Transcript Symptoms of non-allergic rhinitis

 Sensitization
to aeroallergens , animal
dander , house dust mites and
moulds among patients with allergic
rhinitis in warm dry climates
Abbas H. Alsaeed
Assistant Professor and Consultant Hematologist
King Saud University, College of Medical Sciences
 Dept. Of Clinical Laboratory Sciences
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1
Variations in Defining Allergic Rhinitis

Allergic rhinitis was defined as the self-reported
presence, in the previous year, of usual nasal
blockage and discharge apart from colds or the
flu, provoked by allergens, with or without
conjunctivitis (Ng & Tan, 1994)
 Rhinitis was defined as sneezing or a runny or
blocked nose not due to a cold or the flu (Sly,
1999)
 Individuals with rhinitis were defined as those
suffering with three or more symptoms of
rhinitis either throughout the year (perennial) or
for part of the year (seasonal) (Frosh et al 1999)
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Background
 Pollutants
have a direct effect on the nose by
causing cellular damage and stimulating the
release of inflammatory mediators (Bascom,
1991).
 Prevalence rates of rhinitis symptoms among
office workers reported in the western
countries were around 30%, but could be as
high as 60% in some offices (Finnegan 1984;
Viegi et al 1991)
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Symptoms of Allergic Rhinitis
*
Sensitive to specific allergens, e.g. dust
 * Pruritus of the nose, eyes palate, ears
 * Sneezing more than two at a time
 * Watery rhinorrhoea
 * Coexistant asthma or eczema
 * Seasonal symptomas
 * Family history of allergies.
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Classification Allergic Rhinitis
 Seasonal Allergic
Rhinitis (Hayfever)
(SAR)
 Perennial Allergic
Rhinitis (PAR)
 Occupational
Allergens
 Pollen
from a variety of
trees, grasses, and
weeds.
 HDM,
Mold, Animal
epithelial dander, Food
(rare)
 Chemicals
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Perennial Allergic Rhinitis (PAR)

Patients with PAR are more likely than those
with SAR to have asthma (Kubetin 2001).

Positive family history of allergic rhinitis.

Personal history of collateral allergy such as
eczematous dermatitis, urticaria, and/or
asthma.
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Non-allergic Triggers

* Cold air
 * Smoke and perfumes
 * Strong odors
 * Spicy/hot food
 * Alcohol
 * Pregnancy / hormones
 * Decongestant nasal sprays
• * Medications, e.g. antihypertensive agents
•
(Druce 1998).
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Symptoms of non-allergic rhinitis
*
History of negative allergen specific IgE
test
 * Sensitive to temperature changes, smoke,
perfume or environmental irritants
 * Adult onset of symptoms
 * Nasal crusting or drying.
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Common Comorbidity
PAR
SAR
Sinusitis
50%
23%
Asthma
22%
16%
Otitis Media
14%
14%

20-15% of allergic rhinitis patients had asthma
 75-80% of asthma patients had allergic rhinitis

(Kirn 2001).
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Objective
1- To investigate sensitization to
aeroallergens, animal dander, HDM and
mould in adult patients with allergic rhinitis in
warm dry climates using an immunoblot
assay.
2- To estimate the prevalence of rhinitis
symptoms in warm climate.
3- To study the relationship between rhinitis
symptoms and allergens.
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Subjects
 Thirty–eight
adult patients (25 males and
13 females) with diagnosed allergic rhinitis

without a previous history of treatment
attending the outpatient ENT clinic, from
April 2002 to March 2005 on Alflah
International Hospital, Saudi Arabia.
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Investigations

* History: present illness, past medical history,
family history, environmental history, and
impact on quality of life.
 * Physical exam: nose, eyes, ears, lung, skin.
 * Nasal exam with rhinoscope / flexible
nasendoscope.
 * Nasal smear for eosinophils.
 * Nasal mucociliary clearance assessment:
saccharin test, and ciliary best frequency
measurement.
 * Nasal airway assessment.
 * Allergy tests: Allergen specific IgE
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Allergy Test (Method)
Blood
Test
Skin Test
TEST
METHOD
allergen immunoblot assay
Blood serum is
combined with allergen
(RIDA allergen screen)
in trough
Radio-allergosorbent allergy
testing (RAST)
Blood serum is
combined with allergen
in test tube.
Provocation testing
Direct exposure (e.g.
via inhalation or
ingestion to a likely
allergen
Prick testing
Percutaneous
Scratch testing
Percutaneous
Intradermal testing
Intradermal injection
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METHOD
 Allergens are coated to the surface of
nitrocellulose membranes lying in a
reaction trough.
 Patient serum pipetted into the reaction
trough and incubated at RM, washing.
 Allergy screen detection antibody were
added and incubated again at RM,
washing.
 Streptavidin conjugate with alkaline
phosphatase that binds to biotin in the
test fields, and incubated at RM, washing.
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Continue

Substrate a specific enzyme color reaction
of alkaline phosphatase, and incubated at
RM.
 The reaction stopped by rinsing with water
and analysis the results on the test strips
(RIDA allergy screen 2002).
 Negative control had not been coated with
allergen, biotin-labelled bovine serum
albumin had been applied as positive control.
 The color intensity on the test fields is
directly reflect to specific IgE antibody in the
serum of the patients.
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Figure ( ) Illustrates the results appearance on
the surface of nitrocellulose membrane
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Results
Specific IgE antibodies were detected in 65.8%
of all the subjects .
Males demonstrated a higher rate than females
(76% vs. 46.2%) or a M/F ratio of ~ 2:1.
The sensitization rate was highest for pollen
while results for the other allergen groups are
as follows :
pollen ( 68.3%), animal dander (23.9%) ,HDM
(6.0%) and moulds (1.8%).
Among allergenic pollen mixed grasses were
the most common cause of sensitization (11.1%)
while alder, birch, rye and oak have the same,
albeit lower sensitization rates ( 9.4%).
These plants are commonly cultivated for
greening purposes in urban areas .
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Continue results
 Sensitization
rate to cat and dog dander are
(9.4% and 8.5% respectively), while dander
from horse, guinea pig and golden hamster
caused lower rates of sensitization (3.4% 1.7%).
 Dermatophagoides pteronyssinus and
Dermatophagoides farinae are the most
prevalent indoor sensitizers (4.3% and
1.7%, respectively).
 Sensitization
to mould is relatively rare
( 1.8%).
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Table ( ) The relationship between absent
and present of allergen specific IgE in
rhinitis patients
Parameters No.
Allergen Allergen P value
absent
present
13
25
(34.2%) (65.8%) < 0.05
Patients
38
Male
25
06
(24.0%
19
< 0.05
(76.0%)
Female
13
07
(53.8%)
06
0.5
(46.2%)
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Table ( ) Distribution of allergen antibodies in
rhinitis patients
Allergen
System
Pollens
Alder
Birch
Hazel
Mixed Gra.
Rye
Mugwort
Plantain
Oak
Allergen
Ab. No.
Allergen
Ab. %
Antibodies
System %
68.3
11
11
10
13
11
8
5
11
9.4
9.4
8.5
11.1
9.4
6.8
4.3
9.4
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Continue
Allergen
System
Dander
cat
Horse
Dog
Guinea pig
Golden Ha.
Rabbit
Allergen
Ab. No.
Allergen
Ab. %
Antibodies
System %
23.9
11
4
10
1
2
-
9.4
3.4
8.5
0.9
1.7
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Continue
HDM
D. pterony.
D. Farinae
Mould
A. Alternatae
Pen. Notatum
Cldsp. Hebar.
Asp. Fumiga.
Total
6.0
2
5
1.7
4.3
1.8
1
1
0.9
0.9
117
100
100
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Table ( ) Patients with one or multiple allergen
antibodies developed.
No. of Allergen
Ab. developed
No. of Patients
(%)
Sensitized Pt.
(%)
1
2
3
4
5
6
7
8
9
11
Total
06 (15.8%)
01 (2.6%)
03 (7.9%)
02 (5.3%)
03 (7.9%)
03 (7.9%)
01 (2.6%)
04 (10.5%)
01 (2.6%)
01 (2.6%)
65.1
24 %
04 %
12 %
08 %
12 %
12 %
04 %
16 %
04 %
04 %
100
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Figure (2) Relative prevalence of allergens & seasons:
the allergen clender
12
% Cases No.
10
8
6
4
2
0
Winter
Spring
Pollens
Dander
Summer
HDM
Autumn
Moulds
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Report of Prevalence Rates in Allergic Rhinitis
(variation in methodology)
Prevalence
24.0%
62.5%
51.0%
27.6%
41.5%
22.0%
15.9%
26.3%
Age
16-65
High school
High school
6-7
12-15
7-17
20-44
U student
Country
UK
Turkey
Turkey
Singapore
Singapore
Denmark
Italy
Bangkok
Year
1991
1994
1996
1994
1994
2000
2002
2002
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Prevalence of Rhinitis in UK
Prevalence Age
Author
Year
35.1%
6-7
Lau et al.
1998
44.0%
13-14
Leung et al.
1997
29.8%
12-18
Leung et al.
1997
49.5%
Workers
Tong et al.
2001
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Discussion
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Conclusions
The results of this study show that even in warm 
climates pollen , animal dander and HDM
allergens may be important sensitizing allergens .
Pollens of local horticultural plants are the main
sensitizing allergens among patients with allergic
rhinitis in the locality studied .

The practice of greening the country seems to 
contribute to increased rates of allergic
sensitization of persons prone to allergic rhinitis .
Local environmental and genetic factors are
probably involved in the pathogenesis of the
disease .
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Treatment
Allergen
avoidance
* Identification of the
responsible allergens
* Health education on allergen
avoidance
Medical treatment * Antihistamines.
* Topical corticosteroids.
* Anticholinergics.
* Decongestants
Immunotherapy-injection
Sublingual
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Treatment
Symptoms
Symptomatic treatments
Nasal obstruction
due to nonallergic
rhinitis
* Azelastine HCL nasal
spray
* Oral decongestant
Non-purulent chronic * Increase water intake.
post nasal drip
* Nasal saline irrigation.
* Humidity to bedroom.
Bilateral anterior
* Intranasal cortisteroid.
rhinorrhea
* Atrovent spray.
* Nasal saline
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