Definition
“IgE mediated hypersensitivity disease of mucous membrane nasal
airways characterized by sneezing, watery nasal discha itching and
nasal obstruction”
Prevalence-Global health problem
Prevalence 15% and 20% (Nathan et al., 1999)
Higher in pediatric age group(Wright et al., 1994)
Approx. 80% develop symptoms before age of 20
IMPACT ON QUALITY OF LIFE-Not a severe disorder but significantly
alters patient’s social life
-school performance
-work productivity
Risk factors
1. Genetic susceptibility:
2. Family history of atopy: e.g. Asthma, eczema,hay
fever, urticaria,(Genes involved in atopy loci on 5q, 11q and 12q chromosomes)
3. Environmental factors:Pollution-climate interaction - irritant fumes, tobacco smoke, diesel exhaust, mosquito
repellents, perfumes, scented sticks, domestic sprays, bleaches
4. Exposure to allergens:
Seasonal: Pollen, Fungus
Perennial: Dust mite, domestic pets, cockroaches
[Link] hypothesis
Increased exposure to various allergens immune maturation help de the incidence of allergic diseases and
asthma (Svanes C et al., 2003)
Early environmental exposure to infectious agents, protects against development of atopy (Tulic MK et al.,2003)
Early nursery attendance also reduces subsequent atopy (Kramer et al.,2003)
Lack of immune maturation (understimulated immune system) in infancy allergic responses (Liu A,2007)
Acute or early phase reaction
Occurs 5-30 min after antigen exposure
Release of inflammatory mediators
Increased nasal gland secretion →
runny nose
Mucosal edema & Vasodilation → nose block
Nerve irritation → sneezing & itching
Late or delayed phase response
Occurs 2-8 hours after antigen exposure
Infiltration by inflammatory cells
(eosinophils, neutrophils, basophils, monocytes & CD4+ T lymphocytes)
Edema, congestion & thick nasal secretion
Sneezing & itching decreases
Face:
Bunny nose-frequent twitching of face
Dennie-Morgan creases (in lower eyelid skin)
Allergic shiners (dark discoloration below lower eyelids)
Eye: Conjunctiva is congested, increased lacrimation
Ear: Aural fullness(ET dysfunction)
Throat: Chronic pharyngitis, laryngitis
Types of allergic rhinitis
Seasonal allergic rhinitis:
Nasal discharge and conjunctivitis (more common)
Perennial allergic rhinitis:
Nasal blockage (more common), Hyposmia
Less sneezing/nasal discharge /eye symptoms
Seasonal allergic rhinitis
Seasonal allergic rhinitis
Pollen:
Spring (March-June) = Tree pollen
Summer (May-August) = Grass
Fall (August-October) = Weeds
Mold:
Spores in outdoors have seasonal variation (reduced in winter, increased in
summer/fall due to humidity)
House dust mites:
Generally “perennial” allergen, but increased in damp autumn months
Perennial allergic rhinitis
ALLERGENS
Fungi/mold:
Exposure peaks accompany activities such as harvesting & cutting grass
Pet dander (cats, dogs):
up to 4 months after pet removal
House dust mites:
Live in bedding & carpets
Cockroaches:
Respiratory allergy
Important allergen
Diagnosis
[Link]
[Link] exam
[Link] diagnosis
(1) Skin prick test (SPT)
2. Blood tests for allergy: Total IgE, Specific IgE
(III) Nasal allergen challenge test
Nasal endoscopy
CT scan
General medical history
Childhood allergy, asthma, eczema (atopic triad)
Family history-atopic
Nasal symptoms
Environmental and/or occupation/leisure-time activities
How frequent are the symptoms?
Daily, episodic, seasonal, perennial
What medications are you taking? How have they worked?
Nasal discharge
Allergic rhinitis: clear and watery
Bacterial rhinitis/sinusitis: pus (thick/discolored)
Chronic sinusitis: purulent nasal drainage, headache, halitosis
Complication
Differential diagnosis
1. Vasomotor rhinitis (Intrinsic rhinitis/NANIPER)
[Link] polyposis
[Link] medicamentosa
[Link] rhinitis
(Pregnancy, Hypothyroidism, OCP use)
[Link] leak
Management of allergic rhinitis
1. Environmental control measures (Avoidance of allergens)
2. Patient education
3. Nasal douching
[Link] therapy
[Link]
[Link]
Treatment
[Link]:
Topical: Azelastine
Systemic: Cetirizine, Levocetirizine, Fexofenadine, Loratadine, Desloratadine
[Link] Decongestants:
Topical: Oxymetazoline, Xylometazoline
Systemic: Phenylephrine, Pseudoephedrine
[Link] cell stabilizers: Sodium cromoglycate nasal drop
4. Anticholinergics: Ipratropium bromide nasal spray
[Link]:
Topical: Beclomethasone, Budesonide, Mometasone, Fluticasone
Systemic:
Prednisolone
[Link] receptor antagonists: Montelukast, Zafirlukast
Homoeopathic medicine
Allium Cepa:It significantly reduces inflammation symptoms in people
with watery noses and eye discharge. It’s recommended when the
symptoms are accompanied by a burning and itching sensation
Arsenicum Album:It’s another highly effective solution for allergic
rhinitis. It’s recommended for patients with persistent sneezing,
congestion that interferes with sleep, difficulty breathing, tightness in
the chest, and sensitivity to cold. Arsenicum Album improves the
body’s healing ability and reduces its sensitivity to allergens.
Sabadilla:Sabadilla is effective for people with pollen allergies. It’s
also highly effective for those experiencing consistent sneezing with a
blocked nose and hypersensitivity, including sensitivity to specific
odors, like scented candles, perfumes, soaps, etc.
Wyethia:Hay fever causes postnasal drip, which can irritate your
throat. It also feels super dry and parched, making swallowing
difficult. These symptoms can appear with a hoarse voice. Wyethia is
a homeopathic remedy for allergic rhinitis, especially in cases where
throat symptoms are involved. If you have an extremely itchy throat
with a constant urge to scratch it and persistent dryness.
Euphrasia: Also known as eyebright, Euphrasia is used for allergic
rhinitis with profuse, acrid, and watery discharge from the eyes, often
accompanied by a bland nasal discharge.
Natrum muriaticum: Useful for allergic rhinitis with sneezing, watery
nasal discharge like raw egg white, and a constant need to blow the
nose. It may be indicated for individuals who are reserved or prone to
grief.
Nux vomica: Indicated for allergic rhinitis triggered by exposure to
cold, dry winds. Symptoms may include a stuffed-up nose during the
day and a runny nose at night, along with sneezing and a sensation
of a lump in the throat.
Thank you