otorhinolaryngology

2. ALLERGICRHINITIS
PRESENTER:
• DR QAZI AKHTAR LAKHIAR
SENIOR REGISTRAR
DEPT OF E.N.T-LUMHS ,jamshoro Sindh Pakistan
qaziakhtar007@gmail.com

3. ALLERGIC RHINITIS
clinically defined as:
 A symptomatic
disorder of the nose
induced by an IgE-
mediated
inflammation after
allergen exposure to
the membranous
linning the nose

4. ALLERGIC RHINITIS
Most common type of rhinitis.
Most common atopic allergic reaction.
Affects >50% of the population.
50% of rhinitis in field of E.N.T is A.R
Commonly seen in young children and
adolscents.

5. ETIOLOGY
1. Precipitating factors.
2. Predisposing factors.

6. Precipitating factors
Aerobiological flora.
 Allergens present in the environment
 house dust and dust mites.
 feathers
 tobacco smoke
 Industrial chemicals
 animal dander
Nasal physiology:
 Disturbance in normal nasal cycle.

7. Predisposing factors
1. Genetic:
 50% of A.R patients have a positive family
history of Allergic Rhinitis.
 Multiple gene interactions are responsible for
allergic phenotype
 Chromosomes 5,6,11,12 & 14 control
inflammatory process in atopy.

8. Predisposing factors
2. Endocrine :
Puberty
Pregnancy
Post partum state
Menopause
3. psychological state
4. focal sensitivity state

9. Predisposing factors
5. Age & Sex
6. IgA Deficiency
7. fungal infections
8. physical:
 degree of pollution of air
 humidity & temperature differences
 temperature changes

10. Common allergens

11. Pathophysiology

12. How the symptoms are
produced?
Irritation of free
nerve endings---- Itching and sneezing
Increased
mucus production ------ Rhinorrhoea
Vasodilation -------- Congestion
Increased
vascular permeability---- Oedema

13. Symptoms
• Nose: swelling of the nasal
mucosa (allergic
rhinitis)
• Eyes: redness and itching
(allergic conjunctivitis)
• Airways:
bronchoconstriction,
wheezing, itchy or sore
throat, post nasal drip,
and cough
• Ears: feeling of fullness,
possibly pain, and
impaired hearing due to
the lack of eustachian tube
drainage.

14. CLINICAL SIGNS
Nasal crease/ allergic
salute
Allergic shiners
Rhinorhea
High arched palate
Over bite
Congestion of
conjunctiva

15. Classification of A.R- former
 Seasonal:
Hay fever
Summer cold
Rose fever
Perennial:
Allergens present throughout the year.

16. Moderate-severe
 one or more among
following
 abnormal sleep
 impairment of daily
activities, sport, leisure
 abnormal work and school
 troublesome symptoms
Persistent
• ≥ 4 days per week
• and ≥ 4 weeks
Mild
 normal sleep
& no impairment of daily
activities, sport, leisure
& normal work and school
& no troublesome
symptoms
Intermittent
• < 4 days per week
• or < 4 weeks
ARIA – newer Classification
ARIA Report 2001

17. Complications
Allergic asthma
Chronic otitis media
Hearing loss
Chronic nasal obstruction
Sinusitis
Orthodontic maloclussion in children

18. Diagnosis of A.R
 History
 Physical / Nasal
Examination.
 Histamine test
 Nasal smear test
 Intranasal provocation test
 Nasal challenge test
 Nasal cytology
 S. Ig E level
 Skin tests-
 subcuticular tests
 Intradermal tests
 skin end point titration test
 other investigations
 RAST (Radio allegro sorbent
test),
 FAST (fluro allegro sorbent
test)
 PRIST ( paper immune
allegro sorbent test)
 Rhinomanometry
 Serum Ig E level
 Xray P.N.S
 C.T- P.N.S
 NASAL ENDOSCOPY

19. Managing allergic rhinitis
Pharmacotherapy Immunotherapy
Allergen avoidance
Patient education

20. Pharmacotherapy
Medications used to treat allergic rhinitis:
 Antihistamines
 Decongestants
 AH-D combinations
 Corticosteroids
 Mast Cell stabilizers
 Anticholinergics
 Antileukotrienes

21. Actions of Various Nasal Preparations
in the Treatment of Rhinitis
Nasal
Preparation
Sneezing Itching Rhinorrhoea Congestion
Antihistamines +++++ ++++ +++ 0
Anticholinergics 0 0 +++++ 0
Corticosteroids +++++ +++++ +++ +++
Decongestants 0 0 + +++++
Mast cell stabiliser +++++ +++ + 0
Antileukotrienes +++ ++ 0 ++++

22. Moderate/
severe
intermittent
Mild
persistent
Moderate/
severe
persistent
Nasal corticosteroids
Nasal cromone
Anti-histamine (oral or local)
Oral or nasal decongestant (<10 days)
Allergen avoidance
Specific Immunotherapy
Mild
intermittent
Stepwise approach of allergic
rhinitis according to the ARIA
guidelines

23. Immunotherapy
If allergic rhinitis is refractory to
pharmacotherapy or severe,
 helps in reducing the specific serum Ig E level
 Decreases basophil sensitivity
 increases IgG blocking antibody level, thus
preventing allergen from reaching mast cells
and subsequent mast cell degranulation.

24. surgery
Limited role:
Submucosal turbinectomy.
Septoplasty
Sinus surgery