Allergic Rhinitis

&
Vasomotor
Rhinitis

Dr. Aswathi Krishna

16/11/2025
Internal Use
 Allergic Rhinitis
Definition
• IgE-mediated immunologic response of nasal mucosa to
airborne allergens.
• Characterized by watery nasal discharge, sneezing, nasal
obstruction, itching.
Types
1. Seasonal Allergic Rhinitis:
• Symptoms appear around specific seasons.
• Related to plant pollens (grass, trees, weeds).
2. Perennial Allergic Rhinitis:
• Symptoms persist throughout the year.
• Triggered by indoor allergens (dust mites, molds,
cockroach, animals).
Etiology
1. Inhalant Allergens
• Seasonal: pollens.
• Perennial: dust mites, molds, cockroach, fibers, animal
dander.
2. Genetic Predisposition
• If one parent is allergic → child risk = ~20%.
Internal Use • If both parents allergic → child risk = ~47%.
 Allergic Rhinitis
Pathogene
sis
1. Allergen exposure → IgE formation
2. IgE binds to mast cells/basophils.
3. Re-exposure → antigen–IgE interaction → mast cell
degranulation.
4. Release of:
• Preformed mediators: histamine, heparin, ECF-A.
• Newly formed mediators: prostaglandins, leukotrienes,
PAF, TNF-α.
5. Leads to:
• Vasodilation, increased vascular permeability.
• Mucosal edema, sneezing, rhinorrhea, nasal blockage.

Immunoglobin E
(IgE) Antibody

Internal Use
 Allergic Rhinitis
Clinical Features

General
• Onset can be at any age;
• Common around 12–16 years.

Cardinal Symptoms
• Paroxysmal sneezing (10–20
sneezes)
• Watery rhinorrhea
• Nasal obstruction
• Itching of nose, eyes, palate
• May cause bronchospasm

Signs
1. Nasal Signs:
• Allergic salute (transverse
nasal crease)
2. Ocular Signs
• Allergic shiners (dark circles)
• Cobblestoning of conjunctiva
3. Otologic Signs:
• Retracted tympanic membrane
4. Pharyngeal Signs
• Granular Pharyngitis
Internal Use 5. Laryngeal Signs
 Allergic Rhinitis

Investigations

1. Total & differential count: Allergic Rhinitis and its Impact on

eosinophilia (not consistent). Asthma
2. Skin tests: prick, scratch, (ARIA) Classification
intradermal. 1. Based on Duration
3. Specific IgE measurements • Intermittent: <4 days/week or <4
4. RAST test weeks
5. Nasal smear: eosinophils. • Persistent: >4 days/week or >4
6. Nasal provocation test weeks
Complications
2. Based on Severity
1. Recurrent sinusitis • Mild: Normal sleep, normal daily
2. Nasal polyps activities
3. Serous otitis media • Moderate–Severe: Sleep
4. Orthodontic problems disturbance, activity impairment,
from mouth breathing troublesome symptoms

Internal Use
 Allergic Rhinitis
Treatment

Pharmacotherapy

Allergen 1. Antihistamines
• Reduce sneezing, rhinorrhea, itching.
Avoidance
• Side effect: drowsiness.
Remove pets, encase beddings,
avoid foods causing allergies, 2. Sympathomimetics (decongestants)
• Oral or topical.
relocate if necessary. • Includes pseudoephedrine, phenylephrine,
oxymetazoline.
• Caution: Risk of rhinitis medicamentosa.
3. Corticosteroids
Immunotherapy • Very effective for persistent disease.
• Given as nasal sprays/aerosols.
1. Gradual introduction of allergen 4. Sodium Cromoglycate
subcutaneously or sublingually. • Mast cell stabilizer.
2. Used when drug therapy is • Useful for seasonal & perennial types.
inadequate. 5. Anticholinergics
3. Breaks the IgE cycle. • Ipratropium bromide for rhinorrhea.
4. Must continue for 3 years for 6. Leukotriene Receptor Antagonists
• Montelukast, zafirlukast.
effectiveness.
7. Anti-IgE (Omalizumab)
• For moderate–severe allergic asthma.
Internal Use
 Vasomotor Rhinitis (VMR)
Definition
• Non-allergic rhinitis mimicking allergic rhinitis.
• Symptoms: nasal obstruction, rhinorrhea, sneezing.
• Nasal allergy tests are negative.
• Persists throughout the year.

Pathogene
sisRich blood supply of nasal mucosa with venous sinusoids.
1.
2. Imbalance of sympathetic & parasympathetic systems.
3. Emotional stress influences symptoms.
4. Nasal mucosa hyper-reactive to:
• Temperature changes
• Humidity
• Strong smells
• Dust, smoke, air blasts

Internal Use
 Vasomotor Rhinitis (VMR)
Symptoms Treatment
• Paroxysmal sneezing on waking.
• Excessive watery rhinorrhea, may drip [Link]
• Nasal obstruction, alternating sides.
• Postnasal drip 1. Avoid triggers (temperature changes, dust, odors).
2. Antihistamines & nasal decongestants for symptomatic
relief.
Signs 3. Topical steroids (budesonide, fluticasone).
Turbinates congested and hypertrophic 4. Short-term systemic steroids for severe cases.
5. Remove psychological factors (counseling, anxiolytics when
needed).
Surgical
Complicati
•ons
Nasal polyps 1. Correct anatomical causes of obstruction.
• Hypertrophic 2. Reduce turbinate size (e.g., hypertrophied turbinates).
rhinitis 3. Vidarian neurectomy for persistent, severe rhinorrhea.
• Sinusitis

Internal Use
 Thank You…

Internal Use