14. Allergic Rhinitis

7/26/2019 14. Allergic Rhinitis

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Allergic Rhinitis

I MADE SUDIPTA

Dept of OtorhinolaryngologyHead &Neck Surgery


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INTRODUCTION

AR Atopic disease which is often found in

clinical practice

It is a manifestation from type I hypersensitivitybased on Gell & Comb classification. IgE

mediated nasal mucosa as target organ

Affected all age, especially children, teenager

and young adult (productive ages)


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Recurrence , disturbed daily activity and

family

Patient has difficulty to concentrate, headache, sleep disturbance, emotion

disturbance, frequent sneezing

Decreased productivity in worker, added

expenditure for doctor and medicine


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Definition

Allergic rhinitis is an inflammation process in

mucous membranes of the nose which is

mediated by Ig E. This reaction is due to

abnormal reaction / hypersensitivity of

nasal mucosa to specific allergen.

For normal people this process doesnt

cause any reaction


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Etiology

Allergen :

1. Inhalant : house dust, pollen, animal

dander, etc

2. Ingestion : Milk, shrimp, egg, peanuts

3. Injection

4. Contact


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Pathophysiology

If someone ingested [ oral, inhalation ] or

injected with allergen, in several minutes

Immune response with production

of antibody or immunoglobulin

Immunoglobulin will react to that allergen

immunity or allergy

[hypersensitivity ]


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In Immunity, Immunoglobulin will protect ourbody from occurrence of disease.

but

In allergy, Immunoglobulin will cause ourbody to suffer from disease.

In mucosa and blood circulation of patient,there is specific Ig which can only give

reaction to certain allergen


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This allergy reaction will degranulate mast cells and/or

basophils releasing of vasoactive amines such

as: histamine

bradykinine

serotonin etc

Histamine and Serotonin :

Dilatation & Increase permeability of capillary blood

vessels

Smooth muscle contraction

Increase secretion of lacrimal gland, bronchus and

digestive tract


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Bradykinine :

Smooth muscle contraction

Increase permeability of capillary blood

vessels

vasodepressordecrease blood pressure

Increase secretion of salivary gland and

sweat gland


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This process will end if contact with

specific allergen is also discontinued


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Classification

Based on time of exposure and type ofallergen

Seasonal : present during certain season

Perennial : present throughout the year and

do not affected by season


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New classification of AR by WHO ARIA

( Allergic Rhinitis and Impact on Asthma )2007

Based on :

1. Intermittent if* 4 weeks


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Based on severity : Mild all of the following

normal sleep

no impairment of daily activities, sport, leisure

no impairment of work and school

no troublesome symptoms

Moderate-Severe one or more items

abnormal sleep

impairment of daily activities, sport, leisure

impaired work and school

troublesome symptoms


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Moderate-severe

one or more items

. abnormal sleep. impairment of dailyactivities, sport, leisure

. abnormal work and school

. troublesome symptoms

Persistent. 4 days per week. and 4 weeks

Mildnormal sleep

no impairment of dailyactivities, sport,

leisurenormal work and

school

no troublesome

symptoms

Intermittent. < 4 days per week. or < 4 weeks

ARIA Classification


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- Itchy at the nose, ear and soft palate

- Frequent sneezing

- Nasal blockage

- Clear and watery runny nose

- Nasal mucosa: edema, pale or bluish

Sign & Symptoms


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Allergic shiners are the dark discoloration of the

lower eyelids which occurs due to venous stasisin individuals with chronic nasal congestion

Allergic salute, due to itching, patient often rubs

his/her nose using the back of the hand

Allergic crease, a horizontal crease or pale line

that develops across the lower part of the noseas a consequence of frequent upward wiping of

the nose.


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Allergic Salute

Allergic Crease

Allergic Shiner

Adenoid Facies


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Ancillary procedure

1. Skin test :

Single Intracutan or intradermal or serial [ Skin End-point

Titration ]

Prick Test

Scratch Test

2. Nasal mucous cytology for eosinophilia

3. Ig E specific test [ Radioallergosorbent test /RAST ]

4. Paranasal sinus X-Ray [ Water`s ]

5. Elimination and provocation test [ for food allergy ]


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Management

1. Contact avoidance with allergen2. Medicine

- anti histamine

- decongestant- antihistamine + decongestant

- corticosteroid

3. Immunotherapy

4. Increase body resistance with: exercise,good nutrition and enough rest


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ELIMINASI ALERGEN/ AVOIDANCE


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Differential diagnose :

1. Acute Rhinitis.

2. Rhinitis medicamentosa.3. Vasomotor Rhinitis


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14. Allergic Rhinitis