Allergic Rhinitis
Created By : Kaknika, Nary & Veasna
Year5 UHS Medical Student
Contents
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[Link] Classification
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11.. Introduction
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Definition
Definition Public Health
Public Health Impact
Impact
Allergic Rhinitis (AR) is an IgE- Causes sleep disturbances,
mediated inflammatory disorder fatigue, impaired concentration.
of the nasal mucosa triggered by Associated with asthma,
allergen exposure. otitis media, sinusitis, and
eustachian tube
dysfunction.
Epidemiology
Epidemiology
Affects 10–30% of the global population.
Up to 40% of children and 20–25% of
adults in urban areas.
Often underdiagnosed or misdiagnosed.
2. Physiopathology
2. Physiopathology
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Initial sensitization: Allergen exposure leads to antigen presentation to Th2 cells IgE
production by B cells.
Early-phase reaction (within minutes): Histamine, prostaglandins, and leukotrienes
cause sneezing, itching, rhinorrhea, and congestion.
Late-phase reaction (4–8 hours): Infiltration of eosinophils, basophils, T cells →
sustained inflammation and nasal hyperreactivity.
ENT Relevance:
Turbinate hypertrophy, nasal obstruction, postnasal drip, secondary sinusitis.
3. Clinical Classification
By duration: By severity:
Mild: Normal sleep, no daily
Intermittent: <4 days/week or <4
activity impairment
consecutive weeks
Moderate-severe: Sleep
Persistent: ≥4 days/week and ≥4
disturbance, impairment in
consecutive weeks
daily activities/work/school
By pattern:
Seasonal AR (SAR): Pollen, mold spores
Perennial AR (PAR): Dust mites, pet
dander, cockroaches
Occupational AR: Work-related allergens
(latex, flour)
4. Diagnosis
Clinical History
Nasal itching, sneezing, rhinorrhea,
nasal congestion
Diurnal or seasonal variation
Family/personal history of atopy
4. Diagnosis
Physical Examination
Pale, bluish edematous turbinates
Clear nasal discharge
Allergic shiners, Dennie-Morgan lines, nasal
crease (allergic salute)
Dennie-Morgan Lines
Diagnosis Testing
Skin Prick Test (SPT): Quick and sensitive, but requires trained staff.
Serum specific IgE (RAST): Useful if skin testing contraindicated.
Nasal cytology: Eosinophils in smear = allergic etiology.
Endoscopy (ENT): For ruling out nasal polyps, structural abnormalities.
Imaging (CT PNS): If recurrent sinusitis or anatomical suspicion.
Differential Diagnosis
Non-allergic rhinitis (e.g. vasomotor)
Nasal polyps
Sinusitis
Adenoid hypertrophy
Foreign body (in children)
5. Management
A. Allergen Avoidance
Dust mite covers, air filters
Pet avoidance
Mold control
Pollen: stay indoors during peak hours
B. Pharmacotherapy
[Link] corticosteroids
2. Oral/intranasal antihistamines:
(first-line): Fluticasone,
Loratadine,Cetirizine, Fexofenadine
Mometasone Best for nasal
Good for sneezing/itching.
congestion
3. Leukotriene receptor antagonists:
Montelukast Useful in comorbid asthma
4. Decongestants: Pseudoephedrine, oxymetazoline
• Short-term use only (≤5 days)
5. Intranasal anticholinergics: Ipratropium for
rhinorrhea
6. Nasal saline irrigation: Adjunct therapy,
improves mucociliary clearance
C. Allergen-specific Immunotherapy
• Subcutaneous (SCIT) and Sublingual (SLIT)
• Consider in moderate/severe cases unresponsive to meds
• Requires allergist support
D. Surgery (ENT scope)
• Indicated in structural problems or refractory symptoms
• Procedures: Turbinoplasty, septoplasty, adenoidectomy, endoscopic sinus surgery
6. Conclusion: Key Takeaways
• Allergic Rhinitis is underrecognized but highly impactful.
• Accurate diagnosis and classification are essential.
• Treatment must be individualized based on severity and phenotype.
• ENT and general physicians must collaborate closely.
• Immunotherapy and newer biologics hold promise for refractory cases.
References
https ://[Link]/35344304/
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content/uploads/2023/07/GINA-2023-Full-report-23_07_06-[Link]
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Thank you for your attention!