Allergic Rhinitis Management and Immunological Responses

Allergic rhinitis is an immunoglobulin E-mediated inflammatory condition of the nasal mucosa characterised by sneezing, rhinorrhoea, nasal congestion and itching. It affects up to 30 per cent of adults and 40 per cent of children globally and imposes a substantial burden on quality of life and productivity. The pathophysiology centres on a dysregulated type 2 immune response: upon exposure to aeroallergens such as pollens, dust mites or animal dander, antigen-presenting cells activate T helper 2 (Th2) lymphocytes, which secrete interleukins IL-4, IL-5 and IL-13. These cytokines drive B-cell class switching to IgE, mast cell sensitisation and eosinophil recruitment. On re-exposure, crosslinking of IgE on mast cells triggers mediator release—histamine, leukotrienes and prostaglandins—resulting in the early-phase symptoms, followed by a late-phase influx of inflammatory cells. Current management stratifies patients according to symptom severity and impact, employing second-generation antihistamines, intranasal corticosteroids and combination sprays as first-line treatments. Allergen-specific immunotherapy (sublingual or subcutaneous) remains the sole disease-modifying approach, aiming to induce immune tolerance through regulatory T-cell induction and a shift from Th2 to Th1 or T regulatory phenotypes. Emerging research focuses on biomarker-guided personalised immunotherapy, non-invasive cytokine profiling and novel small-molecule or biologic agents targeting key mediators of type 2 inflammation. Integration of clinical, immunological and environmental data is poised to refine risk stratification, enhance long-term control and mitigate progression to asthma.

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Allergic Rhinitis Management and Immunological Responses publication trend

The graph below shows the total number of articles in allergic rhinitis management and immunological responses across all publications each year (not limited to Nature Index journals).

Technical terms

Immunoglobulin E (IgE): Antibody class responsible for sensitisation to allergens and mast cell activation.

T helper 2 (Th2) cells: Subset of CD4+ lymphocytes that secrete IL-4, IL-5 and IL-13, driving type 2 inflammation.

Intranasal corticosteroids: Anti-inflammatory sprays applied to nasal passages to reduce mucosal swelling and mediator release.

Sublingual immunotherapy (SLIT): Administration of allergen extracts under the tongue to desensitise the immune system.

Subcutaneous immunotherapy (SCIT): Repeated injections of allergen extracts to induce long-term immunological tolerance.

References

1. Nasal IL-13 production identifies patients with late-phase allergic responses. Journal of Allergy and Clinical Immunology (2023).
2. Predictors for Short‐Term Efficacy of Allergen‐Specific Sublingual Immunotherapy in Children with Allergic Rhinitis. Mediators of Inflammation (2020).
3. Identification of Robust Biomarkers for Early Predicting Efficacy of Subcutaneous Immunotherapy in Children With House Dust Mite-Induced Allergic Rhinitis by Multiple Cytokine Profiling. Frontiers in Immunology (2022).