Allergic Rhinitis & Immunotherapy

In this episode, Dr. Matthew Ryan joins Dr. Gopi Shah and Dr. Ashley Agan to discuss symptoms and comorbidities of allergic rhinitis, as well as current treatments such as decongestants, antihistamines, steroids, and immunotherapy.

The methods of allergy testing (prick test, intradermal test, and blood draw) are clinically interchangeable, with skin tests being the cheapest. Unfortunately, there are nuances in interpreting allergy test results, and a patient’s symptom complex may have a great deal of variability. There may not be correlation between a patient’s symptoms and their allergy test results. While an allergy test can be helpful, chronic rhinitis can be diagnosed and treated without testing.

As a first-line therapy for allergic rhinitis, Dr. Ryan will prescribe a combination of a nasal steroid spray and a nasal antihistamine spray, and then follow up with the patient to see if these help with symptom relief. The doctors also talk about treating allergic rhinitis and medication considerations in subgroups such as children and patients with nasal polyps, asthma, and hypertension.

For patients who still struggle with symptom control, the doctors discuss two types of immunotherapy, subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Both have advantages and disadvantages based on available clinical data, status of FDA approval, insurance coverage, and convenience for the patient.