Allergic rhinitis & Vasomotor rhinitis

• IgE mediated immunological response of nasal mucosa to air borne allergen

• Characterized by sneezing, itching, watery nasal discharge, nasal obstruction

Aetiopathogenesis

• IgE mediated hypersensitivity reaction to specific allergen

• Allergens- pollen, grass, weeds- seasonal allergic rhinitis- House dust mite, animal hair, dander, perfumes,

feathers, smoke, dust, atmospheric pollutant- perennial allergic rhinitis

• IgE produced by plasma cell- FC fraction bind to mast cell, FAB combines with antigenic substance- degranulation of mast cells- histamine release, slow releasing substance of anaphylaxis

• Atopy– Tendency to develop an exaggerated IgE antibody

response to one or more allergen– Allergic disorder include allergic rhinitis, asthma,

eczema– Genetically inherited

Types

• Seasonal allergic rhinitis (Hay Fever)– Inhaled allergen- pollen grain– Certain season –spring, autumn

• Perennial allergic rhinitis– Occur throughout year– Caused by house dust mite etc

Clinical features

• B/L nasal obstruction• Rhinorrhoea• Paroxysms of sneezing• Hyposmia • Itchiness of nose, eyes, palate• Associated other allergy

• Signs – Boggy, bluish edematous turbinates– Excessive nasal secretions

• Sequelae – Regression– Progression to bronchial asthma, ethmoidal polyp– Recurrent sinusitis– Serous ottitis media

Investigations

• Nasal smear microscopy- eosinophilia• Skin prick test- 10-30% asymptomatic- positive

test• RAST (radioallerosorbent test)• Serum IgE• Nasal provocation test• Scratch test

Treatment

• Avoidance of allergens• Medication– Antihistaminics- cetrizine, fexophenadine,

loratadine– Topical corticosteroids spray- fluticasone,

momentasone, budesonide, beclomethasone– Mast cell stabilizers- sodium chromoglycate– Nasal decongestant- oxymetazoline,

xylometazoline

• Desensitization – Blocking IgG antibody that prevent antigen

binding to IgE– Effective for seasonal allergy– Drawbacks • Multiple allergy• Difficult to identify exact allergen• Series of injections• Anaphylaxis• Recurrence

Vasomotor rhinitis

• Non infective, non allergic condition• Aetiology is obscure• Clinical features similar to allergic rhinitis

• Pathophysiolgy – Disorder of autonomic nervous system-

parasympathetic stimulation– Stress, emotional disturbances – aggravate the

symptoms– Increase in vascularity- nasal mucosal swelling,

rhinorrhea, sneezing• No definitive allergen identified

• Eosinophilic– Moderate nasal

obstruction– Mild rhinorrhea– Minimal sneezing– Hyposmia present– Marked mucosal

swelling– Inf turbinate enlarged– Polyp frequent – Sinus mucosal

thickening- frequent

• Non eosinophilic– Mild nasal obstruction– Severe rhinorrhea– Minimal sneezing– Hyposmia-rare– Mucosal swelling mild– Mild inf turbinate

enlargement– Polyp- never– Sinus mucosal thickening

- rare

• Types – Runners– Blockers

• Treatment– Topical nasal steroids– Antihistaminics– Vedian nerve neurectomy

– Enlarged inferior turbinates• Linear thermal cautery• Submucosal diathermy, cryotherapy• Turbinoplasty