Nasal cavity, paranasal sinuses, nasopharynx

Inflammatory lesions

Allergic rhinosinusitis

Last author update: 1 April 2016
Last staff update: 2 March 2020

Copyright: 2003-2023,, Inc.

PubMed Search: Allergic rhinosinusitis[TI]

Margaret S. Brandwein-Weber, M.D.
Page views in 2022: 4,372
Page views in 2023 to date: 1,278
Cite this page: Sun J, Brandwein-Weber M. Allergic rhinosinusitis. website. Accessed March 26th, 2023.
Definition / general
  • Common IgE mediated sinonasal hypersensitivity reaction provoked by reexposure to a specific antigen, including plant pollen, fungi, dust mites, animal allergens
  • May be acute or chronic
  • Also called hay fever
  • Also called type I IgE immunological rhinitis
  • Acute allergic rhinosinusitis: develops 2 to 5 minutes after antigen-antibody exposure, reaching its peak about 15 minutes later
  • Chronic allergic rhinosinusitis: lasts more than 6 weeks; includes aspirin exacerbated respiratory disease
  • Bilateral nasal cavity and paranasal sinuses
  • IgE antibody binding and mast cells release various mediators (histamine, prostaglandins and leukotrienes) causing vasodilation, edema, eosinophilia, nasal congenstion, rhinorrhea, sneezing and itching
  • Type I IgE hypersensitive reaction to allergens, including pollen, animal dander, dust mites, mold spores and food
  • Aspirin exacerbated respiratory disease (AERD, also known as Samter triad) refers to the syndrome of allergic nasal polyps with eosinophils, aspirin intolerance and bronchial asthma, which affects 4 - 10% of asthmatics
  • AERD is due to inhibition of the cyclooxygenase pathway in sensitive individuals; this shunts metabolism of arachidonic acid to the 5-lipooxygenase pathway, leading to increased proinflammatory leukotrienes and decreased PGE2, a protective prostaglandin
Clinical features
  • Rhinorrhea, sneezing, itching
  • Stained smears of nasal secretion slow > 25% eosinophils
  • Elevated total serum IgE
  • Avoidance of allergens, use of environmental controls, sublingual immunotherapy
Microscopic (histologic) description
  • Mucous secretions have neutrophils and prominent eosinophils
Cytology description
  • Stained smears of nasal secretion: > 25% eosinphils
Differential diagnosis
Back to top
Image 01 Image 02