Allergic Rhinitis
Ahmed Shahab
M08082
Definition
Allergic rhinitis clinically defined as a
symptomatic disorder of the nose induced by an
IgE--mediated inflammation after allergen
exposure of the membranes lining the nose.
Why is it important ?
• Allergic rhinitis affects 20 % of the world ‘s population
and is the most important cause of rhinitis .
• It is not life threatening but impairs the quality of life.
• It has resulted in direct and indirect costs of $5.2 billion
per year in total.
• It can lead to complications like chronic sinusitis, nasal
polyps , Serous otitis media , bronchial asthma ,atopic
dermatitis, learning difficulties, sleep disorders, and
fatigue.
Types of allergic rhinitis
• Seasonal: Symptoms occur in a particular
season , due to exposure to a certain allergen
only present in that season . E.g exposure to
plant allergens.
• Perennial : symptoms are present throughout
the year. E.g dust,insects, mold spores.
• Occupational : symptoms are present only
upon exposure to allergens present at the
workplace and does not occur outside it.
ARIA Classification
Intermittent Persistent
• < 4 days per week • ≥ 4 days per week
• or < 4 weeks • and ≥ 4 weeks
Mild Moderate-severe
normal sleep • abnormal sleep
& no impairment of daily • impairment of daily activities,
activities, sport, leisure sport, leisure
& normal work and school • abnormal work and school
& no troublesome symptoms • troublesome symptoms
ARIA Report 2001
Cause of Allergic rhinitis
Types of mediators
Preformed Newly synthesised
• Histamine • Prostaglandins (PGD2)
• Eosinophil Chemotactic • Leukotrienes
Factor –A • Thromboxane
• Neutrophil Chemotactic
factor – A
Allergens
Natural History of Allergic Rhinitis
• Onset is usually at 12-16 years . However may
occur in infants as young as 6 months.
• Symptoms often wane in older individuals but
can develop or persist at any age.
• No apparent gender selectivity or
predisposition for developing allergic rhinitis.
ISAAC study , Lancett 1998
Clinical Manifestations
• Watery nasal discharge
• Nasal obstruction
• Itchiness of the nose
• Paroxysmal sneezing
How are the symptoms caused?
• Irritation of free
nerve endings---- Itching and sneezing
• Increased
mucus production ------ Rhinorrhoea
• Vasodilation -------- Congestion
• Increased
vascular permeability---- Oedema
Nasal Signs
• Allergic Salute
• Swollen oedematous turbinates
• Thin, watery or mucoid discharge
Ocular signs
• Oedema of lids with congestion
• Cobblestone appearance of conjunctiva
• Allergic shiners
Otologic Signs
• Retracted Tympanic membrane
• Serous Otititis media secondary to Eustachian
tube blockage.
Other signs
• Granular pharyngitis with hyperplasia of
submucosal lymphoid tissue
• Oedema of the vocal cords.
Diagnosis
• History
• Physical/nasal Examination
• Investigations
Investigations
• CBC- for findings of marked eosinophilia
• Nasal Smear
• Prick test
• Provocation test
• Radioallergosorbent test
Treatment
• Avoidance of allergen
• Drug Treatment
• Immunotherapy
Avoidance of allergen
• Reduction of outdoor exposure in the season
of allergic reaction can be somewhat helpful
• Taking a shower after exposure reduces the
chances of allergen being attached to the hair
and skin.
• Bed linens can be washed in hot water every 2
weeks to avoid dust mites.
• Carpeting should be removed.
Drug Treatment
• Antihistamines: Block H1 receptor sites inhibiting vascular
permeability, mucus secretions and pruritis.
• Intranasal steroids : Relieve sneezing,itching rhinorrhea and
congestion.
• Systemic steroids : Used when symptoms are severe .
• Decongestants: Alpha adrenergic receptor agonists causing
vasoconstriction and reducing turbinate congestion.
• Intranasal cholinergics : Inhibit rhinorrhea
• Leukotriene inhibitors: inhibit leukotriene formation thus reducing
all AR symptoms.
• Mast cell stabilisers : These have to be administered before the
symptoms appear in order to be effective.
Immunotherapy
• Allergen is given in gradually increasing doses
until a local reaction or mild systemic
symptom is observed .
• This therapy is continued with the aim of
increasing the thershold of appearance of
symptoms.
Thank you
KHA !!
