Older classification…….

-seasonal-.some seasons due

to pollen , flower…etc

-perennial-.can occur any time

in an year due to-dust mite,

smoke,..etc

AETIOLOGY• GENETIC PREDISPOSITION

ONE PARENT HAVE—20%

BOTH PARENTS HAVE—47%

• ENVIRONMENT

SEASONAL - POLLENS FROM TREES

,GRASSES, & WEEDS

PERENNIAL - DUST MITES ,MOLDS,INSECT

PARTS ,FIBRES & ANIMAL DANDERS

Sensitization

Early phase reaction

Late phase reaction

Systemic reaction

Histamine- vasodialation ,

bronchospasm

Heparine-enhances

phagocytosis

ECF-A-attracts eosinophil

NCF-A-attracts neutrophil

Early phase reactions- 5 to 30

minuts

RELEASE OF MEDIATORS

INCREASEDVASCULAR HYPERACTIVITY SENSORY NERVE

CHANGE IN

SMOOTH

PERMEABILITY & OF GLANDS STIMULATION MUSCLE

TONE

VASODILATATION

TISSUE OEDEMA INCREASED SECRETION

NASAL BLOCKAGE RHINORRHOEA ITCHING &

BROCNCHOSPASM

SNEEZING

Late phase reaction- 6-

12hours

--- cellular inflammation

(recruitment of cells)

eosinophils, basophils,

monocytes,lymphocytes

SYSTEMIC ACTIVATION• ANTIGEN STIMULATION IN THE NOSE OR

LUNG CAUSES THE RELEASE OF

EOSINOPHILS PRECURSORS FROM THE

BONE MARROW WHICH CIRCULATE TO

THE BOTH SITES

Sensitization

Early phase reaction

Late phase reaction

Systemic reaction

CLINICAL FEATURES• SYMPTOMS

SEASONAL

PAROXYSMAL SNEEZING

WATERY NASAL DISCHARGE

NASAL OBSTRUCTION

ITCHING IN THE NOSE

ITCHING IN EYES PALATE OR PHARYNX

BRONCHOSPASM

• PERENNIAL

FREQUENT COLDS

PERSISTENTLY STUFFY NOSE

LOSS OF SENSE OF SMELL

POSTNASAL DRIP

CHRONIC COUGH

HEARING IMPAIRMENT

• SIGNS

NASAL SIGNS

-ALLERGIC SALUTE

• NASAL MUCOSA -PALE AND ODEMATOUS

- TURBINATES ARE SWOLLEN

- THIN WATERY OR MUCOID DISCHARGE

• OCULAR SIGNS

-OEDEMA OF LID

-COBBLESTONE APPEARANCE OF CONJUNCTIVA

-DARK CIRCLES UNDER THE EYES(ALLERGIC SHINERS)

• OTOLOGIC SIGNS

-RETRACTED TYMPANIC MEMBRANE

-SEROUS OTITIS MEDIA

• PHARYNGEAL SIGNS

-GRANULAR PHARYNGITIS

-FEATURES OF PROLONGED MOUTH BREATHING

• LARYNGEAL SIGNS

- HOARSENESS

- OEDEMA OF VOCAL CORDS

THANK U