Classification of Allergic Rhinitis

Introduction to Classification Systems

The American Academy of Otolaryngology-Head and Neck Surgery suggests that allergic rhinitis is classified using two complementary systems: the traditional temporal pattern classification and the ARIA frequency/severity classification, with both systems remaining clinically relevant despite defining different patient populations 1, 2

Seasonal allergic rhinitis symptoms occur only during specific seasons when outdoor allergens are present, caused by IgE-mediated inflammatory response to seasonal environmental aeroallergens 1, 2
Perennial allergic rhinitis symptoms occur year-round without seasonal variation, caused by IgE-mediated response to year-round environmental aeroallergens including dust mites, indoor mold, animal dander, and certain occupational allergens 1, 2
Many patients have year-round symptoms that worsen during specific pollen seasons, representing a significant overlap between seasonal and perennial allergic rhinitis 1
Episodic allergic rhinitis denotes allergic nasal symptoms from sporadic exposures to inhalant aeroallergens not usually encountered in the patient's normal environment, such as visiting a home with pets or a farm with horse exposure 1, 2, 4

The ARIA working group proposes an alternative system that classifies allergic rhinitis as intermittent or persistent, and mild or moderate-severe, with intermittent being less than 4 days per week or less than 4 weeks per year, and persistent being more than 4 days per week and more than 4 weeks per year 1, 2, 5
Mild allergic rhinitis is characterized by none of the following: sleep disturbance, impairment of daily activities, impairment of school or work, troublesome symptoms, while moderate-severe allergic rhinitis has one or more of these factors affecting quality of life 1, 2, 4

The American Academy of Otolaryngology-Head and Neck Surgery notes that 44% of patients traditionally classified as seasonal rhinitis have persistent rhinitis according to ARIA classification, and 44% with traditional perennial allergic rhinitis were reclassified as intermittent by ARIA criteria 1, 7
Mixed rhinitis, or combined allergic and nonallergic rhinitis, occurs in 44% to 87% of patients with allergic rhinitis, and is more common than either pure allergic rhinitis or pure nonallergic rhinitis 1, 5, 7
The FDA continues to use seasonal/perennial terminology for medication approval, making this classification practically relevant for prescribing 2