Diagnosis and Treatment Guide for Allergic Rhinitis

Symptoms of Allergic Rhinitis

Allergic rhinitis is classified into two types: perennial and seasonal. The former occurs year-round, while the latter occurs only during pollen seasons. Patients with seasonal allergic rhinitis suffer most during the six months spanning March to May (spring tree pollen) and July to September (autumn weed pollen).

The hallmark symptoms include nasal itching, sneezing, and profuse watery nasal discharge, often accompanied by nasal congestion. Without timely treatment, complications may arise, such as a diminished sense of smell (anosmia) or itchy eyes. Recurrent inflammation can lead to sinusitis, nasal polyps, secretory otitis media, and even asthma. If a patient develops yellow nasal discharge, headaches, or a fever, it often indicates that sinusitis has developed.

Treatment of Allergic Rhinitis

There are currently three primary methods for treating allergic rhinitis: Allergen Avoidance, Pharmacotherapy, and Immunotherapy.

1. Immunotherapy: Has an efficacy rate of approximately 80%. However, it requires a long treatment cycle and strict intervals, making it difficult for many to complete.
2. Allergen Avoidance: Requires patients to stay away from triggers like pollen, dust mites, and mold. This is often difficult to achieve due to work and lifestyle constraints.
3. Pharmacotherapy: The most common approach because it is not restricted by time or location. While medication alleviates discomfort and prevents organ damage, it does not “cure” the underlying allergy.

Medication Reference

• General Principles: Anti-allergics + Nasal Sprays + Vitamin C + Antacids + Immune-boosting supplements.
• Common Medications: Ebastine (Mindi), Cetirizine (Xikewei), Loratadine, Xanthium Nasal Capsules (Cang Er Zi), etc.
• Combined Therapy Examples:
  • Loratadine + Xanthium Nasal Capsules / Danxiang Rhinitis Tablets + Nasal Spray.
  • Cetirizine Hydrochloride + Xanthium Nasal Capsules / Danxiang Rhinitis Tablets + Nasal Spray.

Advice: Adjust to climate changes and keep warm. If symptoms worsen in cold weather, avoid “cold” natured foods (e.g., bitter melon, raw lettuce). If symptoms worsen in heat, avoid “hot” foods (e.g., lamb, chili, ginger).

Classification of Drugs

Current medications are generally divided into two categories:

• Corticosteroids (Glucocorticoids): Includes Budesonide, Fluticasone Propionate, and Mometasone Furoate. Nasal sprays have relatively low systemic absorption and provide dual anti-allergic and anti-inflammatory effects. Note: Use only under medical supervision; do not stop abruptly. Patients with glaucoma, hypertension, or osteoporosis must use with caution.
• Non-Steroidal Medications:
  1. Antihistamines (e.g., Chlorpheniramine, Cetirizine): Block histamine receptors. Long-term use may lead to drug resistance; it is recommended to rotate different types periodically.
  2. Leukotriene Receptor Antagonists (e.g., Montelukast Sodium): Improve symptoms by antagonizing leukotrienes.
  3. Mast Cell Stabilizers (e.g., Sodium Cromoglicate): Effective for prevention. Best used before high-exposure periods or at the first sign of discomfort.

Distinguishing Allergic Rhinitis from the Common Cold in Children

Many parents mistake allergic rhinitis for a common cold, which delays proper treatment. In children, allergic rhinitis presents as nasal itching, runny nose, and sneezing fits. If prolonged, it can cause complications like sinusitis, adenoid hypertrophy, and otitis media. Note that parents of children with allergic rhinitis often have an allergic constitution themselves.

Traditional Chinese Medicine (TCM) Perspective

TCM suggests that allergic rhinitis is not caused by bacteria or viruses, but by a deficiency in Lung and Spleen Qi, making the body hypersensitive to external stimuli.

• Limitations of Western Medicine: Hormones and anti-allergics often treat the “symptoms” (the branch) but may not change the underlying allergic state (the root).
• TCM Diagnosis: The condition is seen as an imbalance of Yin and Yang, categorized into three types:
  1. Lung Qi Deficiency: Often triggered by recurring colds that were never fully cured.
  2. Spleen Qi Deficiency: Often triggered by poor diet and physical/mental exhaustion.
  3. Kidney Deficiency: Often linked to congenital factors or genetics.

TCM aims to treat the “root” by regulating the body’s constitution and restoring balance, making the patient less reactive to allergens.