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Rhinology

The Affiliated Hospital of Ningxia


Medical College
Allergic Rhinitis (Definition and
Classification)
Definition: Allergic rhinitis is a symptomatic
disorder of the nose induced, after allergen
exposure, by an immunoglobulin (Ig) E-
mediated inflammation of the nasal mucosa.
Classification: For practical purposes,
allergic rhinitis can be divided into seasonal
and perennial allergic rhinitis.
Allergic rhinitis
Symptoms: common
symptoms include
sneezing; stuffy nose;
Itchy eyes, nose and
throat; and watery
eyes.
Allergic rhinitis
Causes:
1. seasonal allergic rhinitis usually results from tree, grass,
or weed pollen. Grass pollens also vary by geographic
location. (In NING XIA it is Artemisia L. in INDIA?) Most of
the common grass species are associated with allergic
rhinitis, A number of these grasses are cross-reactive,
meaning that they have similar antigenic structures. a
person who is allergic to one species is also likely to be
sensitive to a number of other species. The grass pollens
are most prominent from the late spring through the fall but
can be present year-round in warmer climates.
Allergic rhinitis
2. Perennial allergic rhinitis can cause year-
round symptoms. This allergic reaction is
the result of indoor or outdoor irritants such
as feathers, mold spores, animal’s hair and
skin shed by pets or dust mites.
House dust is a mixture of approximately
28 allergenic components.
Allergic rhinitis

Mold Pets Pollen

Antigens for allergic rhinitis

Mite

Artmisia L.
Pathophysiology
Allergic rhinitis are thought to be type I allergic
reactions.
Allergens enter the body through the airways, In
atopic patients an allergen is recognized as being
foreign to the immune system. B cells are
stimulated to produce specific IgE antibodies.
These IgE antibodies bind to the surface of mast
cells. On subsequent exposures, the allergens
bind to the IgE antibodies. Bridging two IgE
antibodies makes the mast cell releases histamine
and other cytokines[®saitou"kain] that cause
allergic reactions.
Pathology of allergic rhinitis
Pathology of rhinitis
Pathology of rhinitis
Early Response
The early response is initiated after bridging of
IgE antibodies on the mast cells. Mast cells
release mediators such as histamine,
prostaglandins, leukotrienes, These mediators
cause vascular dilatation, increased permeability,
and attract inflammatory cells into the tissues
starting the inflammation. The early response is
characterized by sneezing, rhinorrhea,
bronchoconstriction, and increased bronchial
responsiveness.
Pathology of rhinitis
Late Response
The mediators released from mast cells attract
inflammatory cells such as eosinophils,
lymphocytes, neutrophils, and monocytes into the
tissues. Therefore, the late response is a cell-
mediated response. The late response is
characterized by prolonged mucus secretion,
edema formation, and bronchial
hyperresponsiveness.
Diagnosis
The diagnosis of allergic rhinitis is made on the
basis of the history and confirmed with relevant
physical findings and the test results.
1.History: family history of allergic diseases;
environment exposures; occupational exposures;
and effects on quality of life. A thorough history
may help identify specific triggers, suggesting an
allergic etiology for the rhinitis.
Diagnosis
Family history: Because allergic rhinitis has a
significant genetic component. A positive
family history for atopy makes the diagnosis
more likely. Children of individuals with
allergies have been shown to have a higher
incidence of allergies than that of other
children. If both parents have allergies, their
child has a 50% chance of having the same
problem.
Diagnosis
Environmental exposure: This should include
investigation of risk factors for exposure to
perennial allergens. Risk factors for dust
mite exposure include carpeting, heat,
humidity, and bedding that does not have
dust mite-proof covers. Chronic dampness
in the home is a risk factor for mold
exposure.
Diagnosis
2. Physical findings:
While pale, bluish nasal
turbinates, and swollen
mucosa is typical for
allergic rhinitis, but
mucosal examination
findings cannot
definitively distinguish
between allergic and
nonallergic causes of
rhinitis.
Diagnosis
3. Lab studies: Allergic testing, Testing for reaction
to specific allergens can be helpful to confirm the
diagnosis of allergic rhinitis and to determine
specific allergic triggers. Allergy testing provides
knowledge of the degree of sensitivity to a
particular allergen. The most commonly used
methods of determining allergy to a particular
substance are allergy skin testing and in vitro
diagnostic tests, such as the radioallergosorbent
test.
Diagnosis

Allergy skin testing


Diagnosis
Total blood eosinophil count: Eosinophils are
most mediators of allergic rhinitis. An
elevated eosinophil count supports the
diagnosis of allergic rhinitis, but it is neither
sensitive nor specific for diagnosis.
Complications
Possible complications include:
1. Otitis media.
2. Eustachian tube dysfunction.
3. Acute sinusitis and chronic sinusitis.
4. Asthma.
5. Nasal polyps occur in association with
allergic rhinitis.
Treatment
The best treatment for allergic is to avoid
allergen. When it is impossible, medication
can usually control the symptoms of a
reaction. But because each individual is
unique, there is no standard treatment for
allergic rhinitis.
Treatment
How to avoid
allergen? Avoid going to picnic during pollen season.
Pollen avoidance Wear sunglass outdoors.
* A Pollens Stay inside in the late afternoon. *
rise with the heat
during the day and Keep the windows closed in the afternoon.
come down as the air *
starts cooling during
late afternoon. Keep the windows closed in the car.
Therefore, in the late
Use pollen filters if possible.
afternoon exposure
is highest.
Treatment

Avoid humidity.
Avoid warm environment.
Ventilate adequately.
Avoid wall-to-wall carpeting.
Remove dust reservoirs such as stuffed animals
with artificial fur, soft toys, woollen blankets, old
mattresses, silk flowers, mounted animals, books
on open shelves, feather pillows or bedding,
upholstered furniture.
Use pillow covers and mattress covers
impermeable to dust mites
Use filter vacuum cleaners preferable (at least
twice a week.
Clean with a damp cloth every week
Wash the laundry with water hotter than 60°C
every week; if possible expose to sunlight.
Drug treatment
These medications are used to treat allergic rhinitis:
1. H1-antihistamines.This kinds of medicine can block the
action of the histamines. They compete with histamine for
histamine receptor type 1 receptor sites in the blood
vessels. They are considered the “mainstay of treatment.”
before. Their side effects include drowsy, dizziness,
blurred vision, dry mouth. Some second-generation
antihistamines haven't appear to produce significant
sedation at usual doses. H1-antihistamines do significantly
improve symptoms of allergic rhinitis but do not
significantly improve nasal congestion.
Drug treatment
2. Corticosteroids: Mechanism of Action
Corticosteroids reduce nasal inflammation and
nasal hyperactivity. Side Effects Intranasal There
are minor local side effects, a wide margin for
systemic side effects and there are growth
concerns with some molecules only. In young
children, consider the combination of intranasal
and inhaled drugs. Oral Systemic side effects are
common in particular for drugs. injections may
cause local tissue atrophy.
Treatment
3. Specific Immunotherapy: Immunotherapy
are used in cases whose symptoms are not
well controlled with avoidance measures
and pharmacotherapy.