Allergic Rhinitis
BY
Dr Zakarie Dhif
• It is an IgE-mediated immunologic response of nasal mucosa to airborne allergens
• Two clinical types:
• 1. Seasonal. Symptoms appear in or around a particular season when the pollens
of a particular plant, to which the patient is sensitive, are present in the air.
• 2. Perennial. Symptoms are present throughout the year.
AETIOLOGY
• Inhalant allergens. They may be seasonal or perennial. Seasonal allergens include
pollens from trees, grasses and weeds.
• genetic predisposition
PATHOGENESIS
• Inhaled allergens produce specific IgE antibody in the genetically predisposed
individuals. This antibody becomes fixed to the blood basophils or tissue mast cells
• On subsequent exposure, antigen combines with IgE antibody at its Fab end. This
reaction produces degranulation of the mast cells with release of several chemical
mediator are responsible for symptomatology of allergic disease. Depending on
the tissues involved, there may be vasodilation, mucosal oedema, infiltration with
eosinophils, excessive secretion from nasal glands or smooth muscle contraction.
CLINICAL FEATURES
• There is no age or sex predilection. It may start in infants as young as 6 months or
older people. Usually the onset is at 12–16 years of age.
• symptoms of seasonal nasal allergy include
• [Link], 10–20 sneezes at a time
• 2. nasal obstruction
• 3. watery nasal discharge
• 4. itching in the nose
• Symptoms of perennial allergy
• persistently stuffy nose,
• loss of sense of smell due to mucosal oedema
• chronic cough
INVESTIGATIONS
• 1. Total and differential count. Peripheral eosinophilia may be seen
• 2. Nasal smear. It shows large number of eosinophils in allergic rhinitis
• 3. Skin tests. These tests help to identify specific allergen
TREATMENT
• Treatment can be divided into:
• 1. Avoidance of allergen.
• 2. Treatment with drugs.
• 3. Immunotherapy
• 1. Avoidance oF allergen. This is most successful if the antigen involved is single.
• 2. treatment with drugs
• A. Antihistaminics. They control rhinorrhoea, sneezing
• and nasal itch. All antihistaminics have the side effect of drowsines
• [Link] drugs (oral or topical). Alpha-adren-
• ergic drugs constrict blood vessels and reduce nasal
• congestion and oedema.
• Pseudoephedrine and phenylephrine are
• often combined with antihistaminics for oral admin-
• istration
• C. Corticosteroids. Oral corticosteroids are very effective in controlling the
symptoms of allergic rhinitis
• 3. immunotherapy. Immunotherapy or hyposensitization is used when drug
treatment fails to control symptoms or produces intolerable side effects.
•
• THANKS
