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5/20/2018 Allergic Rhinitis
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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)