ALLERGIC RHINITIS

1
ALLERGIC RHINITIS
2
RHINITIS Inflammation of the mucosal lining of
the nose.
ALLERGIC RHINITIS Hypersensitivity respons
to allergens mediated by IgE antibodies
Seasonal /
Perennial NON -ALLERGIC RHINITIS Congenital
etc
3
EXAMINATION

• Obvious signs of
• allergic rhinitis
• ENT system
• Systemic (exclude
• other diseases)

4
Allergic Symptoms and Signs

• Nose
• Itching
• Allergic Salute and supratip crease associated
  with itching and rubbing
• Facial grimace
• Nasal obstruction due to mucosal oedema and
  excess mucus
• Sneezing

5
Allergic Symptoms and Signs

• -Watery rhinorrhoea might be seen
• -Mucosa is oedematous and has
• a blue-grey appearance
• -Swollen inferior turbinates
• often appear polypoid due to oedema
• -Nasal polyps

6
TURBINATE Tender, non mobile, lateral
POLYP Not tender, mobile, between septum and
turbinate
7
Allergic Symptoms and Signs

• Mouth
• Chronic mouth breathing due to nasal obstruction
• Palatal itching
• Nocturnal tooth grinding

8
Allergic Symptoms and Signs

• Pharynx
• Dry, irritated, frequently sore throat due to
  allergen exposure, chronic mouth breathing or
  both
• Repeated throat clearing
• Lymphoid aggregates or patches on posterior
  pharyngeal wall

9
(No Transcript)
10
(No Transcript)
11
SPECIAL INVESTIGATIONS
NASAL CHALLENGE TEST NASAL SMEARS PHADIOTOP IgE S
KINPRICK TEST RAST RADIOLOGY
12
NASAL CHALLENGE TESTING

• A specific allergen is introduced into the nose
  to assess the changes
• -the organ directly affected by the allergy is
  tested instead of an indirect action tested
  during skin tests
• Rhinomanometry and acoustic rhinometry can be
  used for the challenge test
• Both methods yielded comparative results

13
NASAL SMEARS Excludes bacteria Exclude malignant
cells Detect eosinophils (Normal in babies lt 6/12)
14
PHADIOTOP TEST 1st line test Screening
inhalant allergens 96 accurate
15
IgE Normal values in 20 of allergic people Race
differences Increased in parasite infections What
is the increase value?
16
SKIN PRICK TEST CI Kids lt2yrs
Old people Eczema
Dermographia Discontinue antihistamine before
test Method important Gives qualitative measure
of allergy only Will miss low degree of allergy
(false negatives) Grading of skin test is
subjective
17
RADIOALLERGOSORBENT TEST (RAST TEST)
Specific IgE tested Inhalation diet allergies
tested Safe Not necessary to discontinue
antihistamines before test Eczema not a
contraindication Does not test colourants
preservatives EXPENSIVE
18
TREATMENT AVOIDANCE MEDICAL
SURGICAL
19
MEDICAL TREATMENT
ANTICHOLINERGICS DECONGESTANTS ANTIHISTAMINES C
ORTICOSTEROIDS DESENSITISATION
20
EMERGING ALLERGIES
Nuts
Ginseng caps Atjar
Cockroaches
Latex.
Bananas, Avocado, Nuts,
Kiwi fruit,
Raw potatoes
21
EXOGENOUS

1. Seasonal
2. Climate
3. Humidity
4. Pollution
5. Medication
6. Food
7. Allergens
8. Noise
9. Aircon
10. Trauma

22
Perennial Inhalant Allergens

• Animal Danders
• Cats
• Fel D1 antigen produced by sebaceous glands in
  skin
• Found on cat skin scales that are shed
• Particles remain airborne for long periods
• Dogs
• Allergen not understood

23
Allergic Symptoms and Signs

• Larynx and lungs
• Hoarseness
• Asthma with cough, wheezing and expiratory
  slowing
• Wet cough ( especially with mould allergy)

24
Allergic Symptoms and Signs

• Eyes
• Allergic Shiners
• Long, silky eyelashes
• Dennies Lines fine horizontal lines in lower
  lids
• Conjunctivitis, burning, itching
• Lymphoid aggregates on palpebral conjunctiva
• Injection of bulbar conjunctiva

25
POLYPS ?Cystic fibrosis