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PPT on Allergic Rhinitis.pptx

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PPT on Allergic Rhinitis.pptx

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Allergic rhinitis (AR) is an atopic disease presenting with symptoms of sneezing, nasal congestion, clear rhinorrhea, and nasal pruritis. It is an IgE-mediated immune response that is against inhaled antigens in the immediate phase, with a subsequent leukotriene-mediated late phase

Allergic rhinitis (AR) is an atopic disease presenting with symptoms of sneezing, nasal congestion, clear rhinorrhea, and nasal pruritis. It is an IgE-mediated immune response that is against inhaled antigens in the immediate phase, with a subsequent leukotriene-mediated late phase

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PPT on Allergic Rhinitis.pptx

  1. 1. Allergic Rhinitis By Koushik Darivemula M. Sc Biotechnology Kowshikrishna123@gmail.com
  2. 2. What is Allergic Rhinitis ??  Allergic rhinitis (AR) is an atopic disease presenting with symptoms of sneezing, nasal congestion, clear rhinorrhea, and nasal pruritis. It is an IgE-mediated immune response that is against inhaled antigens in the immediate phase, with a subsequent leukotriene-mediated late phase.1  In the past, allergic rhinitis was considered to be a disorder localized to the nose and nasal passages, but current evidence indicates that it may represent a component of a systemic airway disease involving the entire respiratory tract.2  Co-morbid conditions includes Asthma, Atopic Dermatitis & Nasal polyps.3  Allergic Rhinitis symptoms result in sleep disturbance, fatigue, depressed mood and cognitive function compromise that impairs quality of life and productivity.3  Around 20–30 % of the Indian population suffers from allergic rhinitis and that 15 % develop asthma.3
  3. 3. Etiology  Early phase: Allergic rhinitis is an immunoglobulin (Ig)E-mediated response against inhaled allergens that cause inflammation driven by type 2 helper (Th2) cells, occurs within five to 15 minutes of exposure to an antigen, resulting in degranulation of host mast cells. This releases histamine, which is one of the primary mediators of allergic rhinitis, induces sneezing via the trigeminal nerve and also plays a role in rhinorrhea by stimulating mucous glands.1  Late phase: Immune mediators such as leukotrienes and prostaglandins are also implicated as they act on blood vessels to cause nasal congestion. Four to six hours after the initial response, an influx of cytokines, such as interleukins (IL)-4 and IL-13 from mast cells occurs, signifying the development of the late phase response. These cytokines, in turn, facilitate the infiltration of eosinophils, T lymphocytes, and basophils into the nasal mucosa and produce nasal edema with resultant congestion.
  4. 4. Classification of AR based on symptoms and severity3 Based on Symptoms 1. Intermittent - <6 weeks 2. Persistent – symptoms lasts throughout the year Based on Severity 1. Mild 2. Moderate- severe Note: • Mild symptoms includes Normal sleep, no impairment of daily activities. • Moderate- severe symptoms includes abnormal sleep, impairment of daily activity.
  5. 5. Diagnosis  Allergic rhinitis is largely a clinical diagnosis made based on a thorough history and physical.1 Diagnosis tests: 1. Skin pricking test2 2. Allergen-specific IgE test2 3. Radiographic imaging, Computerized tomography is used to exclude chronic rhinosinusitis, tumors.3 4. The diagnosis of asthma- Asthma and rhinitis are common co-morbidities, suggest ing the concept of ‘‘one airway, one disease.
  6. 6. Treatment  The main aim of treating Allergic Rhinitis is relief from symptoms.2  therapeutic options include avoidance measure, antihistamines, intranasal steroids, Intranasal corticosteroid therapy, leukotriene receptor antagonists (LTRAs), combination intranasal corticosteroid/antihistamine sprays and allergen immunotherapy. 2  Avoidance measure: Precautions can be taken to avoid dust mites, animal dander.1  Antihistamines: First-generation antihistamines include diphenhydramine, chlorpheniramine, and hydroxyzine, whereas fexofenadine, loratadine, desloratadine, cetirizine and Azelastine. 1  Intranasal corticosteroid therapy: Beclomethasone, budesonide, fluticasone propionate, mometasone furoate, ciclesonide, fluticasone furoate and triamcinolone acetonide are few nasal sprays used.1  Leukotriene receptor antagonists (LTRAs): Montelukast and zafirlukast are most effective.  Allergen immunotherapy: Allergen immunotherapy involves the subcutaneous administration of gradually increasing quantities of the patient’s relevant allergens until a dose is reached that is efective in inducing immunologic tolerance to the allergen. Allergen immunotherapy is given on a perennial basis with weekly incremental increases in dose over the course of 6–8 months, followed by maintenance injections of the maximum tolerated dose every 3–4 weeks for 3–5 years.2  Types of immunotherapy includes Subcutaneous immunotherapy (SIT), Local nasal immunotherapy (LNIT) and sublingual immunotherapy (SLIT).3
  7. 7. Role of antihistamines in treating AR  Antihistamines bind to histamine receptors on the surface of cells. There are four types of histamine receptors in the body (H1 -H4 ), with H1 and H2 being most widely expressed.4  H1 histamine receptors are found on a variety of cells including airway and vascular smooth muscle cells, endothelial cells, epithelial cells, eosinophils and neutrophils.4  H1 antihistamines (H1 receptor antagonists or H1 receptor blockers)commonly used medications in the world not only for prevention and treatment of symptoms in allergic rhinitis.7
  8. 8. Azelastine role in Allergic Rhinitis  Azelastine nasal spray (Astelin® Nasal Spray) is an effective topical management for the symptoms of seasonal allergic rhinitis. The active ingredient, azelastine hydrochloride, is a selective, high-affinity, histamine H1- receptor antagonist with structural and chemical differences (it is a phthalazinone derivative) that distinguish it from currently available antihistamines. 6  On a milligramper-milligram basis, azelastine is approximately 10 times more potent than chlorpheniramine at the H1-receptor site.6  azelastine is more than just an anti-histamine. It exhibits a very fast and long-acting effect based on a triple mode of action, with anti- inflammatory and mast cell stabilizing properties in addition to its anti- allergic effects.5  Azelastine inhibits the activation of cultured mast cells and release of interleukin (IL)-6, tryptase, and. It also reduces mediators of mast cell degranulation such as leukotrienes which are involved in the late phase allergic response, in the nasal lavage fluid of patients with rhinitis. 5
  9. 9.  Other anti-inflammatory properties of azelastine include inhibition of tumor necrosis factor alpha (TNFα) release reduction of granulocyte macrophage colony-stimulating factor (GM-CSF) generation, as well as a reduction in the number of a range of inflammatory cytokines including interleukin (IL)-1β, IL-6, IL-4 and IL-8.5  Recent results from 2 studies have shown that azelastine nasal spray at a dosage of 1 spray per nostril twice daily is effective and has a better tolerability profile compared to 2 sprays per nostril twice daily in patients (12 years; n = 554) with moderate to severe SAR.5  The 1-spray dose could be used as a starting dose in patients with mild-to-moderate symptoms, and if necessary the dose increased to 2 sprays per nostril twice daily if symptom control proved to be inadequate.5 Comparisons with intranasal corticosteroids
  10. 10. Comparisons with oral antihistamines Azelastine nasal spray and cetirizine 10 mg/d were compared in a randomized, double-blind, multicenter study in 136 patients during a 2-week study period. The total symptom scores improved 47% and 61% for azelastine and 55% and 67% for cetirizine on days 7 and 14, respectively.6
  11. 11. Conclusion  Azelastine nasal spray is an effective topical treatment for the symptoms of seasonal allergic rhinitis including nasal congestion and ocular symptoms. Azelastine affects early- and late-phase allergic reactions through interrelated effects on histamine and other mediators of the inflammatory response.6  Azelastine nasal spray had a relatively low incidence of somnolence (7.7%) associated with its use in long-term studies and did not demonstrate psychomotor impairment even at oral dosages 4 to 8 times the recommended daily dosage of azelastine nasal spray.6  Azelastine is not associated with drug interactions and the types of adverse cardiac effects that have been reported with terfenadine and astemizole.  The advantages of intranasal delivery include lower risk of systemic side effects and drug interactions, azelastine nasal spray was well-tolerated for treatment durations up to 4 weeks in both adults and children (12 years).5
  12. 12. References: 1. Allergic Rhinitis Shweta Akhouri; Steven A. House 2. Allergic rhinitis Peter Small1 , Paul K. Keith2 and Harold Kim2,3* 3. Allergic Rhinitis: an Overview Jitendra Varshney • Himanshu Varshney 4. Antihistamines and allergy Katrina L Randall Staff specialist1 Senior lecturer2 Carolyn A Hawkins Staff specialist1 Lecturer2 1 Department of Immunology Canberra Hospital 2 Australian National University Medical School Canberra 5. Effectiveness of twice daily azelastine nasal spray in patients with seasonal allergic rhinitis Friedrich Horak Medical University Vienna, ENT – Univ. Clinic, Vienna, Austria 6. Management of allergic rhinitis with a combination antihistamine/antiinflammatory agent Phil Lieberman, MD Knoxville, Tenn 7. H1 Antihistamines Current Status and Future Directions F. Estelle R. Simons* **þ§ and Keith J. Simons

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