Transcript Allergic Rhinitis

Allergic Rhinitis
Richard Douglas
Prevalence
• Most common disease
• 20% adult population
Diagnosis
• What’s the problem?
nasal blockage
clear rhinorrhoea
sneezing
itchy eyes
Diagnosis
• When during the year do you get these
symptoms?
perennial
worse in springtime
Pathogenesis
• IgE mediated hypersensitivity to
common aeroallergens
• Release of histamines, leukotrienes
More history
• Previous medications
occasional antihistamine, Otrivine
spray
• Past medical history
mild asthma as child
• Drug allergies
nil
Examination
• Headlight, Thuddicum’s speculum
• Nasendoscope
• Otoscope
Investigations
• Skin prick tests
Atopy
• Atopy is an inherited predisposition to
produce IgE to environmental allergens
Atopics
Non-atopics
Allergic
Rhinitis
Differential diagnosis
• Allergic rhinitis
• Non-allergic rhinitis with eosinophilia
• Vasomotor rhinitis
Treatment
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Drugs
Allergen avoidance
Immunotherapy
Surgery
Drugs
• Antihistamines
Intermittent symptoms
Work quickly
Expensive
• Intranasal steroids
Constant symptoms
Slow onset of action
Inexpensive
Nasal Obstruction
Allergen avoidance
• Grass pollen difficult to avoid
• Best trial of dust mite avoidance shows
no effect on allergic rhinitis
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
What is the role of surgery?
•Highly effective
•Submucosal resection for good long term
results