ALLERGIC RHINITIS
Dr. Hayat AL AKOUM
DEFINITION OF RHINITIS
Rhinitis is inflammation of the lining of the nasal
cavity. As the lining of the nasal cavity and the
para nasal sinuses is continuous, inflammatory
process tend to involve both areas to a greater or
lesser extent.
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CLASSIFICATION OF RHINITIS
Allergy
-Seasonal ,Perennial,
food related ,drug
induced
Infectious
-Acute
-Chronic
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ALLERGIC RHINITIS
Its an IgE mediated
hypersensitivity
response to allergen
lead to
rhinitis ,associated
allergic conjunctivitis
and asthma may occur.
The disease is common
prevalence depend on
age ,gender,
geographical
distribution
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ALLERGIC RHINITIS CLASSIFICATION
1. Intermittent (Seasonal)
2. Persistent (Perennial)
3. Mild
4. Moderate - severe
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SEASONAL RHINITIS
Also known as intermittent rhinitis
It usually lasts less than 4 days a week
The whole disorder lasts for about a month
Usually caused due to exposure to seasonal
allergens like pollen
Common during spring when flowers bloom
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PERENNIAL RHINITIS
Also known as persistent rhinitis
Symptoms last for more than 4 days a week
Whole disorder lasts for more than a month
This is due to continuous exposure to allergen. eg.
House dust mite
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MILD ALLERGIC RHINITIS
Allergic rhinitis is considered to be mild if the
symptoms
Does'nt cause:
Sleep disturbance
Impairment of daily activity
Impairment of work
Troublesome symptoms
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MODERATE ALLERGIC RHINITIS
This includes one or more of the following:
Sleep disturbance
Impairment of daily activity
Impairment of work
Troublesome symptoms
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ALLERGIC RHINITIS
PATHOPHYSIOLOGY
The reaction occurs in 4 phases
1. Sensitization
2. Subsequent reaction to allergen – early phase
3. Late phase reaction
4. Systemic activation
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PATHOLOGICAL CHANGE
Local mucosal change
edema
infiltration with eosinophils and plasma cells
watery discharge
vascular dilatation
polyp
Superadded infection
Involvement of sinuses
generalized thickening
polyp in the sinuses( single or multiple)
fluid effusion in the sinuses
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Etiology of Allergic Rhinitis :
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Dust mite
Fel d1
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CLINICAL MANIFESTATIONS
- Sneezing , may be in paroxysm.
- Rhinorrhea
- nasal obstruction and loss of smell
- Itchiness of nose ,eye,palate
- Tearing ,itching ,redness of eyes
- Burning sensation in the throat.
- symptom related to asthma
(cough,shortness of breath, wheeze)
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OCCUPATIONAL ALLERGINS
Rhinitis may occur as a consequence
of allergins inhaled in work place
frequently associated with asthma
Biological agent include flour (in
baker ,grain worker), laboratory animal
,wood dust,biological washing
powder,latex
Chemical agent
paint manufacturer and painter (spray)
platinum salt in platinum refiner
drugs in pharmaceutical worker
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FOOD INDUCED RHINITIS
It’s a rare cause of allergic rhinitis, symptom
of rhinitis often associated with urticaria,
angioedema and GIT symptom
Food may occasionally provoke IgE induced
rhinitis
In children Milk, egg, cheese,
In adult nuts ,fish, shellfish, citrus fruit
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TREATMENT
Avoidance of allergins .
Drugs .
Immunotherapy (desensitization) .
Surgery .
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NURSING ASSESSMENT
The examination and history of the patient reveal
sneezing, often in paroxysms, thin and watery nasal
discharge, itching eyes and nose, lacrimation, and
occasionally headache. The health history includes a
personal or family history of allergy. The allergy
assessment identifies the nature of antigens, seasonal
changes in symptoms, and medication history. The
nurse also obtains subjective data about how the
patient feels just before symptoms become obvious,
such as the occurrence of pruritus, breathing problems,
and tingling sensations. In addition to these symptoms,
hoarseness, wheezing, hives, rash, erythema, and
edema are noted. Any relationship between emotional
problems or stress and the triggering of allergy
symptoms is assessed.
NURSING DIAGNOSES
Ineffective breathing pattern related to
allergic reaction
Deficient knowledge about allergy and the
recommended modifications in lifestyle and
self-care practices
Ineffective individual coping with chronicity
of condition and need for environmental
modifications
ALLERGY MANAGEMENT
Verbalize how to maintain a dust-free environment by
removing drapes, curtains, and venetian blinds and
replacing them with pull shades; covering the mattress with
a hypoallergenic cover that can be zipped; and removing
rugs and replacing them with wood flooring or linoleum.
Identify rationale for washing the floor and dusting and
vacuuming daily.
Identify rationale for replacing stuffed furniture with wood
pieces that can easily be dusted.
State rationale for wearing a mask whenever cleaning is
being done.
Identify rationale for avoiding use of tufted bedspreads,
stuffed toys, and feather pillows and replacing them with
washable cotton material.
State rationale for avoiding the use of any clothing that
causes itching.
ALLERGY MANAGEMENT
Verbalize ways to reduce dust in the house as a whole by using
steam or hot water for heating rather than air and using air
filters or air conditioning.
Verbalize ways to reduce exposure to pollens or molds by
identifying seasons of the year when pollen counts are high;
wearing a mask at times of increased exposure (windy days
and when grass is being cut); and avoiding contact with weeds,
dry leaves, and freshly cut grass.
State rationale for seeking air-conditioned areas at the height of
the allergy season.
State rationale for avoiding sprays and perfumes.
State rationale for use of hypoallergenic cosmetics.
State rationale for taking prescribed medications as ordered.
Identify specific foods that may cause allergic symptoms.
(Examples of foods that can cause allergic reactions are fish,
nuts, eggs, and chocolate.)
Develop a list of foods to avoid.
