for study purpose

1. ALTERED IMMUNE RESPINSE
BY
GARIMA SRIVASTAVA

2. DEFINITION
IgE mediated hypersensitivity disease of mucous membranes of
nasal airways characterized by sneezing, watery nasal discharge ,
itching and nasal obstruction”

3. RISK FACTORS
1.Genetic susceptibility
2.Family history of atopy: e.g. asthma,eczema,hay fever,urticaria
3. Environmental factors
•Pollution
•Irritants eg. fumes, tobacco smoke, diesel exhaust, mosquito
repellents, perfumes, scented sticks, domestic sprays, bleaches

4. Cont…
4. Exposure to allergens:
•Seasonal : Pollen, Fungus
•Perennial: Dust mite, domestic pets, cockroaches

5. Cont….
5.Hygiene hypothesis
•Increased exposure to various allergens.
•Early environmental exposure to infectious agents, protects
against development of atopy.
•Early nursery attendance also reduces subsequent atopy.
•Lack of immune maturation (understimulated immune system) in
infancy allergic responses.

6. RESPONSE OF IMMUNE SYSTEM
Acute or early phase response
• 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

7. Cont…
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.

8. SYMPTOMS
 Running
 Blocking
 Sneezing
 Itching

9. Cont…
SIGNS
 Nasal crease Pale turbinate
 Face: Bunny nose-frequent twitching of face, Dannie-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

10. TYPES OF ALLERGIC RHINITIS
Seasonal allegic rhinitis- symptoms appear in or around a
particular season. And is caused by pollen grains
Perennial allergic rhinitis- symptoms are present throughput year
and is caused by dust miles, insect, cockroaches, animal danders.

11. DIAGNOSIS
1.History
2.Physical exam
3.Allergy diagnosis
(I) Skin prick test (SPT).
(II) Blood tests for allergy: Total IgE, Specific IgE.
(III) Nasal allergen challenge test.
(IV) Radio-allergosorbent test (RAST)
(V) Nasal endoscopy CT scan-Nose

12. MANAGMENT
Management of allergic rhinitis
1. Environmental control measures (Avoidance of allergens)
2. Patient education
3. Nasal douching
4. Medical therapy
5. Immunotherapy
6. Surgery

13. Cont…
Antihistamines:
1.Topical:Cetirizine,Levocetirizine,Fexofenadine,Loratadine,
Desloratadine
2.Nasal Decongestants: Topical: Oxymetazoline, Xylometazoline
Systemic: Phenylephrine, Pseudoephedrine
3.Mast cell stabilizers: Sodium cromoglycate nasal drop

14. Cont…
4.Anticholinergics: Ipratropium bromide nasal spray
5.Corticosteroids:Topical:Beclomethasone,Budesonide,Mometasone
,Fluticasone Systemic: Prednisolone
6.Leukotriene receptor antagonists: Montelukast, Zafirlukast

15. GENERAL INSTRUCTIONS
1. Environmental control measures (Avoidance of allergens)
2. Patient education
3. Nasal douching
4. Medical therapy
5. Immunotherapy
6. Surgery
7. Removing allergen from the indoor environment should be a primary
strategy

16. Cont…
 Avoid irritants: smoke, dust, vehicular & other atmospheric
pollutants,
 Physical factors – extreme changes in temperature
 Avoid foods & drugs to which you are allergic
 Avoid occupational irritants or change profession
 Avoidance of indoor allergens

17. Cont…
 Avoidance of animal allergen
 Remove pet animals (cats, dogs) from bedroom
 Wash the pet weekly
 Measures to avoid house dust mite
 Mattress covers
 Covers for pillows & bedding
 Regulation of ventilation & humidity at home
 Protein denaturating agents- Tannic acid

18. Cont…
 Pollen avoidance measures
 Avoid walking in open grassy spaces during hot, dry days
 Keep windows closed
 Wear facemask & sunglasses when moving out
 Nasal douching
 Saline irrigation
 Improves quality of life