Prognosis of Allergic Rhinitis

Natural History and Disease Progression

Allergic rhinitis is a chronic condition with generally favorable prognosis when properly treated, but left untreated or poorly controlled, it significantly impairs quality of life, increases risk of asthma development, and in children can cause permanent structural facial deformities 1
Patients with allergic rhinitis face increased risk for developing asthma, making this a critical prognostic consideration 2

Untreated or poorly controlled allergic rhinitis causes substantial morbidity, including sleep disorders and chronic fatigue, limitations of daily activities, impaired social functioning, and sexual dysfunction, which normalizes with appropriate treatment 1
Moderate-to-severe perennial rhinitis produces functional impairment equal to moderate-to-severe asthma 1
The consequences of uncontrolled allergic rhinitis in children are particularly severe and include permanent complications, such as structural facial deformities, poor sleep and secondary sleep apnea, school absenteeism, and learning impairment 1, 5

After effective treatment of perennial allergic rhinitis, improvement in school attendance, concentration, and sleep can be demonstrated 1
Treatment brings patients' functioning back toward normal across multiple domains 1
Allergen immunotherapy is the only treatment that can potentially modify the natural history of allergic rhinitis, with clinical benefits that may be sustained for years after discontinuation of treatment 3, 4
Clinical benefits of immunotherapy include reduced risk for future asthma development, prevention of development of new allergen sensitizations, and clinical improvement usually noted after reaching maintenance dose 2, 3, 4

Continuous treatment is required for perennial allergic rhinitis, as intermittent dosing is less effective due to ongoing allergen exposure 6
Periodic assessment of quality of life is essential and should include evaluation of time lost from work or activities, sleep quality, smell and taste function, fatigue level, and general well-being 7, 8

Allergic rhinitis frequently coexists with and worsens other conditions, such as asthma, and treatment of allergic rhinitis may improve asthma control 2