Intended for healthcare professionals

Clinical Review

Perennial rhinitis

BMJ 2007; 335 doi: (Published 06 September 2007) Cite this as: BMJ 2007;335:502
  1. Hesham A Saleh, consultant rhinologist/ENT surgeon; and honorary senior lecturer1,
  2. Stephen R Durham, professor of allergy and respiratory medicine; and honorary consultant physician2
  1. 1Charing Cross and Royal Brompton Hospitals, London; and Imperial College of Medicine, London
  2. 2Imperial College of Medicine, National Heart and Lung Institute, London; and Royal Brompton Hospital, London
  1. Correspondence to: H Saleh h.saleh{at}
  • Accepted 1 August 2007

Perennial rhinitis can be defined clinically as an inflammatory condition of the nose characterised by nasal obstruction, sneezing, itching, or rhinorrhoea, occurring for an hour or more on most days throughout the year. Rhinitis is commonly managed by both primary and secondary care physicians. Although most cases can be diagnosed and treated in primary care, referral to secondary care is often necessary when patients do not respond to treatment or other diagnoses are suspected. A recent large scale, cross sectional study in six western European countries found that the overall prevalence of rhinitis was 23%.1 The study also showed that the condition is often undiagnosed, as 45% of patients with investigator confirmed allergic rhinitis had not previously received a diagnosis from their physicians. A published review of previous population based studies showed that, as with asthma, both seasonal and perennial rhinitis seem to be increasing.2

Summary points

  • Perennial allergic rhinitis is a common condition in general practice

  • The most common allergen is the house dust mite, followed by cats and dogs

  • Diagnosis is through history and skin prick testing

  • Patients with unilateral symptoms, especially if they have pain or bleeding, should be referred to an ear, nose, and throat specialist

  • Avoidance measures should be taken where appropriate

  • Medical treatment, mainly with antihistamines, topical corticosteroids, or both, is usually highly effective

  • Immunotherapy is reserved for severe cases in which avoidance measures and medical treatment are either not effective or not tolerated

  • Surgery is reserved for certain patients who have structural abnormalities

How is perennial rhinitis classified?

Allergic rhinitis

Perennial allergic rhinitis can be more difficult to diagnose than seasonal allergy, particularly if the patient presents with secondary symptoms of sinusitis and a “permanent cold.” The most common allergen to account for perennial allergy symptoms is the house dust mite (Dermatophagoides pteronyssinus). Other common causes are animals, particularly cats, …

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