Allergic Rhinitis

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Allergic Rhinitis
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Background

• Rhinitis is defined as inflammation of the nasal
  membranes and is characterized by a symptom
  complex that consists of any combination of the
  following sneezing, nasal congestion, nasal
  itching, and rhinorrhea. Allergic rhinitis is the
  most common cause of rhinitis.

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Background

• Total cost 5.3 billion per year. (in America)
• Morbidity 10-40 ( in China)
• Classification
• Perennial allergic rhinitis
• Seasonal allergic rhinitis (pollinosis)

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Pathophysiology

• Allergic reaction is an exaggerated or
  inappropriate immune reaction and causes damage
  to the host
• Type I immediate hypersensitivity reaction
• mediated by IgE antibodies, which
  trigger the mast cells and basophils to release
  pharmacologically active agents.

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CLINICAL

• History Obtaining a detailed history is
  important in the evaluation of allergic rhinitis.
• Allergy history
• environmental exposures
• occupational exposures
• effects on quality of life
• Family history
• Past medical history

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CLINICAL

• Signs and Symptoms of Allergic Rhinitis
• Sneezing
• Itching (nose, eyes, ears, palate)
• Rhinorrhea(watery secretions)
• Congestion
• Hyposmia (????)

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CLINICAL

• "Allergic shiners"
• "Nasal crease" (allergic salute).
• Nasal examination swollen (boggy), pale,
  blue-gray mucosa

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Lab Studies

• Total serum IgE
• Finding allergen
• Common allergen page 58
• Perennial house dust ,mite ,fungus, pollen
• chemical material
• Seasonal pollen ( sunflower, corn , glass
  )

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Lab Studies

• Finding allergen
• a. Skin testing prick test
• (????)
• 
  intracutaneous test
• (????)
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
• b. Nasal allergen challenge test
• c. Serum special IgE determination

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Diagnosis

• history
• Clinical manifestation
• Allergy diagnosis

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Differential Diagnosis

• Nonallergic rhinitis with eosinophilia
• ??????????????
• Vasomotor rhinitis
• ???????

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Complication

• Allergic sinusitis
• ??????
• Asthma
• ??
• Secretory otitis media
• ??????

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Treatment

• Medical Care
• (1) Avoidance
• Environmental controls and
• allergen avoidance
• (2) Pharmacotherapy
• (3) Immunotherapy

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Treatment

• (2) Pharmacotherapy
• a. Steroid topicalnasal steroid sprays
• general
• b.Antihistamines H1-receptor antagonist
• First-generation toldrin (drowsiness )
• Second-generationclarity (dont cross the
• blood- brain barrier)
• c.Mast cell stabilizing drugdisodium
  cromoglycate
• d. Decongestants

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Treatment

• (3) Immunotherapy
• Exact mechanism unknown
• Decrease allergen-specific IgE levels
• Increase allergen-specific IgG levels
• IgG molecules ( blocking antibodies that are
  important in impeding the allergic reaction. )

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Treatment

• (3) Immunotherapy
• method increasing doses of injected allergen
• until the maximum tolerated dose
  is
• reached
• maintenance dose(maximum tolerated dose )
• course 2 years or more

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Treatment

• Surgical Care Surgical care is not
• indicated for allergic rhinitis but may be
• indicated for comorbid or complicating
• conditions.

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Patient Education

• Educate patients on environmental control
  measures, which involve both the avoidance of
  known allergens (substances to which the patient
  has IgE-mediated hypersensitivity) and the
  avoidance of nonspecific, or irritant, triggers

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Question

• What are the major symptoms of allergic rhinitis?
• The main complications of allergic rhinitis are
• The indication of the immunotherapy?(p60)