Perennial Allergic Rhinitis (PAR) is a chronic inflammatory condition of the nasal lining, triggered by allergens present throughout the year. It is a common condition that leads to persistent, cold-like symptoms. This type of allergy results from the immune system overreacting to generally harmless airborne particles found predominantly indoors.
Defining Perennial Allergic Rhinitis
Perennial Allergic Rhinitis (PAR) is defined by the chronic presence of nasal symptoms for an hour or more on most days of the year. This ongoing inflammation occurs when the immune system mistakenly identifies a substance as a threat, triggering a release of chemicals like histamine. This immune response causes swelling and fluid production in the nasal passages.
The term “perennial” distinguishes PAR from Seasonal Allergic Rhinitis (SAR), commonly known as hay fever. SAR is caused by outdoor allergens like pollen, and the symptoms are limited to specific times of the year. Conversely, PAR is sustained because the exposure to the responsible allergens is constant and not tied to the changing seasons.
Identifying Common Indoor Triggers
The persistent nature of Perennial Allergic Rhinitis is linked to indoor allergens that do not fluctuate with the seasons. The most common trigger is the house dust mite, tiny organisms that thrive in warm, humid environments like bedding, carpets, and upholstered furniture. The allergic reaction is to proteins found in their fecal matter.
Another major cause is pet dander, which consists of microscopic flakes of skin shed by animals. These proteins from the skin, saliva, and urine of pets are lightweight and remain suspended in the air, circulating throughout the home. Mold spores are also significant triggers, growing in damp areas such as basements, bathrooms, or near leaky pipes.
The spores are airborne and can be inhaled. Finally, cockroach droppings and saliva are potent allergens, especially in densely populated areas, contributing to year-round symptoms.
Recognizing the Symptoms
The physical manifestations of Perennial Allergic Rhinitis often mimic a persistent cold. Classic nasal symptoms include rhinorrhea (a continuous runny nose with a clear, watery discharge) and nasal congestion (a feeling of stuffiness or blockage). Frequent sneezing and an itchy nose, throat, or roof of the mouth are also common.
The inflammation often leads to post-nasal drip, where mucus runs down the back of the throat, causing a scratchy feeling and persistent coughing. Ocular symptoms, such as itchy, watery eyes, can also occur. Chronically obstructed nasal breathing can lead to disturbed sleep, resulting in daytime fatigue, reduced concentration, and a decreased sense of smell.
Untreated PAR is associated with a higher risk of developing chronic sinusitis, recurrent ear infections, and worsening asthma symptoms. The constant effort to manage these symptoms can significantly impact an individual’s overall quality of life and productivity.
Diagnosis and Management Strategies
Diagnosis of Perennial Allergic Rhinitis begins with a detailed medical history and physical examination. A healthcare provider looks for signs of chronic inflammation, such as a pale, swollen nasal lining. To confirm specific triggers, two primary tests are used: the skin prick test and the specific Immunoglobulin E (IgE) blood test. The skin prick test involves placing small amounts of various allergens on the skin to observe a localized reaction.
Management of PAR follows a three-pronged approach aimed at reducing symptoms. The first step is allergen avoidance, involving environmental control measures like using dust-mite-proof bedding covers, maintaining low indoor humidity, and using high-efficiency particulate air (HEPA) filters. The second strategy is pharmacological treatment, which utilizes medications to control the inflammatory response.
Intranasal corticosteroids are the most effective initial treatment because they directly reduce inflammation in the nasal passages. Oral or topical antihistamines help control itching and sneezing. Decongestants can temporarily relieve congestion but should be used sparingly to avoid rebound swelling. For long-term modification of the immune response, immunotherapy may be recommended. This treatment, delivered through allergy shots or sublingual tablets, exposes the individual to increasing doses of the allergen over time to build tolerance.