Allergic rhinitis (AR) – colloquially called hay fever – (synonyms: allergic rhinopathy; allergic rhinitis; pollen-related allergic rhinitis, hay fever or pollinosis from Lat. pollen = fine flour; grass pollen allergy; hay allergy; ragwort pollen allergy; herb pollen allergy; pollen allergy; rye allergy; rose pollen allergy; rhinitis allergica; summer catarrh; ICD-10-GM J30. 1: Allergic rhinopathy due to pollen) is a symptomatic hypersensitivity reaction of the nose induced by IgE-mediated inflammation of the nasal mucosa (rhinitis) as a result of allergen exposure. With a share of more than 50%, the disease is the most frequent manifestation of the diseases from the atopic group (atopy). Hay fever is essentially triggered by the pollen of trees, shrubs, grasses, cereals or herbs. Allergic rhinitis (AR) is classified according to the WHO ARIA document (2003) as follows:
- Mild allergic AR:
- Symptoms present but not bothersome
- No deterioration in quality of life (sleep; school or work performance; daily and sports activities)
- Moderate to severe AR
- Symptoms present, usually also annoying
- Deterioration of quality of life (sleep; school or work performance; daily and sports activities).
- Intermittent allergic AR: symptoms < 4 days per week or < 4 consecutive weeks.
- Persistent AR: > 4 days per week or > 4 weeks.
Furthermore, can be classified as follows:
- Seasonal allergic rhinitis
- Perennial allergic rhinitis – here are compared to seasonal allergic rhinitis other allergens (substances that trigger an allergic reaction) such as animal dander, mites or molds that are present in the environment throughout the year about
- Occupational allergic rhinitis
Seasonal accumulation of the disease: seasonal allergic rhinitis occurs only at certain times of the year. The timing of occurrence depends on the particular seasonal allergens (pollen, mold spores), although they may be present for many months of the year. Perennial allergens like mites show seasonal variations regarding their concentration. Sex ratio: Men (+ 28 %)
Frequency peak: The disease occurs predominantly in early childhood; 80% of cases erupt before the age of 30; increasingly, first manifestations in the elderly. The prevalence (disease frequency) is 16 % (in Germany). The proportion in children and adolescents is estimated at 15-39 %. In Europe, about 23 % of the population suffers from allergic rhinitis, 50 % have the disease all year round. Course and prognosis: Persistent allergic rhinitis has an unfavorable prognosis without causal therapy (medical treatment that attempts to eliminate the causes of a disease) and also requires constant conservative therapy (in this case: drug therapy)! The therapy of allergic rhinitis includes allergen abstinence (measures to avoid exposure to allergens partially or completely) as far as possible, pharmacotherapy (e.g. with antihistamines) and, if necessary, specific immunotherapy (SIT; hyposensitization; improvement in pollen and mite allergy approx. 60-75 %). If the therapy is started as early as possible, the development of bronchial asthma (“floor change”), for example, can be prevented. In the further course, the affected persons can develop allergic reactions to certain foods. One then speaks of so-called cross-allergies. For example, a birch pollen allergy is typically followed by an allergy to hazelnuts and pome fruits. Comorbidities (concomitant diseases): Allergic rhinitis can be associated with bronchial asthma, atopic eczema (atopic dermatitis, neurodermatitis) and rhinosinusitis (simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses (“sinusitis“)).Furthermore, the disease may be accompanied by gastrointestinal discomfort (gastrointestinal complaints), food allergy, insomnia (sleep disturbances), and difficulty concentrating.Patients with allergic rhinitis are twice as likely to develop cholesteatoma (ingrowth of multilayered keratinizing squamous epithelium into the middle ear with subsequent chronic purulent inflammation).
