Do not underestimate the burden of allergic rhinitis

Midst the fever and fury of catching up post COVID, we must pause and recognize that allergic rhinitis, whether seasonal or perennial, have a significant impact on quality of life.  Research has shown that allergy suffers experience sleep disturbances/poor sleep quality, cognitive impairment, and mental health issues such as anxiety and depression.  Allergies can be a leading cause for work absenteeism and can negatively affect workplace and academic performance.  Older anti-allergy medications (more to come about this) also pose a challenge as they themselves may lead to drowsiness and brain fog.  Allergic rhinitis is more than just a runny nose and as such, we need to be proactive in asking our patients how allergies affect them.

Missed clinical opportunities

Allergic rhinitis is often underrecognized by sufferers themselves.  Firstly, patients may not correlate their symptoms with other adverse health outcomes such as cognitive changes or sleep disturbances.  Afterall, it’s just a sneeze, right?  Access to medical care continues to be limited and anti-allergy over the counter options are limitless and readily available.  Just pass through a drugstore and see what lies on the shelves.  Patients can access over-the-counter medication and often undertreat, overtreat or mistreat.  I have had so many conversations with patients, whom out of desperation fill their medication cabinets with first generation antihistamines (good reliable diphenhydramine, Benadryl) or use the sedating power of other medications such as dimenhydrinate (Gravol).  These medications come with a myriad of side effects such as drowsiness, poor cognition, reduced reflex time and general brain fog.  Think of the implications for fall risk or driving errors. Furthermore, interaction with other medications are of equal concern.   When assessing a patient with allergic rhinitis, we must take time to record a detailed drug history, including what they are accessing over-the-counter.  You don’t know what you don’t know until you ask (and then know!).

So where do I start?