ALLERGIC RHINITIS WHEN ALL FAILS - PowerPoint Presentation

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ALLERGIC RHINITIS WHEN ALL FAILS

ADIL WARIS

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SPONSOR MESSAGE

BAYER SPONSORED SESSION

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Diagnosis

Usually not difficult

Symptoms can be seasonal or perineal

Allergic salute

Allergic crease

Look up nostrils at the inferior

turbinates

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Investigations

Usually not needed

Eosinophilia

Serum

IgE

Skin prick allergy test

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Real six pack

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TREATMENT 1 Antihistamines

For how long

Value of changing molecules

6 percent alcohol

Systemic delivery or local

For mild disease

For rhinorrhea

For sneezers

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TREATMENT 2 Nasal steroids

Treatment of choice for blockers especially

Little side effects

Local application

Changing molecules

Different preservatives and

propellents

Some with antihistamines

Onset of action 7 days and wears off in 7 days

Banov

C,

LaForce

C, Lieberman P. Double blind trial of

Astelin

nasal spray in the treatment of vasomotor rhinitis. Ann Allergy Asthma

Immunol

2000; 84:138.

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TREATMENT 3 Saline douches

Washes out the cytokines

Do it before the steroid spray

Sea sprays

Saline sprays

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TREATMENT 4 Montelukast

Systemic

Quick onset

Not all benefit

Useful is asthma is onboard

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Cromolyn sodium nasal spray

1-2 sprays 3-4 times daily

No adverse effects

Cromolyn

is

less effective than glucocorticoid nasal

sprays

Controlling mild

symptoms

.

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Ipratropium bromide

0.03

percent nasal

spray

Decreasing rhinorrhea

Decreasing the

release of substance P

.

less

effective than glucocorticoid nasal

sprays

Useful in

children or adults who have profuse rhinorrhea not otherwise controlled with topical nasal

corticosteroids

Adult patients

with concomitant allergic and

nonallergic

(or vasomotor) rhinitis. 

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TREATMENT 5 Prevention

Allergy testing

House dust mite

Grass pollens especially Bermuda grass

Mould

spores

Milk

Animal dander … remove pet all or nothing /

hypoallergic

animals

Other foods very unlikely

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RESULTS

Children aged 1 to 18 years

2005 to date

1150 patients results

Atopic asthmatics

Allergic rhinitis

Combinations of above

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POLLENS

Mould Mix

445

- 38.7%

Bermuda Grass

251

- 21.8%

Grass Pollen Mix

193

- 16.8%

Tree Pollens Mix

149 - 12.9%

Weed Pollen Mix

38

- 0.03%

Pyrethrum

4

- 0.003%

Aspergillus

2

- 0.001%

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LIVING CREATURES

House dust mite 704

- 61.2%

Cat

405

- 35.2%

Cockroach

372

- 32.3%

D

og

335

- 29.1%

Feathers

320

- 27.8%

Horse

5

- 0.004%

Rabbit

5

- 0.004%

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FOODS

Egg White

160

- 13.9%

Milk

155

- 13.4%

Soya

140

- 12.1%

Citrus Mix

68

- 5.9%

Egg Yolk

44

- 3.8%

Cereal mix

26

- 2.2%

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NON ATOPIC STATE DEFINED

All negative 83

- 7.2%

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Nasal decongestant sprays

Phenylephrine

,

 

oxymetazoline

, 

xylometazoline

, and 

naphazoline

.

Downregulation of

the alpha-adrenergic receptor develops after three to seven

days,

Rebound nasal

congestion may

result.

Then

viscious

cycle --

eventual dependency -- rhinitis

medicamentosa

. 

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Chronic nonallergic

rhinitis

 

50

percent of patients with chronic rhinitis have a component of

nonallergic

rhinitis

Perennial symptoms

and mild or absent nasal itching and sneezing

.

Chronic nasal

congestion and/or rhinorrhea

changes

in temperature and relative humidity, odors, or alcohol

.

They

have little nasal itching or sneezing

.

Headaches,

anosmia, and sinusitis are common

.

Negative

skin tests to inhalant

allergens.

Include vasomotor

rhinitis, gustatory rhinitis, and

nonallergic

rhinitis with nasal eosinophilia syndrome. 

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Nasal hyperreactivity

Non

IgE

mediated

Biomass fuels

Oudh and incense

Smokers

Mossi

chips and coils

Painting /varnishing

Scented candles

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Nasal hyperreactivity

Karvol

/

vicks

/Echinacea

Humidifiers

…

mould

counts

Vaporisers

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Chronic rhinosinusitis 

Inflammatory condition

involving the paranasal sinuses and linings of the nasal

passages

CRS

can coexist with allergic

rhinitis

Requires any

 

two

 of the following symptoms, present for at least 12 weeks:

•Anterior and/or posterior mucopurulent drainage

•Nasal obstruction

•Facial pain, pressure, and/or fullness

•Decreased sense of smell

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Rhinitis due to systemic medications

Birth control

pills, antihypertensive drugs (alpha-adrenergic blockers, beta-adrenergic blockers, angiotensin-converting enzyme [ACE] inhibitors), erectile dysfunction drugs, and

NSAIDs.

Psychiatric

medications

c

hlorpromazine

, 

thioridazine

, 

perphenazine

, 

chlordiazepoxide

, 

amitriptyline

, and 

alprazolam

.

c

yclosporine

 and mycophenolic acid

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Alternative therapies

Traditional Chinese medicine (TCM) includes herbal therapy, acupuncture, massage, and dietary therapy.

Studies

of acupuncture for the treatment of allergic rhinitis have shown modest

benefit

There

are several herbal therapies that have demonstrated efficacy, including

Ayurvedic

mixes, butterbur, and 

Tinospora

cordifolia

.

Nasal

sprays consisting of dilute solutions of 

capsaicin

 have shown efficacy for allergic rhinitis in randomized trials when administered several times daily

.

National Center for Complementary and Alternative Medicine. Expanding Horizons of Health Care: Strategic Plan 2005-2009. NIH publication no. 04-5568, National Center for Complementary and Alternative Medicine; NIH, Bethesda, MD 2005.

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Allergic rhinitis under in infancy

Does it exist

Airway sensitization

Role of milk allergy via breast milk

Ng ML,

Warlow

RS,

Chrishanthan

N, et al. Preliminary criteria for the definition of allergic rhinitis: a systematic evaluation of clinical parameters in a disease cohort (I).

Clin

Exp

Allergy 2000; 30:1314.

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NEVER FORGET

Are the patients adherent

Is the inhaler technique for the nose spray correct

Douche first then steroid spray

Have you treated asthma?

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Kenya future

Allergen

immunotherapy … takes long and do you have the correct ingredients

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