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    Allergic Rhinitis: S Pandey

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    Dr-Firas Nayf Al-Thawabia
    Allergic rhinitis is an inflammation of the nasal mucosa caused by an allergen, most commonly occurring as seasonal or perennial allergic rhinitis. Common symptoms include sneezing, nasal congestion, and rhinorrhea. Diagnosis involves identifying triggers through skin or blood tests and ruling out other causes. Treatment focuses on avoidance of allergens, use of oral or intranasal medications like antihistamines and corticosteroids, and occasionally immunotherapy or surgery for refractory cases. Prognosis is generally good with treatment and avoidance of triggers.

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    Allergic Rhinitis: S Pandey

    Uploaded by

    Dr-Firas Nayf Al-Thawabia
    48 views37 pages
    Allergic rhinitis is an inflammation of the nasal mucosa caused by an allergen, most commonly occurring as seasonal or perennial allergic rhinitis. Common symptoms include sneezing, nasal congestion, and rhinorrhea. Diagnosis involves identifying triggers through skin or blood tests and ruling out other causes. Treatment focuses on avoidance of allergens, use of oral or intranasal medications like antihistamines and corticosteroids, and occasionally immunotherapy or surgery for refractory cases. Prognosis is generally good with treatment and avoidance of triggers.

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    Allergic rhinitis is an inflammation of the nasal mucosa caused by an allergen, most commonly occurring as seasonal or perennial allergic rhinitis. Common symptoms include sneezing, nasal congestion, and rhinorrhea. Diagnosis involves identifying triggers through skin or blood tests and ruling out other causes. Treatment focuses on avoidance of allergens, use of oral or intranasal medications like antihistamines and corticosteroids, and occasionally immunotherapy or surgery for refractory cases. Prognosis is generally good with treatment and avoidance of triggers.

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    48 views37 pages

    Allergic Rhinitis: S Pandey

    Uploaded by

    Dr-Firas Nayf Al-Thawabia
    Allergic rhinitis is an inflammation of the nasal mucosa caused by an allergen, most commonly occurring as seasonal or perennial allergic rhinitis. Common symptoms include sneezing, nasal congestion, and rhinorrhea. Diagnosis involves identifying triggers through skin or blood tests and ruling out other causes. Treatment focuses on avoidance of allergens, use of oral or intranasal medications like antihistamines and corticosteroids, and occasionally immunotherapy or surgery for refractory cases. Prognosis is generally good with treatment and avoidance of triggers.

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    of 37

    ALLERGIC RHINITIS

    S PANDEY
    OUTLINE

    Definition and
    Introduction
    Etiologies
    Presentation
    Diagnosis
    Prognosis
    Management
    RHINITIS

    Two or more nasal symptoms of:


    Nasal congestion
    Rhinorrhea
    Sneezing/Itching
    Impairment of Smell for
    more than 1 hour a day
    RHINITIS

    Occurs most commonly as allergic rhinitis


    Noninfectious rhinitis has been classified as either
    allergic or non-allergic.
    Allergic rhinitis is defined as immunologic nasal
    response, primary mediated by immunoglobulin E
    (IgE).
    Non-allergic rhinitis is defined as rhinitis symptoms
    in the absence of identifiable allergy, structure
    abnormality or sinus disease.
    INTRODUCTION

    Nasal function includes


    Temperature regulation
    Olfaction
    Humidification
    Filtration and Protection
    INTRODUCTION
    Nasal lining contains secretion of IgA, proteins
    and enzymes
    Nasal Cilia propel the matter toward the natural
    ostia at frequency of 10-15 beats per minute
    Mucous move at a rate of 2.5-7.5 ml per
    minute
    ALLERGIC RHINITIS

    Defined as an inflammation of the nasal


    mucosa, caused by an allergen
    Most common atopic allergic reaction
    Affects 10 to 25% of population
    50% of rhinitis in ENT is AR
    Most commonly seen in young children and
    adolscents
    ETIOLOGY

    Classified as
    Precipitating factors
    Predisopsing factors
    PRECIPITATING FACTORS
    Aerobiological flora
    Allergens present in the environment
    House dust and dust mites
    Feathers
    Tobacco smoke
    Industrial chemicals
    Animal dander

    Nasal physiology
    Disturbances in normal nasal cycle
    PREDISPOSING FACTORS

    Genetic
    Multiple gene interactions are responsible for allergic
    phenotype
    Chromosomes 5, 6, 11, 12 & 14 control inflammatory process
    in atopy
    50% of allergic rhinitis patients have a positive family history
    of allergic rhiniits

    Endocrine
    Puberty
    Pregnant states and post partum stages
    menopausal
    PREDISPOSING FACTORS.

    Psychological
    Focal sensitivity states
    Infections: fungal infections nb
    Physical
    Degree of pollution of air
    Humidity and temperature differences
    Temperature changes
    Age & sex
    IgA deificiency
    COMMON ALLERGENS
    Pollens
    Spring tree pollens(maple alder, birch)
    Summet : grass pollent (bluegrass, sheep shorell etc
    Autums: weed pollen (ragweed)
    Molds
    Penicillium, cladosporium etc
    Insects
    Cockroaches, house flies, fleas, bed bugs
    Animals
    Cats. Dogs. Horse, monkeys, rats, rabbits etc
    Dust mites
    dermatophagoides
    Ingestants
    Nuts, fish, eggs, milk etc
    PATHOPHYSIOLOGY

    Immunoglobulin (Ig) E mediated type 1


    hypersensitivity response to an antigen
    (allergen) in a genetically susceptible person
    Type 1 Hypersensitivity causes local
    vasodilation and increased capillary
    permeability
    CLASSIFICATON - FORMER
    Seasonal
    Often known by its misnomer of Hay fever
    Neither caused by hay or has fever
    Summer cold
    Caused by virus causing URTI (not a true allergic
    rhinitis
    Rose fever
    Often cited in indian subcontinent
    Colourful or fragrant flowering plants rarely cause
    allergy as their pollens to heavy to be airborne
    Perennial
    Allergens present throughout the year
    CLASSIFICATION - CURRENT

    Intermittent
    Symptoms present less than 4 days per week and
    less than 4 weeks per year

    Persistant
    Symptoms present more than 4 days per week and
    more than 4 weeks per year
    SEVERITY

    Mild
    No interference with daily activity or troublesome
    symptoms

    Moderate severe
    Presence of at least one:
    Impaired sleep, daily activity work or school
    Troublesome symptoms
    COMPLICATIONS:

    Allergic asthma
    Chronic otitis media
    Hearing loss
    Chronic nasal obstruction
    Sinusitis
    Orthodontic malocclusion in children
    SIGNS AND SYMPTOMS

    Sneezing Earache
    Itchy nose, ears, Tearing of eyes
    eyes and palate Red eyes
    Rhinorrhea Swollen eyes
    Post nasal drip Fatigue
    Congestion Drowsiness
    Anosmia Malaise
    Headache
    PHYSICAL EXAMINATION
    Nasal crease
    Horizontal crease
    across the lower half
    of the bridge of the
    nose

    Rhinorrhoea
    Thin watery secretions
    Deviated or
    perforated nasal
    septum
    EXTRA NASAL MANIFESTATIONS

    Retracted and
    abnormal flexibility
    of TM
    Injection and swelling
    of palpebral
    conjunctivae with
    excess tearing
    Cobblestoning on
    oropharynx
    CLASSICAL SIGNS OF AR

    Over bite
    High arched palate
    Allergic shiners
    Allergic salute
    Transverse crease over
    tip of nose and lower
    eye lid
    Conjunctival
    congestion
    Periorbital oedema
    INVESTIGATIONS

    FBC
    Histamine test
    Nasal smear
    Intranasal provocation test
    Skin tests
    Subcuticular test
    More accurate with lower incidence of false positive
    results
    Contraindicated in case of anti histaminic, anti
    inflammatory or decongestant treatment
    Intradermal tests
    Be prepared for anaphylaxis
    Skin end point titration test
    Quantitative intradermal test for specific allergen
    Nasal challenge
    Nasal cytology
    Take a sample of nasal cavity without anaesthesia
    and send for identificaton of cell types in the nasal
    cavity
    Increased number of eosinophils suggests allergic
    disease
    OTHER INVESTIGATIONS

    RAST (radio allergo sorbant test)


    FAST ( fluro allergo sorbant test)
    PRIST (paper immuno allergo sorbant test)
    Xray PNS
    CT PNS (for complicated cases with polyposis)
    Nasal endoscopy ( under local or GA)
    Evaluate for asthma
    PROGNOSIS

    Treatment is available and patients remain


    symptom free only until re exposure to allergic
    antigen
    No evidence of mortality from the disease
    itself, but high morbidity
    Seasonal allergic Symptoms improve as
    patients age
    MANAGEMENT:
    AVOIDANCE

    MEDICAL SURGICAL
    AVOIDANCE

    Minimize contact with offending allergens


    Reduce dust mite exposure by encasing bed
    pillows and matress in allergen proof covering
    Use of allergen proof bedding..
    ACUTE PHASE MEDICATIONS
    Antihistamines effectively block histamine effects
    (runny nose and watery eyes)
    Side effects : sedation, dry mouth, nausea, dizziness,
    blurred vision, nervousness
    Non sedating antihistamines (cetrizine, loratidine)
    Fewer side effects
    Fexofenadine may be effective
    Carries a lower risk of cardiac arrythmias
    Decongestants
    Shrink nasal mucous membrane by vasoconstriction
    Available OTC and in combination with antihistamines,
    analgesics and anti cholinergics
    COMMONLY PRESCRIBED
    ANTIHISTAMINES
    Anticholinergenic agents
    Inhibit mucous secretions, act as drying agent
    Topical eye preparations
    Reduce inflammation and relieve itching and burning
    MEDICAL: PREVENTIVE THERAPY
    Intranasal corticosteroids
    Reduce inflammation of mucosa
    Prevent mediator release
    Can be used safely daily
    May be given systemically for a short course during a
    disabling attack

    Intranasal cromolyn sodium


    Mast cell stabiliser
    Prevents release of chemical mediators
    Oral mast cell stabilizer
    Otpthalmic solution cromolyn
    Leukotriene receptor antagonists
    Montelukast (singulair) and Zafirlukast (accolate)
    Systemic agents used for asthma
    Reduce inflammation, edema and mucous sectetions
    of allergic rhinitis
    TOPICAL NASAL STEROIDS
    AMERICAN ALLERGOLOGY
    GUIDELINES
    IMMUNOTHERAPY
    If allergic rhinitis is refractory to
    pharmacotherapy or severe
    Helps in reducing the specific serum IgE
    level
    decreases the basophil sensitivity
    increases IgG blocking antibody level , thus
    preventing allergen from reaching mast
    cells and subsequent mast cell
    degranulation
    SURGICAL THERAPY

    Limited
    Submucosal turbinectomy - reduces size of
    boggy turbinates
    Septoplasty correction of deviation of
    septum
    Sinus surgery clearance of sinuses if
    sinusitis is present
    Thank you.

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