for the implementation of treatment. • AR is a risk factor for asthma. • Other co-morbidities of AR include: sinusitis, nasal polyposis, conjunctivitis, otitis media with effusion, upper respiratory infections, breathing through the mouth, and sleep disorders. • AR has a significant impact on patients based on the degree of the severity of their symptoms. It has psychological effects, interferes with social interactions, and creates an economic burden not only for the affected subject, but for the family and for the society at large. • Management is based on patient education, environmental control measures, pharmacotherapy and specific immunotherapy. Introduction Allergic rhinitis is defined by the presence of nasal congestion, anterior and posterior rhinorrhea, sneezing, and nasal itching secondary to IgE-mediated inflammation of the nasal mucosa. It must be differentiated from other non allergic forms of rhinitis with a similar clinical picture. Risk factors for the development of AR include a family history of atopic diseases, increased total serum IgE before 6 years of age, higher socio-economic class, and the presence of positive immediate-type hypersensitivity skin tests. The most common causative allergens include pollens, dust mites, molds, and insects Clinical Classification and Co-morbidities Table 1 — Prevalence of Rhinitis and Rhinoconjunctivitis in Latin America and the World* Worldwide (%) Latin America (%) 6-7 years old 13-14 years old Rhinitis last 12 months 20.7 33.2 27.9 37.6 Rhinoconjunctivitis 8.3 15.1 12.1 18.5 Severe rhinitis 0.6 1.0 1.1 1.1 * ISAAC study, see reference 2. ARIA (Allergic Rhinitis and its Impact on Asthma), the first ever evidence-based guidelines for allergic rhinitis, proposed a new classification of AR into four categories according to the severity and frequency of the symptoms: 1) Mild intermittent; 2) Mild persistent; 3) Moderate/severe intermittent; and 4) Moderate/ severe persistent. Patients with AR frequently have symptoms of other allergic diseases, mainly atopic dermatitis, conjunctivitis and asthma. More than 40% of patients with AR have asthma, and more than 80% of asthmatic patients suffer concomitant rhinitis. Also, patients with rhinitis have an increased risk of developing asthma. Other co-morbidities that are observed with increased frequency in patients with AR include sinusitis, nasal polyposis, upper respiratory infections, otitis media with effusion, breathing through the mouth, sleep disorders, decreased quality of life, and impaired learning and attention in children (Figure 1). Figure 1. Co-morbidities of allergic rhinitis Allergic Rhinitis SECONDARY DECREASED QUALITY OF LIFE SLEEPING DISORDERS LEARNING AND ATTENTION IMPAIREMENT MOUTH BREATHING DENTAL MALOCLUSION ASTHMA PRIMARY ATOPIC DERMATIS CONJUNCTIVITIS SINUSITIS POLYPOSIS UPPER RESPIRATORY INFECTIONS OTITIS MEDIA Severity of Allergic Rhinitis The severity and duration of symptoms of AR varies in different patients. The classification of AR into mild and moderate/ severe is useful for therapeutic purposes. Severe persistent rhinitis sufferers are those patients whose symptoms are inadequately controlled despite adequate (i.e., effective, safe, and acceptable) pharmacologic treatment based on guidelines. Bousquet et al have reported that current treatment and allergy diagnosis have no effect on the patient’s assessment of rhinitis severity and that the severity, rather than the duration, had a greater impact on Visual Analogue Scale levels. Therefore, we should consider control of the disease as the main target of management. It is likely that a large proportion of this group of patients may benefit from allergen specific immunotherapy. The Burden of Allergic Rhinitis AR has a significant socio-economic impact on the patient, the patient’s family and society. It affects multiple parameters including quality of life, physical, psychological and social functioning and has financial consequences. Physical Symptoms: Allergies in America, a survey conducted by telephone involving 2,500 adults with AR, showed that the most common symptoms are congestion, rhinorrhea, nasal and ocular itching, tearing, sneezing, headache, facial and ear pain (Table 2). Table 2 — Physical and Mental