Allergic rhinitis affects up to 33.5% of school-age children and nearly 10% of adults in India, making it one of the most prevalent chronic conditions in the country and one of the most undertreated. Commonly called hay fever, it is not caused by hay and rarely produces a fever; it is an IgE-mediated hypersensitivity reaction of the nasal mucosa to inhaled allergens.
In Gurugram, where vehicular pollution, construction dust, and seasonal pollen combine to create a near year-round allergic burden, understanding the symptoms, causes, types, and treatment options for allergic rhinitis is essential for every patient and family. This blog covers everything from what triggers hay fever allergy to the full spectrum of treatment, including allergen immunotherapy.
Why Allergic Rhinitis Demands Medical Attention?
Most people who live with allergic rhinitis have given it a different name: 'my dust allergy,' 'seasonal sneezing,' 'my nose problem,' or simply 'hay fever.' For many in India, it is considered a minor inconvenience that is managed with the occasional antihistamine or simply tolerated. This perception needs to be changed.
Allergic rhinitis is a chronic inflammatory disease caused by an overactive immune response to harmless environmental triggers like pollen, dust mite feces, pet dander, and mold spores.
It disrupts sleep, impairs concentration, reduces school and work performance, and significantly diminishes quality of life. The ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines specifically classify it as a condition that deserves structured diagnosis and management, not simply symptom suppression with over-the-counter remedies.
What is Allergic Rhinitis and What is Hay Fever?
Allergic rhinitis is triggered by inhaled allergens. When a sensitized individual inhales an allergen dust mite, pollen, pet dander, or mold spore), their immune system recognizes it as a threat and deploys mast cells and basophils loaded with IgE antibodies.
Hay fever is the common name for allergic rhinitis, particularly the seasonal form triggered by pollen. The term is historically misleading on both counts: hay is rarely the actual trigger (grass pollen, tree pollen, and weed pollen are the more common culprits), and the condition does not cause fever.
Allergic rhinitis shares immunological mechanisms with other atopic conditions: asthma, atopic eczema, allergic conjunctivitis, and food allergy. These conditions frequently co-occur (the atopic march'), and their shared IgE-mediated pathophysiology means that treating one often has indirect benefits for the others and that leaving one untreated can worsen the others.
What are the Types of Allergic Rhinitis?
The ARIA (Allergic Rhinitis and its Impact on Asthma) classification system, adopted by allergists globally and recommended in India, categorizes allergic rhinitis on two axes: duration and severity.
By Duration
- Intermittent Allergic Rhinitis: Symptoms present for fewer than 4 days per week or fewer than 4 consecutive weeks per year. Often seasonal, triggered by specific pollen seasons (spring tree pollen, summer grass pollen, and autumn weed pollen) or isolated allergen exposures (visiting a home with pets). In Indian cities, this typically corresponds to specific pollution or pollen peaks, notably October to January, the period identified in the cross-sectional Indian AR study as the highest burden.
- Persistent Allergic Rhinitis: Symptoms present for more than 4 days per week AND more than 4 consecutive weeks. Most commonly caused by perennial allergens house dust mites, cockroach allergens, pet dander, and indoor mould. In India, house dust mite (Dermatophagoides pteronyssinus and D. farinae) is the dominant perennial allergen. In humid cities and homes, dust mite populations thrive year-round, producing persistent allergic rhinitis that has no 'off-season'.
By Severity
Severity | Mild | Moderate-Severe |
Sleep | Normal, undisturbed sleep | Sleep disturbed by nasal obstruction and mouth breathing |
Daily Activities | Normal work, sports, leisure | Activities impaired: difficulty exercising, concentrating |
Work / School | Performance unaffected | Productivity reduced; school attendance affected in children |
Bothersome Symptoms | Symptoms present but manageable | Symptoms troublesome, distressing, or disabling |
Treatment Priority | Oral/intranasal antihistamine or INCS | Intranasal corticosteroids are first line; consider immunotherapy |
Local Allergic Rhinitis (LAR): A third, increasingly recognized variant, Local Allergic Rhinitis presents with all the symptoms of allergic rhinitis but with normal serum IgE and negative skin prick tests. It represents a localized IgE-mediated response confined to the nasal mucosa. LAR is frequently misdiagnosed as non-allergic rhinitis and requires nasal provocation testing for diagnosis. A 2024 scoping review highlighted LAR as a clinical challenge requiring collaboration between allergologists and ENT surgeons.
What Causes Allergic Rhinitis?
Allergic rhinitis and hay fever are caused by an IgE-mediated immune reaction to be inhaled allergens in a genetically predisposed individual. The condition requires two components:
- A genetic susceptibility to atopy (the inherited tendency to produce IgE antibodies against environmental proteins)
- Sufficient allergen exposure to trigger and then maintain sensitization.
Hay fever is caused by pollen-specific IgE; perennial allergic rhinitis causes involve indoor allergens.
Common Allergens — The Primary Hay Fever Causes and AR Triggers in India
Allergen Category | Specific Sources |
House Dust Mites (HDM) | Dermatophagoides pteronyssinus, D. farinae — in bedding, carpets, soft furnishings |
Pollen | Grass (Cynodon dactylon / Bermuda grass), weed (Parthenium, Amaranthus), tree (Prosopis, Acacia) |
Cockroach Allergens | Periplaneta americana, Blattella germanica — in kitchens, drains, food storage areas |
Pet Dander | Cat (Fel d 1 protein), dog (Can f 1), small mammals |
Mould Spores | Aspergillus, Alternaria, Cladosporium — in damp walls, air conditioners, soil |
Indoor Air Pollutants and Irritants (Non-Allergenic Co-Factors) | PM2.5, PM10, diesel exhaust particles, tobacco smoke, incense, mosquito coils |
Occupational Allergens | Flour (bakers), latex, wood dust, chemicals, animal proteins |
How to Diagnose Allergic Rhinitis?
Diagnosis begins with a structured history and physical examination. Key elements include the pattern of symptoms (seasonal vs perennial), specific triggers, family history of atopy, response to previous treatment, and concurrent conditions (asthma, eczema, conjunctivitis).
Physical examination looks for the characteristic findings: pale, bluish-grey, swollen nasal turbinates ('allergic appearance'); clear watery discharge; the transverse nasal crease; and allergic shiners.
Here are the tests suggested by the doctors:
- Skin-Prick Test (SPT): Small amounts of standardised allergen extracts are applied to the skin (usually forearm or back) and introduced via a lancet prick.
- Serum specific IgE testing (sIgE / ImmunoCAP): Blood test measuring allergen-specific IgE antibodies. Useful when SPT is not feasible (severe eczema, dermatographism, patients who cannot stop antihistamines, infants).
- Nasal cytology: Examination of nasal smear for eosinophils, supports eosinophilic inflammation consistent with allergy when SPT is equivocal.
- Nasal provocation test: Allergen instilled directly into the nasal mucosa; used for diagnosing Local Allergic Rhinitis when systemic allergy tests are negative.
Experiencing frequent sneezing, nasal congestion, or itchy eyes?
onsult our ENT and allergy specialists in Gurgaon for accurate diagnosis and effective treatment.
Allergic Rhinitis Treatment in India
Reducing allergen exposure is the foundation. While rarely sufficient alone, it reduces the allergen load and can meaningfully lower symptom severity and medication requirements. Here ate the first line for moderate-severe AE.
Intranasal Corticosteroids (INCS)
INCS are the most effective single pharmacological treatment for allergic rhinitis. Applied as a nasal spray, they reduce mucosal inflammation across all four nasal symptoms: rhinorrhoea, sneezing, itching, and congestion as well as secondary symptoms including nasal polyp growth.
The 2025 Indian expert consensus recommends INCS as first-line for moderate-to-severe AR. They are safe for long-term use (including in children and pregnant women) at recommended doses, as systemic absorption is minimal.
Second-Generation Oral Antihistamines
Non-sedating (second-generation) antihistamines is the first-line for mild intermittent AR and as adjuncts to INCS for breakthrough symptoms. They are most effective for rhinorrhoea, sneezing, and itching, but less effective than INCS for nasal congestion.
Some antihistamines have the advantage of being non-sedating even at higher doses. First-generation antihistamines are not recommended for regular use due to sedation, impaired cognitive function, and anticholinergic effects.
Intranasal Antihistamines
Nasal spray has a rapid onset (within 15–30 minutes), targets local nasal symptoms directly, and is useful for as-needed relief. Combination nasal spray preparations containing both INCS and antihistamine have demonstrated superior efficacy over either component alone in head-to-head trials.
Note: Surgery does not treat the allergic mechanism but can address structural consequences of chronic allergic rhinitis particularly inferior turbinate hypertrophy (enlarged nasal tissue causing persistent obstruction despite medical treatment) and nasal polyposis.
Allergic Rhinitis vs Common Cold vs Sinusitis: How to Tell the Difference
Feature | Allergic Rhinitis | Common Cold | Sinusitis |
Onset | After allergen exposure | Gradual, after viral exposure | Follows cold or AR episode |
Duration | Weeks to months (persistent) or episodic | 7–10 days | 12+ weeks (chronic sinusitis) |
Discharge | Clear, watery | Initially clear; turns yellow/green | Thick, purulent, yellow/green |
Sneezing | Prominent, in paroxysms | Mild | Minimal |
Itching | Nasal and eye itching prominent | None | None |
Fever | None (hay fever does not cause fever) | Low-grade possible | Possible with acute sinusitis |
Facial pain/pressure | Mild from congestion | Mild | Prominent; worse on bending forward |
Eye symptoms | Common (rhinoconjunctivitis) | Occasional | Rare |
Response to antihistamines | Significant relief | Minimal | None |
Seasonal pattern | Yes (if seasonal AR) or year-round (perennial) | Winter predominant but any season | Can follow any nasal infection |
Allergic Rhinitis Care at Artemis Hospitals, Gurugram
At Artemis Hospitals, Gurugram, the ENT and allergy team provides:
- Specialist ENT and allergy consultation for accurate diagnosis of allergic rhinitis, local allergic rhinitis, and related conditions
- Skin-prick testing against India-specific allergen panels (house dust mites, Parthenium, Bermuda grass, cockroach, Alternaria, pet dander, food allergens where relevant)
- Serum specific IgE testing and total IgE where SPT is not feasible
- Personalised pharmacotherapy selection intranasal corticosteroids, non-sedating antihistamines, combination nasal sprays, or LTRAs based on symptom pattern, severity, and comorbidities
- Allergen immunotherapy (subcutaneous and sublingual) for eligible patients with demonstrated allergen sensitisation and persistent or severe AR
- Surgical assessment for patients with structural complications (turbinate hypertrophy, nasal polyps, deviated nasal septum) that are contributing to treatment-resistant obstruction
- Paediatric allergy care a significant proportion of AR patients are children, and age-appropriate management differs from adult protocols
If you or your child have had recurring sneezing, persistent nasal congestion, chronic post-nasal drip, or worsening respiratory symptoms consult our specialist for allergy assessment.
Article by Dr. Arpit Jain
Head – Internal Medicine
Artemis Hospitals
