Allergic Rhinitis

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)
Rhinorrheawatery secretions)
Congestion
Hyposmia


CLINICAL
"Allergic shiners"
"Nasal crease"
(allergic salute).
Nasal
examination :swol
len (boggy), pale,
blue-gray mucosa
Lab Studies
Total serum IgE
Finding 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

intracutaneous test

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

Diagnosis
history

Clinical manifestation

Allergy diagnosis
Differential Diagnosis
Nonallergic rhinitis with eosinophilia

Vasomotor rhinitis

Complication
Allergic sinusitis

Asthma

Secretory otitis media

Treatment
Medical Care
(1) Avoidance
Environmental controls and
allergen avoidance
(2) Pharmacotherapy
(3) Immunotherapy
Treatment
(2) Pharmacotherapy
a. Steroid: topicalnasal steroid sprays
general
b.Antihistamines: H
1
-receptor antagonist
First-generation: toldrin (drowsiness )
Second-generation:clarity (dont 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) Immunotherapy
method: 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)