work and school can occur; when the pollen season coincides with exam periods, this matters all the more for students. Because older-generation antihistamines can cause drowsiness, people who drive need to be careful; you can ask your doctor or pharmacist whether the medicine you are using causes drowsiness. If snoring is marked, an assessment for snoring and sleep apnea is also carried out. With regular treatment, sleep and daily life improve noticeably in most people.

Frequently asked questions

Does allergic rhinitis go away completely? The tendency to allergy is often lifelong; however, with allergen avoidance and regular treatment, symptoms are well controlled in most people. In some people symptoms may lessen on their own over the years.

Are steroid nasal sprays harmful or habit-forming? Very little of an intranasal corticosteroid spray is absorbed into the body, and long-term use on medical advice is generally safe. Unlike decongestant sprays, they are not habit-forming and do not cause rebound congestion. Dryness or slight bleeding in the nose may occur; aiming the spray outwards, away from the septum, reduces these effects.

Can I use my medicines only when I have symptoms? Because antihistamines act quickly, they can be used when needed for mild, occasional symptoms. Intranasal corticosteroid sprays, on the other hand, work through regular use; using them only when you have symptoms does not give the expected relief.

Does everyone need an allergy test? No. The diagnosis is usually made from the history and examination. Allergy tests are useful if the diagnosis is unclear, if medicines do not give enough relief, or if knowing the trigger will affect avoidance measures or a treatment decision such as immunotherapy.

Does allergic rhinitis turn into asthma? Allergic rhinitis does not turn into asthma; however, because the two conditions arise from the same allergic background, they often occur together, and people with allergic rhinitis are more likely to develop asthma. If you have a cough, wheezing or chest tightness, mention this at your examination; good control of nasal symptoms can also make asthma easier to control.

Will surgery cure my allergy? No. Surgery does not cure the allergy; when blockage persists despite medical treatment, it makes breathing easier by reducing the turbinates or straightening a deviated septum. Allergy treatment for sneezing, itching and runny nose continues after surgery too.

This article is for general information; please consult your physician for diagnosis and treatment.