Diagnosis of allergic rhinitis

What is allergic rhinitis and why you shouldn’t ignore the symptoms

Allergic rhinitis is a common reaction of the body to everyday substances in the environment. The nasal mucosa overreacts to allergens that are not harmful by themselves but are seen as a threat by the immune system. This triggers a defense response that causes sneezing, a runny or stuffy nose, and itching. It is often mistaken for a cold, but there are key differences. Allergic rhinitis does not cause a fever, and symptoms repeat under the same conditions or during the same seasons.

What types of allergic rhinitis exist?

Razlikuju se dve vrste alergijskog rinitsa:

• Seasonal allergic rhinitis typically appears in spring, summer, or fall. It is usually caused by pollen from grass, trees, and weeds. Symptoms start when pollen levels rise and stop after the blooming season ends. Symptoms return each year at the same time, making them easier to recognize.
• Perennial allergic rhinitis lasts all year and does not depend on the season. It is mostly triggered indoors by dust, mites, mold, and pet dander. People with this type often have a constantly stuffy nose without a cold, mild runny nose, itching, and fatigue — even when the weather outside is stable.

Symptoms may appear occasionally or persist.

• Intermittent allergic rhinitis occurs from time to time and lasts for a shorter period.
• Persistent allergic rhinitis lasts longer and strongly affects daily life. Without treatment, symptoms can continue for weeks or months and won’t go away on their own.

Most common symptoms of allergic rhinitis

Allergic rhinitis has a recognizable pattern of symptoms that usually appear in waves. Some are mild, while others can seriously affect daily life. Our ENT specialists at Dr Prlja Medical help patients receive a quick diagnosis and relief.

The most common symptoms include:

• Frequent sneezing, especially in the morning or after going outside – caused by histamine release and nasal lining irritation after allergen exposure.
• Itching in the nose and the back of the throat – due to stimulation of nerve endings by inflammatory mediators.
• Clear nasal discharge or persistent congestion – caused by increased mucus production and swelling of the nasal lining.
• Watery and red eyes, often with a burning sensation – triggered by conjunctival inflammation from allergen contact.
• Headache or sinus pressure – caused by mucus buildup due to swollen nasal passages.
• Fatigue and poor sleep – chronic rhinitis worsens breathing at night. Lying down increases congestion, which disrupts sleep.
• Reduced sense of smell and throat irritation – swelling blocks smell receptors, and mucus irritates the back of the throat.

Allergic rhinitis in children: Is there a difference?

Allergic rhinitis in children and adults has similar causes and core symptoms, but the condition differs in several important ways. Children often can’t describe how they feel, so the first sign of allergic rhinitis is usually difficulty breathing. Symptoms in children can often be recognized through behavior:

• mouth breathing
• rubbing the nose
• red eyes
• sleep and attention problems

In adults, the symptoms are more clearly expressed. In children, signs are often more visible — dark circles under the eyes and a nasal voice. If children snore at night, this may also be a sign. Symptoms tend to affect focus and school performance more. While the same diagnostic methods apply across all ages, results in children are interpreted more carefully since their immune systems are still maturing. Treatment is also adjusted based on age and symptom severity.

How is allergic rhinitis diagnosed?

The examination lasts between 30 and 60 minutes. Before your visit, it’s helpful to bring a list of current medications and any previous results, if available. In most cases, results are provided the same day, and the doctor will suggest a treatment plan right away.

Clinical examination

• ENT nasal exam: The first step in diagnosing allergic rhinitis. During this exam, the doctor closely examines the:
  • nasal cavity
  • mucous membranes
  • sinuses

This step helps detect structural issues that may be causing symptoms and evaluates the severity of inflammation. Based on the findings, further testing may be recommended.

• Endoscopic exam: This painless and noninvasive procedure allows the doctor to view the inside of the nose and sinuses using a small camera. It is used when structural changes are suspected, such as:
  • nasal polyps
  • blockage due to allergies
  • sinus inflammation

Allergy testing

• Prick test (skin testing): The most commonly used allergy test for identifying allergens. Small amounts of allergens are applied to the skin, and the reaction is monitored and evaluated.
• Nasal provocation test (NPT): A test in which allergens are applied through the nasal passage to directly assess the response of the nasal mucosa.

Cytological analyses

Nasal smear for eosinophils: This test analyzes the presence of eosinophils in a nasal swab. A result up to 5% is considered normal, while a higher percentage suggests an allergic response.

Blood tests

• Eosinophil count: An elevated number of eosinophils may indicate an allergic reaction.
• IgE measurement, RIST, and RAST tests: These tests detect specific antibodies and help identify allergens responsible for the reaction.

What do my results mean?

An allergic rhinitis exam enables accurate identification of allergens causing symptoms. Based on the skin prick test or blood test results, it is possible to determine whether a patient reacts to inhaled allergens such as pollen from grasses, trees, weeds, house dust mites, mold, or pet allergens like cat or dog dander.

In addition to identifying allergens, the intensity of the allergic reaction is assessed. The size of the skin reaction in the prick test (measured in millimeters) or the concentration of specific IgE antibodies in the blood (classified from 0 to 6) reflects the level of sensitization. Higher values usually indicate a greater risk of stronger symptoms and potentially more complex clinical conditions.

In some cases, tests can reveal cross-reactivities — situations where the body reacts to related allergens due to similar molecular structures. For example, a person sensitized to birch pollen may develop symptoms after eating apples, hazelnuts, or carrots.

How is allergic rhinitis treated?

Allergic rhinitis cannot be completely cured, but with proper diagnosis and treatment, symptoms can be managed. This leads to better sleep, easier breathing, and improved quality of life. A specialist ENT exam is a safe way to identify the cause of symptoms and find the right solution.

Immunotherapy (desensitization) is the only treatment that targets the root cause of allergic rhinitis. It is used in patients with strong sensitivity to airborne allergens like pollen, dust mites, mold, and pet dander, especially when standard therapy is not effective. Treatment can be delivered in two ways:

• Sublingually as tablets placed under the tongue
• Subcutaneously in a series of injections

The treatment period for allergic rhinitis lasts from 3 to 5 years. Immunotherapy does not guarantee a complete cure, but in many cases, it leads to lasting symptom reduction and increased tolerance to allergens. For patients who follow the therapy regularly as recommended, significant improvement may be noticeable within a few months.

Progress is monitored through check-ups every three to six months. During these visits, the dosage, treatment duration, or allergy status may be adjusted if needed. This systematic approach provides safe and long-term symptom relief for most patients.

Allergic rhinitis: Treatment, additional measures, and lifestyle changes

In some cases, along with immunotherapy, dietary adjustments are recommended — especially if a confirmed cross-allergy exists. This comprehensive approach helps maintain long-term symptom control, increases allergen tolerance, and significantly improves quality of life.

n addition to medical treatment, the following measures are recommended to reduce allergen exposure in daily life:

• regularly ventilating rooms
• using HEPA filters in air conditioners and air purifiers
• washing bedding at high temperatures to reduce dust mites