1. Intermittent/fluctuating: usually related to increased blood flow in the venous sinusoids of the turbinates, with subsequent swelling and narrowing of the nasal passages, and is temporally related to exposure to the allergic trigger; this symptom is related to the effect of mediators released during the allergic reaction and is considered by patients to be the most bothersome nasal symptom of allergic rhinitis; nasal obstruction frequently alternates between nostrils as a function of the physiologic nasal cycle

2. Constant one-sided: this should alert the examiner to the presence of a fixed anatomic obstruction such as a nasal septal deviation or a nasal polyp which could be coexistent

• Rhinorrhea: occurs because of increased secretions in the nasal cavity produced primarily by the nasal glands in response to the allergic trigger; nasal secretions related to allergic triggers are typically clear in color

• Hyposmia/changes to smell: many patients with allergic disease will have an impairment in the sense of smell most likely related to nasal obstruction and lack of penetration of odorants to the olfactory mucosa

Other Upper Airway Symptoms

• Palatal itching

• Chronic mouth breathing: usually as a result of chronic nasal obstruction; this can lead to snoring at night and a negative impact on the quality of sleep of affected subjects

• Nocturnal bruxism

• Repetitive throat clearing: usually the result of post-nasal drainage

• Intermittent dysphonia

• Cough

Other General Symptoms

• Headache

• Facial fullness

• Tiredness and fatigue: may occur as a result of poor sleep related to nasal obstruction but can also be secondary to the sedating effect of older generation antihistamines

• Lack of productivity at work: Many studies have shown a negative impact of allergic diseases on the productivity of sufferers, leading to both absenteeism as well as presenteeism.

ALLERGENS

Common Allergens

• Outdoor allergens

1. Pollens: trees, grasses, weeds

2. Outdoor molds

• Indoor allergens

1. Animal dander (cat, dog, other): Exposure is guaranteed if the patient has pets in the house; one can also be exposed to dander from other people who may be carrying dander on their clothing even if one does not own a pet personally.

2. House-dust mites: allergen in feces, less prevalent at high altitudes

3. Cockroach: common allergen in the inner city and urban dwellings

4. Indoor molds: common in damp environments such as a humid, poorly ventilated basement

• Occupational exposure

1. Rat/laboratory animals: allergens can be present in skin, fur, saliva, and/or feathers

2. Latex: commonly found in gloves and a strong allergen

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