Allergic rhinitis is a global health problem affecting 10% to 20% of the population. It represents an immunoglobulin E (IgE)-mediated inflammation of the nasal mucosa.

The symptoms of allergic rhinitis include sneezing, nasal discharge, postnasal dribbling, nasal obstruction and nasal itchiness. It affects social life, sleep, work and school. Serious allergic rhinitis may lead to sinusitis, asthma, etc.

Allergic rhinitis can be seasonal or perennial. Outdoor allergens (e.g. pollen) appear to constitute a greater risk for seasonal rhinitis than indoor allergens and indoor allergens (e.g. house dust mite) a greater risk for perennial rhinitis.

Treatment

Allergens Avoidance

House dust mites feed on human skin danders. Warm and humid condition facilitates their growth. Bed mattress, pillows, carpet, upholstered furniture and fluffy toys should be cleaned regularly.

Animal danders are present in high amounts in domestic dust, upholstered furnishings and mattress. Avoid keeping pets if possible.

Pollens that cause most common allergies are grasses, weeds and trees. Wearing mask for outdoor activity during the pollen seasons is recommended.

Medication

The most common prescribed medication is antihistamine. Both sedating and non-sedating antihistamine are available.

The other type of medication is vasoconstrictor which can be administered as oral or local via nasal spray. Vasoconstrictor is useful for relieving nasal obstruction. Oral vasoconstrictor may cause systemic side effects while local vasoconstrictor should not be used continuously for more than a week.

Steroid nasal spray is useful for all nasal symptoms including nasal obstruction. It is more effective than the oral medication.

Surgical intervention

If nasal obstruction persists after optimal medical treatment, surgical intervention is indicated.

Radiofrequency of inferior turbinate

It is a minimal invasive procedure for nasal obstruction caused by inferior turbinate hypertrophy. A special designed applicator is used to apply the radiofrequency to the submucosal tissue of the inferior turbinate. With a controlled increase in temperature, volume reduction is achieved through the scaring and later resorption of the submucosal tissue. The whole procedure is performed under local anaesthesia in outpatient basis. No hospital stay is required. The pain or discomfort will be minimal and easily controlled by analgesic.

Inferior turbinectomy

Nasal obstruction can be caused by the mucosa hypertrophy of the inferior turbinate. Under general anaesthesia, the inferior turbinate will be removed. A dramatic relieve of nasal obstruction will be expected.

Septoplasty

Nasal obstruction can be caused by a deviated nasal septum. By removing the deformed bone or cartilage and repositioning of the septum, the septum can be straightened. Symmetric patent nasal air flow can then be restored. The operation is performed under general anaesthesia.