Transcript Allergic Rhinitis Combined 2015x

Allergic Rhinitis
• allergic rhinitis
• <immunology> An inflammatory response in
the nasal passages to an allergic stimulus. Often
includes: nasal congestion, sneezing, runny or
itchy nose
Allergic Rhinitis
• The most common atopic disease
• The hallmark of ~: a temporal relationship between
the exposure to allergens & the development of nasal
symptoms
• It takes at least 2 years of exposure to aeroallergens
(airborne environmental allergens) to develop AR
(thus, very rare in children <1 year)
• The prevalence of AR: lowest in children < 5 yrs
highest 2nd---- 4th decades
• Genetic predisposition (60%)
•
• In a sensitized individual, allergic
rhinitis occurs when mucous
membranes are exposed to inhaled
allergenic materials that elicit a
specific response mediated by
immunoglobulin E (IgE).
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Allergen
sensitization and the
allergic response. A.
Exposure to
antigen stimulates
IgE production and
sensitization of mast
cells with antigen
specific
IgE antibodies. B.
Subsequent exposure
to the same antigen
produces an
allergic reaction
when mast cell
mediators are
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released.
Mast cells degranulating and releasing vasoactive
amines.
Classification
• AR is classified as seasonal or perennial
• Seasonal: repetitive and predictable
symptoms (severe)
• Perennial: symptoms persist throughout the
year without any obvious seasonal pattern
• WHO: replace terms with intermittent or
persistent
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Allergic Rhinitis
• Most patients develop symptoms before age 30
• Asthma develops in about 19% of children with
rhinitis (more likely with perrenial allergic rhinitis)
• The term “rhinitis” refers to the inflammation of the
nasal mucous membranes. Whenever a a causative
allergen can be identified allergic rhinitis
• It is difficult sometimes to distinguish between
different types of rhinitis
• Comparison between different types of rhinitis
Features of Common Rhinitis Symptoms
Allergic
rhinitis
Infectious
rhinitis
Vasomotor rhinitis
Rhinitis
Medicamentosa
Etiology
Allergen
Viral or
bacterial
Unknown
Tachyphylaxis to
topical decongestants
Symptoms
Rhinorrhea,
congestion,
sneezing,
pruritis, cough
with postnasal
drip ocular
itching etc
Fever (more
common in
children),
mucupurulent
rhinorrhea,
scratchy throat,
congestion,
cough
Rhinorrhea,
congestion
Congestion
Pattern
Perennial or
seasonal
Any time
Any time
Temporal relationship
with use of topical
decongestant
Associated
Factors
Concurrent
None
atopic disease,
family history
Affects women
primarily, strong
odours, alcohol, stress,
change in humidity
and temperature
Overuse of topical
decongestants,
concurrent use of
antihypertensive
therapy
Perennial Allergic Rhinitis
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• Caused by continuous exposure to many different
types of allergens
• Dust Mite the most common cause of perennial
allergic rhinitis
• Commonly: household dust mites, molds,
cockroaches, house pets
• Less commonly: cottonseed & flaxseed (found in
fertilizers, hair setting preparations and foods); some
vegetable gums (found in hair setting prep & foods)
Caused by:
Dust mites
Perennial Allergic Rhinitis
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• Dust mite: thrive in carpets, beddings & reproduce best in
warm (18-21ºC) humid (>50%) environment found in most
homes
• Mites feed on human skin scales and their own faeces.
• Mite itself is not allergen, the main allergen is the
glycoprotein that coats their faeces.
• Dust mite remain airborne for about 30 minutes after being
disturbed
• Molds: grow best in warm, moist environment
• Cat-derived allergens: light small proteins secreted through
the sebaceous glands in the skin. May remain airborne for up
to 6 hrs. Can be detected at home even 6 months after removal
of the cat.
Seasonal Allergic Rhinitis
• Caused by wind-borne plant pollens (e.g.
tree, grass. etc)
• “hay fever”, and “rose fever” are terms
related to seasons associated grass
pollinosis and NOT associated with
FEVER!
Complications
1.
2.
3.
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Sinusitis
Recurrent otitis media & hearing loss
Patients who develop:
fever,
purulent nasal discharge,
refer to Dr. for evaluation
frequent HA,
and treatment
earache
Symptoms of Allergic Rhinitis
• Ocular: itching, lacrimation, mild soreness, puffiness
& conjuctival erythema
• Nasal: congestion, watery rhinorrhea, itching,
sneezing, postnasal drip and nasal pruritus
• Head & Neck: loss of taste and smell, mild sore throat
due to postnasal drip, earache, sinus HA, itching of the
palate and throat
• Systemic: malaise & fatigue:
Physical Assessment
• “allergic shiners”  venous/lymphatic congestion
• Chronic mouth breathing highly arched palate
• A horizontal crease across the lower third of the
nose (in patients repeatedly rub their noses
upward) called “nasal salute”
• Nasal mucosa: pale & swollen
• Nasal secretions: clear & watery
• Eyes: watery with scleral & conjuctival erythema
and periorbital edema
Allergic shiners
Arched palate because of mouth
breathing
Periorbital edema
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