OUTLINE
• Introduction
• Epidemiology
• Pathophysiology
• Clinical presentation
ALLERGIC RHINITIS • Management
By: Dr. Hapunda
• Future
INTRODUCTION INTRODUCTION
§ Rhinitis is a global health problem that affects 20-
40%.
§ Rhinitis classified as AR & NAR
§ AR is based on clinical manifestations and
supported by +ve SPT or sIgE antibodies to
aeroallergens3
INTRODUCTION EPIDEMIOLOGY
• Severe allergic rhinitis has been associated u AGE:
u Race
with significant impairments in quality of life, ü Mean age onset 8-11yrs
sleep and work performance Affects all races
ü 80% of cases AR develops
• AR and asthma appear to represent a by age 20 years u Gender
combined airway inflammatory dz In childhood: boys> girls
ü Prevalence of 40% in adulthood: equal prevalence
children
PATHOPHYSIOLOGY PATHOPHYSIOLOGY
PATHOPHYSIOLOY
PATHOPHYSIOLOY
sensitization sensitization
Early stage Early stage
Late stage Late stage
Systemic activation Systemic activation
PATHOPHYSIOLOGY PATHOPHYSIOLOGY
PATHOPHYSIOLOY
sensitization
Early stage
Late stage
Systemic activation
Courtesy of NEJM
PATHOPHYSIOLOGY RISK FACTORS
LATE PHASE • SYSTEMIC PHASE
• Family history of Allergic Rhinitis
• Male gender
• Within 2 to 8 hrs Up regulation of
eosinophil & basophil • Higher socio-economic class
• Lasts 12 hrs precursor from bone • 1st born
marrow
• Infiltration of • Maternal asthma
inflammatory cells
• Early weaning
• Eosinophil most • Serum total IgE >100iu/l
prominent
• Priming effect
Classification Classification
Seasonal Perennial Episodic
ragweed House dust mites Pet fur
grasses Indoor molds
Outdoor molds Animal dander
Tree pollen cockroaches
ARIAS GUIDELINE
[Link]
[Link] [Link]
DIAGNOSIS: HISTORY HISTORY
• Classic symptoms: • An evaluation of the nature, duration, and time course of symptoms
• possible triggers for symptoms
ü sneezing
• response to medications
ü itching (of nose, eyes, ears, palate), • comorbid conditions
ü rhinorrhea • family history of allergic diseases
• environmental exposures
ü congestion
• occupational exposures
Others :anosmia, headache, earache, tearing, red
eyes, eye swelling, fatigue, drowsiness, and malaise. • and effects on quality of life
CLINICAL FINDINGS INVESTIGATION
• Ocular findings u IN VIVO
• Allergic shiners ü Skin prick test
• Nasal crease ü Nasal Allergen Challenge
• Bluish or pale swelling of u INVITRO
nasal mucosa
ü Total IgE
• Clear rhinorrhea
• Cobblestone oropharynx
ü Specific IgE :
• Chest examination o RAST
o ELISA
MANAGEMENT
• Allergy skin tests (immediate hypersensitivity testing): An in Education
vivo method of determining immediate (IgE-mediated)
hypersensitivity to specific allergens Allergen avoidance
• Radioallergosorbent test (RAST): Indirectly measures the Nasal douching
quantity of immunoglobulin E (IgE) serving as an antibody
to a particular antigen
Pharmacotherapy
• Total serum IgE: Neither sensitive nor specific for allergic
rhinitis, but the results can be helpful in some cases when Allergen-Specific Immunotherapy
combined with other factors
Surgery (Turbinate surgery, Septoplasty and Endoscopic
• Total blood eosinophil count: Neither sensitive nor specific Sinus Surgery for Rhinosinusitis)
for the diagnosis, but, as with total serum IgE, can
sometimes be helpful when combined with other factors
Pharmacotherapy Pharmacotherapy
Intranasal steroid Mechanism Minimum Adverse effects
age
Antihistamine Mechanism Minimum Adverse effects
Beclomethasone Inhibits the influx of 6 years Bitter aftertaste, age
inflammatory cells; burning, epistaxis,
Cetrizine Blocks H1 receptors; 6 months Dry mouth,
Budesonide onset of action is less 6 years headache, nasal
onset of action is 15 to sedation at higher
than 30 minutes dryness, potential
30 minutes than recommended
risk of systemic
Fluticasone furoate 2 years Desloratidine 6 months doses
absorption, rhinitis
medicamentosa,
Mometasone 2 years stinging, throat Levocetrizine 12 years
irritation
Fluticasone 12 years Loratadine 2 years
propionate
Pharmacotherapy ARIAS GUIDELINE
Drug Mechanism Minimum age Adverse effects
Decongestant Vasoconstriction onset 12 years Arrthymias ,
Pseudoephedrine action 15-30 minutes hypertension , dizziness
,tremors
Intranasal Blocks acetylcholine 6 years Epistaxis, headache,
anticholinergic receptors; onset of nasal dryness
Ipratropium action is 15 minutes
Antileukotriene Blocks leukotriene 6 months Elevated levels of
Montelukast receptors; onset of alanine transaminase,
action is two hours aspartate transaminase,
and bilirubin
Intranasal Inhibits histamine 6 months Epistaxis, nasal irritation,
Chromones release; results typically sneezing
Sodium noted in one week.
chromoglycate
THE END