Patterns of Allergic Rhinitis

Table 1. Patterns of allergic rhinitis

The following ways of thinking about the pattern of symptoms are useful to help guide treatment:

Intermittent versus persistent

Intermittent: symptoms <4 days per week or <4 weeks at a time

Persistent: symptoms >4 days per week or >4 weeks at a time		 Even in intermittent allergic rhinitis, a course of continuous INCS is likely to be more effective than partial treatment with inadequate doses, which may allow the nasal passages to remain inflamed and hypersensitive to irritants. These classifications may overlap (e.g. frequent short bouts throughout the year).
Severity

Moderate-severe: any of impairment of sleep, daily activities, leisure or sport, school or work.

Mild: doesn’t impair any of these		 Individuals’ symptom severity fluctuates. Categorising allergic rhinitis as moderate or severe is mainly useful when recommending treatment, e.g. a person who has been in the habit of using insufficient doses of over-the-counter medication intermittently may consider adopting a more rational self-management regimen after it is explained that any impairment of activities indicates that allergic rhinitis warrants adequate medication.
Seasonal versus perennial

Seasonal (hay fever): triggered by wind-borne pollen from grasses, weeds sometimes trees. Symptoms most common in Spring and Summer but depends on individual allergen exposure, geography, rainfall, time of day (e.g. pollen exposure is highest in morning, outside, windy days, after thunderstorms)

Perennial: triggered by exposure to allergens present all year round (e.g. house dust mite, animal dander, moulds).		 People who predictably experience symptoms only part of the year may benefit from pre-emptive INCS course timed for usual onset,44 and can usually discontinue treatment afterwards. Generally at least 6 weeks’ treatment is needed during a pollen season. A mixed pattern of seasonal and perennial features is common.