Allergic Rhinitis

prepared by :

Zirgham Hafeez

Background

Rhinitis is defined as inflammation of the nasal membranes and is characterized by a symptom complex that consists of any combination of the following: sneezing, nasal congestion, nasal itching, and rhinorrhea. Allergic rhinitis is the most common cause of rhinitis.

Background

Total cost $5.3 billion per year. (in America)

Morbidity 10%-40% ( in China)Classification Perennial allergic rhinitis Seasonal allergic rhinitis (pollinosis)

Pathophysiology

Allergic reaction is an exaggerated or inappropriate immune reaction and causes damage to the host

Type I immediate hypersensitivity reaction

mediated by IgE antibodies, which trigger the mast cells and basophils to release pharmacologically active agents.

CLINICAL

History: Obtaining a detailed history is important in the evaluation of allergic rhinitis.

Allergy history environmental exposures occupational exposures effects on quality of life Family history Past medical history

CLINICAL

Signs and Symptoms of Allergic Rhinitis

Sneezing

Itching (nose, eyes, ears, palate)

Rhinorrhea（ watery secretions)

Congestion

Hyposmia （嗅觉下降）

CLINICAL

"Allergic shiners" "Nasal crease"

(allergic salute). Nasal

examination :swollen (boggy), pale, blue-gray mucosa

Lab Studies

Total serum IgEFinding allergen

Common allergen: page 58

Perennial: house dust ,mite ,fungus, pollen

chemical material

Seasonal: pollen ( sunflower, corn , glass )

Lab Studies

Finding allergen a. Skin testing: prick test （点刺试验） intracutaneous test （皮内试验）

b. Nasal allergen challenge test c. Serum special IgE determination

Diagnosis

history

Clinical manifestation

Allergy diagnosis

Differential Diagnosis

Nonallergic rhinitis with eosinophilia

嗜酸粒细胞增多性非变应性鼻炎Vasomotor rhinitis

血管运动性鼻炎

Complication

Allergic sinusitis 过敏性鼻窦炎 Asthma 哮喘 Secretory otitis media

分泌性中耳炎

Treatment

Medical Care

(1) Avoidance

Environmental controls and

allergen avoidance

(2) Pharmacotherapy

(3) Immunotherapy

Treatment

(2) Pharmacotherapya. Steroid: topical—nasal steroid sprays general

b.Antihistamines: H1-receptor antagonist First-generation: toldrin (drowsiness ) Second-generation:clarity (don’t cross the blood- brain barrier)c.Mast cell stabilizing drug:disodium cromoglycate d. Decongestants

Treatment

(3) Immunotherapy

Exact mechanism unknown

Decrease allergen-specific IgE levels

Increase allergen-specific IgG levels

IgG molecules ( blocking antibodies that are important in impeding the allergic reaction. )

Treatment

(3) Immunotherapymethod: increasing doses of injected allergen until the maximum tolerated dose is reached maintenance dose(maximum tolerated dose )

course: 2 years or more

Treatment

Surgical Care: Surgical care is not

indicated for allergic rhinitis but may be

indicated for comorbid or complicating

conditions.

Patient Education

Educate patients on environmental control measures, which involve both the avoidance of known allergens (substances to which the patient has IgE-mediated hypersensitivity) and the avoidance of nonspecific, or irritant, triggers

Question

What are the major symptoms of allergic rhinitis?

The main complications of allergic rhinitis are:

The indication of the immunotherapy?(p60)