Further Outpatient Care

Monitor doses and adverse effects of medication.

Inpatient & Outpatient Medications

Regimen depends on the patient's symptoms and other coexisting medical problems.

Transfer

Candidates for immunotherapy may be transferred to an allergist for care, and therapy is administered at the discretion of the treating physician.

The clinician should be familiar with immunotherapy and its risks. He or she should be able to deal with any allergic emergency.

Deterrence/Prevention

See Avoidance of allergens and environmental controls for methods of deterrence and prevention.

Complications

Complications may include bacterial rhinosinusitis and exacerbation of asthma.

Prognosis

Most patients with allergic rhinitis can expect an improved quality of life with appropriate environmental control measures; pharmacotherapy; and, when necessary, immunotherapy.

Patient Education

The clinic should have literature about allergies, and the office staff should continually educate patients and reinforce their understanding of avoidance and environmental control techniques.

Patients undergoing immunotherapy should be instructed to report any reactions from the previous injection and any changes in their health status during each visit (eg, change in medication, new onset of upper respiratory tract infection, worsening of asthma).

Questions

Mudarri DH. Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US. J Environ Public Health. 2016. 2016:2386596. [QxMD MEDLINE Link]. [Full Text].
Munoz del Castillo F, Jurado-Ramos A, Fernandez-Conde BL, Soler R, Barasona MJ, Cantillo E, et al. Allergenic profile of nasal polyposis. J Investig Allergol Clin Immunol. 2009. 19(2):110-6. [QxMD MEDLINE Link].
Shahsavan S, Pirayesh A, Samani OZ, et al. The relationship between IL-17A and IL-22 expression and clinical severity in patients with moderate/severe persistent allergic rhinitis. Am J Otolaryngol. 2018 Dec 18. [QxMD MEDLINE Link].
Romano MR, James S, Farrington E, Perry R, Elliott L. The impact of perennial allergic rhinitis with/without allergic asthma on sleep, work and activity level. Allergy Asthma Clin Immunol. 2019. 15:81. [QxMD MEDLINE Link]. [Full Text].
Rodrigues J, Franco-Pego F, Sousa-Pinto B, Bousquet J, Raemdonck K, Vaz R. Anxiety and depression risk in patients with allergic rhinitis: a systematic review and meta-analysis. Rhinology. 2021 Jul 13. [QxMD MEDLINE Link].
Cazzoletti L, Ferrari M, Olivieri M, et al. The gender, age and risk factor distribution differs in self-reported allergic and non-allergic rhinitis: a cross-sectional population-based study. Allergy Asthma Clin Immunol. 2015. 11:36. [QxMD MEDLINE Link].
Lee A, Lee SY, Lee KS. The Use of Heated Tobacco Products is Associated with Asthma, Allergic Rhinitis, and Atopic Dermatitis in Korean Adolescents. Sci Rep. 2019 Nov 27. 9 (1):17699. [QxMD MEDLINE Link]. [Full Text].
Van Bulck P, Cools L, Soumya MS, et al. A multicenter real-life study on the multiple reasons for uncontrolled allergic rhinitis. Int Forum Allergy Rhinol. 2021 Jul 14. [QxMD MEDLINE Link].
Radulovic S, Calderon MA, Wilson D, Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2010 Dec 8. 12:CD002893. [QxMD MEDLINE Link].
FDA OKs Oralair, First US Sublingual Allergy Immunotherapy. Medscape. Available at http://www.medscape.com/viewarticle/822975. Accessed: April 4, 2014.
Grastek [package insert]. Whitehouse Station, NJ: Merck & Co, Inc. April 2014. Available at [Full Text].
Maloney J, Bernstein DI, Nelson H, Creticos P, Hébert J, Noonan M, et al. Efficacy and safety of grass sublingual immunotherapy tablet, MK-7243: a large randomized controlled trial. Ann Allergy Asthma Immunol. 2014 Feb. 112(2):146-153.e2. [QxMD MEDLINE Link].
Creticos PS, Esch RE, Couroux P, Gentile D, D'Angelo P, Whitlow B, et al. Randomized, double-blind, placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2014 Mar. 133(3):751-8. [QxMD MEDLINE Link].
Creticos PS, Maloney J, Bernstein DI, Casale T, Kaur A, Fisher R, et al. Randomized controlled trial of a ragweed allergy immunotherapy tablet in North American and European adults. J Allergy Clin Immunol. 2013 May. 131(5):1342-9.e6. [QxMD MEDLINE Link].
Devillier P, Molimard M, Ansolabehere X, et al. Immunotherapy with grass pollen tablets reduces medication dispensing for allergic rhinitis and asthma: a retrospective database study in France. Allergy. 2018 Dec 27. [QxMD MEDLINE Link].
FDA. Vaccines, Blood & Biologics: Odactra. US Food and Drug Administration. Available at https://www.fda.gov/BiologicsBloodVaccines/Allergenics/ucm544326.htm. 2017 Mar 3; Accessed: March 10, 2017.
Nolte H, Bernstein DI, Nelson HS, et al. Efficacy of house dust mite sublingual immunotherapy tablet in North American adolescents and adults in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2016 Dec. 138 (6):1631-8. [QxMD MEDLINE Link].
Soh JY, Thalayasingam M, Ong S, Loo EX, Shek LP, Chao SS. Sublingual immunotherapy in patients with house dust mite allergic rhinitis: prospective study of clinical outcomes over a two-year period. J Laryngol Otol. 2016 Jan 19. 1-6. [QxMD MEDLINE Link].
[Guideline] Seidman MD, Gurgel RK, Lin SY, et al, Guideline Otolaryngology Development Group. AAO-HNSF. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015 Feb. 152 (1 Suppl):S1-43. [QxMD MEDLINE Link]. [Full Text].
Harrison P. New Guidelines for Allergic Rhinitis Change Treatment. Medscape. 2017 Nov 9. [Full Text].

Media Gallery

Boggy inferior turbinate in an allergic patient.

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Author

Quoc A Nguyen, MD Associate Clinical Professor, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Medical Center

Quoc A Nguyen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Phi Beta Kappa, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Stephen G Batuello, MD Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American Medical Association, Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan, Ryte, Neosoma, MI10<br/>Received income in an amount equal to or greater than $250 from: , Cliexa;;Neosoma<br/> Received ownership interest from Cerescan for consulting; for: Neosoma, eMedevents, MI10.

Additional Contributors

Lanny Garth Close, MD Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons

Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Head and Neck Society, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, New York Academy of Medicine

Disclosure: Nothing to disclose.