Allergic Rhinitis DR. ABHISHEK BHARDWAJ - PowerPoint Presentation

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Allergic Rhinitis

DR. ABHISHEK BHARDWAJ

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Rhinitis

is defined clinically as having

two or more

symptoms

of

-anterior

or posterior

rhinorrhoea

,

-sneezing

-nasal blockage

and/or

-itching

of the nose

D

uring

two or

more consecutive

days for more than one hour on most days

.

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Allergic rhinitis

-caused by allergen exposure leading to an

IgE

mediated reaction

Allergic rhinitis is

subdivided into

:

-

intermittent

(IAR) or

persistent

(PER) disease

- severity into

mild

or

moderate

/

severe

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Two clinical types:

1.

Seasonal.

2.

Perennial.

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AETIOLOGY

Inhalant allergens

Genetic predisposition

Chances

of children

One suffer -20%

Both parents – 47%

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Hygeine

Hypothesis

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PATHOGENESIS

“

Priming

e

ffect

”

mucosa

earlier

sensitized to

an allergen will react to smaller doses of subsequent

specific allergen

.

It

also gets “primed” to other nonspecific

antigens to

which patient was not

exposed

Nonspecific nasal

hyper-reactivity is seen in patients of allergic rhinitis

.

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Clinically, allergic response occurs in two phases:

1.

Acute or early phase.

occurs immediately within 5–30 min, after exposure to the specific allergen

due to release of

vasoactive

amines like histamine.

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2.

Late or delayed phase.

occurs 2–8 h after exposure

to allergen without additional exposure.

due to infiltration

of

inflammatory cells at

the

site of

antigen deposition causing swelling, congestion

and thick

secretion.

In

the event of repeated or

continuous exposure

to allergen, acute phase

symptomatology

overlaps the

late phase.

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CLINICAL FEATURES

No

age or sex predilection.

Usually, onset

is

at 12–16

years of age.

The

cardinal

symptoms of seasonal nasal allergy include

paroxysmal

sneezing, 10–20 sneezes at a time,

nasal obstruction,

watery nasal discharge and

itching in the nose Itching may also involve eyes, palate or pharynx.

Some may get

bronchospasm

.

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Symptoms of perennial allergy

are not so severe as that

of

the

seasonal type.

frequent colds

stuffy nose

a

nosmia

/

hyposmia

,

postnasal drip

chronic

cough

hearing

impairment

due to

eustachian

tube blockage or fluid in the middle

ear

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Signs of allergy

Nasal

signs

transverse

nasal crease—a black

line

across

the middle of dorsum of nose due to

constant upward

rubbing of nose simulating a salute (

allergic salute)

pale and

oedematous

nasal mucosa

Turbinates

are swollen.

Thin

mucoid

discharge is usually present.

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Ocular signs

oedema

of lids,

congestion

and

cobblestone appearance

of the conjunctiva,

dark

circles

under the

eyes (

allergic shiners

)

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Otologic

signs

retracted

tympanic membrane

serous

otitis

media

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Pharyngeal signs

granular

pharyngitis

due to hyperplasia of

submucosal

lymphoid tissue.

A child with perennial allergic rhinitis may show all the features of prolonged mouth breathing as seen in adenoid hyperplasia.

•

Laryngeal signs

include hoarseness and

oedema

of the

vocal cords.

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Investigations

Peripheral

eosinophilia

Raised

IgE

Skin prick test

Radioallergosorbent

test- Specific

IgE

measurements

Nasal allergen challenge test

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COMPLICATIONS

Nasal

allergy may cause:

1. Recurrent

sinusitis

2. Formation of nasal

polypi

in about 2%.

3. Serous

otitis

media.

4. Orthodontic problems and other ill-effects of

prolonged mouth

breathing especially in children.

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5. Bronchial

asthma

.

Patients

of nasal allergy have

four times

more risk of developing bronchial asthma.

Twenty to

thirty per cent of patients with rhinitis have asthma.

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TREATMENT

Treatment

can be divided into:

1. Avoidance of allergen.

2.

Pharmacotherapy

3. Immunotherapy.

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Immunotherapy

U

sed

when drug treatment

fails

Allergen

is given in

gradually increasing

doses till the maintenance dose is reached

.

Suppresses

the formation of

IgE

.

R

aises

the

titre

of specific

IgG

antibody.

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To

be given

till significant improvement of

symptoms can be noticed.

Discontinued

if

uninterrupted treatment

for 3 years shows no clinical improvement.

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Routes of allergen

adminidtration

-

Subcutaneous

-S

ublingual

-N

asal

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