— Understanding Allergic Rhinitis, One of the Most Common Nasal Conditions
Yu Wen Huang, MD.
Do you often wake up sneezing, with a runny or congested nose and itching in your nose or eyes?
If these symptoms occur regularly, especially in the early morning, they may indicate a condition
known as allergic rhinitis.
1. What Is Allergic Rhinitis, and Why Do Symptoms Appear So Quickly?
Allergic rhinitis is a common condition in which the body’s immune system reacts excessively to
harmless substances such as dust mites, pollen, pet dander, or mold. When these allergens
enter the nasal cavity, they trigger the release of histamine and other inflammatory mediators,
resulting in a range of symptoms.
- Sneezing 👈 stimulation of sensory nerve endings
- Runny nose 👈 increased mucus gland secretion in the nasal lining
- Nasal congestion 👈 swelling of the nasal mucosa and blood vessel dilation
- Itchy nose and eyes 👈 irritation caused by inflammatory substances
Symptoms are often worse in the early morning, due to prolonged nighttime exposure to allergens
(like dust mites in bedding), combined with changes in autonomic nervous system activity. Some
studies also show that immune cells related to allergy responses are more active in the morning,
intensifying symptoms.
2. Classification: Seasonal vs. Perennial Rhinitis, and Symptom Severity
Allergic rhinitis is typically categorized into two types:
- Seasonal allergic rhinitis (hay fever): triggered by pollen during specific seasons (e.g., spring)
- Perennial allergic rhinitis: symptoms persist throughout the year, commonly due to indoor allergens
In Taiwan, perennial allergic rhinitis is more prevalent, as the humid subtropical climate supports the growth
of dust mites and molds.
Symptom severity can also be classified as:
- Mild/intermittent: symptoms occur occasionally and do not interfere with daily life
- Moderate-to-severe/persistent: symptoms are frequent, and may affect sleep, concentration, or quality of life
3. Do I Need an Allergy Test?
Many patients ask whether allergy testing is necessary. However, it is important to understand that
testing is not always required for diagnosis.
Blood tests (such as serum IgE or MAST) may not fully reflect clinical symptoms, especially in adults.
Some individuals with typical allergic symptoms may test negative, while others with positive test
results may not experience symptoms in daily life.
Testing may be considered in the following situations:
- Symptoms appear linked to specific environmental exposures or seasons
- There is coexisting asthma, eczema, or allergic conjunctivitis
- Family history of allergies, particularly in children
- Considering allergen immunotherapy (e.g., dust mite desensitization)
- Results may help guide environmental or lifestyle adjustments
In Taiwan, eligibility for insurance-covered testing depends on clinical judgment and criteria
(e.g., IgE levels, symptom severity). Testing can be helpful in selected cases, but it is not universally necessary.
4. Why Don’t Antihistamines Work for Everyone?
Antihistamines are effective for relieving sneezing, runny nose, and nasal itching, all of which are
primarily mediated by histamine. However, they are usually less effective for nasal congestion,
which is caused by blood vessel swelling and inflammation.
For patients with predominant congestion, doctors often recommend a topical steroid nasal spray
or combination therapy to reduce inflammation more effectively.
Additionally, not all cases of rhinitis are caused by classical allergies. Some patients may have
non-allergic rhinitis or chronic sinusitis, which require different treatment strategies.
A future article will provide an overview of available treatment options, including medications and immunotherapy.
5. Timely Treatment Can Significantly Improve Your Quality of Life
Frequent sneezing, nasal congestion, or a runny nose every morning should not be ignored. With appropriate
evaluation and personalized treatment, most patients with allergic rhinitis can achieve excellent symptom
control and a better quality of life.
If you are experiencing these symptoms—whether you have lived in Taiwan long-term or recently relocated—
it may be time to consult an ENT specialist. A careful assessment can help identify the root cause and guide
you toward effective, evidence-based care.
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