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Allergic Rhinitis

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Background

Rhinitis is defined as inflammation of

the nasal membranes and ischaracterized by a symptom complexthat consists of any combination of the

following: sneezing, nasal congestion,nasal itching, and rhinorrhea. Allergicrhinitis is the most common cause ofrhinitis.

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Background

Total cost $5.3 billion per year. (inAmerica)

Morbidity 10%-40% ( in China) Classification

Perennial allergic rhinitis

Seasonal allergic rhinitis (pollinosis)

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Pathophysiology

Allergic reaction is an exaggerated orinappropriate immune reaction andcauses damage to the host

Type I immediate hypersensitivityreaction

mediated by IgE antibodies,which trigger the mast cells andbasophils to release pharmacologicallyactive agents.

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CLINICAL

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

Allergy history

environmental exposures

occupational exposures

effects on quality of lifeFamily history

Past medical history

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CLINICAL

Signs and Symptoms of Allergic Rhinitis

Sneezing

Itching (nose, eyes, ears, palate)

Rhinorrheawatery secretions)Congestion

Hyposmia

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CLINICAL

"Allergic shiners"

"Nasal crease"(allergic salute).

Nasal

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

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Lab Studies

Total serum IgE

Finding allergen

Common allergen: page 58

Perennial: house dust ,mite ,fungus, pollen

chemical material

Seasonal: pollen ( sunflower, corn , glass )

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Lab Studies

Finding allergen

a. Skin testing: prick test

intracutaneous test

b. Nasal allergen challenge test

c. Serum special IgE determination

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Diagnosis

history

Clinical manifestation

Allergy diagnosis

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Differential Diagnosis

Nonallergic rhinitis with eosinophilia

Vasomotor rhinitis

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Complication

Allergic sinusitis

Asthma

Secretory otitis media

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Treatment

Medical Care

(1) AvoidanceEnvironmental controls and

allergen avoidance

(2) Pharmacotherapy

(3) Immunotherapy

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Treatment

(2) Pharmacotherapya. Steroid: topicalnasal steroid sprays

general

b.Antihistamines: H1-receptor antagonist

First-generation: toldrin (drowsiness )

Second-generation:clarity (dont cross the

blood- brain barrier)

c.Mast cell stabilizing drug:disodium cromoglycate

d. Decongestants

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Treatment

(3) Immunotherapy

Exact mechanism unknownDecrease allergen-specific IgE levels

Increase allergen-specific IgG levels

IgG molecules ( blocking antibodiesthat are important in impeding theallergic reaction. )

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Treatment

(3) Immunotherapymethod: increasing doses of injected allergen

until the maximum tolerated dose isreached

maintenance dose(maximum tolerated dose )

course: 2 years or more

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Treatment

Surgical Care: Surgical care is not

indicated for allergic rhinitis but may be

indicated for comorbid or complicating

conditions.

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Patient Education

Educate patients on environmental

control measures, which involve boththe avoidance of known allergens(substances to which the patient hasIgE-mediated hypersensitivity) and theavoidance of nonspecific, or irritant,triggers

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Question

What are the major symptoms of allergic

rhinitis?

The main complications of allergic rhinitis are:

The indication of the immunotherapy?(p60)