Allergic Rhinitis

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Allergic Rhinitis

• Richard Douglas

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Prevalence

• Most common disease
• 20 adult population

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Diagnosis

• Whats the problem?
• nasal blockage
• clear rhinorrhoea
• sneezing
• itchy eyes

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Diagnosis

• When during the year do you get these symptoms?
• perennial
• worse in springtime

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Pathogenesis

• IgE mediated hypersensitivity to common
  aeroallergens
• Release of histamines, leukotrienes

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More history

• Previous medications
• occasional antihistamine, Otrivine spray
• Past medical history
• mild asthma as child
• Drug allergies
• nil

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Examination

• Headlight, Thuddicums speculum
• Nasendoscope
• Otoscope

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Investigations

• Skin prick tests

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Atopy

• Atopy is an inherited predisposition to produce
  IgE to environmental allergens

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Atopics
Non-atopics
AllergicRhinitis
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Differential diagnosis

• Allergic rhinitis
• Non-allergic rhinitis with eosinophilia
• Vasomotor rhinitis

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Treatment

• Drugs
• Allergen avoidance
• Immunotherapy
• Surgery

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Drugs

• Antihistamines
• Intermittent symptoms
• Work quickly
• Expensive
• Intranasal steroids
• Constant symptoms
• Slow onset of action
• Inexpensive

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Nasal Obstruction
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Allergen avoidance

• Grass pollen difficult to avoid
• Best trial of dust mite avoidance shows no effect
  on allergic rhinitis

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Immunotherapy

• Repeated exposure to high doses of allergen
  causes anergy
• Low dose to high dose
• Three year course
• Risk of anaphylaxis
• Highly effective when the allergen is known

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What is the role of surgery?

• Highly effective
• Submucosal resection for good long term results