BEST CLASS FOR UNDERGRADUATES(MBBS)

1. ALLERGIC RHINITIS
DR.B.KRISHNA SANTOSH,ASSOCIATE
PROFESSOR OF ENT,GSL MEDICAL
COLLEGE

2. Definition
 Multifocal
 igE
 Type1 hsn
 Of nasal mucosa
 To various allergens

3.  Inheritance-
 If one parent has h/o allergy-20-40% chance
 If both parents- 50-70% chance.

4.  Seasonal
 Perennial
 Occupational

5.  Common durring adolosence
 More common in males
 Genetic
 Focal sensitivity of nasal mucosa
 igA deficiency state
 Environmental factors
 psychology

6.  Pollen and dust.
 Fungus
 Danders
 Miscellaneous

7.  Allergens-
 Pollens
 Molds-fungal spores,aspergillus,
curvalaria,alternaria.
 Insects-cockroach,bed
bugs,houseflies,musquitoes.
 Animal dander-cat,doghorse,rabbit,guinea pig.
 House dust.
 Dustmite-in matresses.dermatophagoides.
 Foods- eggs,strawberries,nuts or fish,milk,
wheat.

8. Pollen common culprits

9. Flowers

10. Grasses and trees

11. Pets / animal dander

12.  Primary response :- allergic challenge in less
than 24 hrs.
 Late phase :- after 48 hrs
 Histamine secretion leads to sneezing, watery
discharge, itching.
 Pg,ld,n-mucous secretion and blockage.
 Eosinophils, mononuclear cells lead to
mucopurulent discharge.

13.  Ag + ige
 Degranulation release of mediators
 First response-rapid phase, sneezing,watery
discharge,itching.
 Late phase-noseblock,mucosal
secretion,inflamatory phase.- sub acute,
chronic.

15.  Preformed mediators
 Newly synthesized membrane derived lipid
mediators.

17.  Antigen molecules cross react with ige.this
cross linking allows formation of a calcium
channnel and the calcium influx triggers the
events that lead to histamine release .

19. Clinical features
 Nasal pruritis
 Paroxyms of sneezing
 Rhinorrohea
 Bilateral nasal stuffiness
 Seasonal > Perennial
 Mostly school children
 Assoc symp- cough, wheezing,chest
tightness,dyspnoea,eye
irritation,pruritis,eczematous dermatitis.

20.  Allergic salute, allergic shiners.
 Pale mucosa,boggy, blue tinged.
 Thin watery discharge
 Polyps
 Superadded imfection
 Complications-polyps,sinusitis,cobblestone
conjunctiva,edema of lids,allergic shiners.
 Serous otitis media,granular
pharyngitis,hoarseness of voice, bronchial
asthma.

21. Allergic salute

22. Investigations
 Cbp- eosinophils are raised.
 Nasal smear show-eosinophils
 Intranasal provacation test- crude method
(nasal challenge test).
 Specific ige antibody tests
 Skin test or invitro method.

23. Skin test
 prick or intradermal skin test
 Wheal(induration) ,flare ( erythema)which is
maximal at 15-20 mins.
 Detects presence of ige ab in tissueand shows
biologic activity.

24. In vitro tests
 RAST-it is a invitro test and measures the
specific igE concentration in patients serum.
 ELISA

25. TREATMENT
 AVOIDANCE –
 Pollen-close windows, remain in ac
 Animal dander- remove pets, HEPA Filter
(highefficiency particulate arresting ).
 Dust mite-encase pillows, matresses.
 Remove carpets.
 Molds- avoid gardening.

26. Drug therapy
 Anti histamines :-
 1st gen-chlorpheneramine,dimenhydramine.
 2nd gen-loratidine,cetrizine
 3rd gen-fexofenadine,levocetrizine.
 Topical-azelastine.
 Nasal decongestants-
 Pseudoephedrine,phenylephrine.
 Topical – xylo,oxy metazoline.

27.  Corticosteroids-anti inflamatory action.
 Systemic
 Topical-fluticasone, mometasone,
beclomethasone, nasal sprays.
 Mast cell stabilisers-sodium cromoglycate,
 Prophylaxis,stabilise the mast cell.

28.  Anti cholinergic agents
 Ipatropium bromide
 Donot cause rhinitis medicamentosa
 Mainly helps in treatment of post nasal drip
and rhinorrohea.

29.  Leukotriene modifiers
 Monteleukast-leukottriene inhibitor
 Zileuton-5-lipo oxygenase inhibitor.
 Anti ige antibody therapy-
 Omalizumab,

30.  Immunotherapy
 Repeated longterm injections of allergens.
 Circulating levels of ige antibodies increase
slightly during first few months but later on
decrease to substantially lower levels than
prior to injection.
 Subcutaneous injections gradually increasing
doses.weekly or twice a week.

31.  Surgery
 Inferior turbinectomy
 Laser , cryosurgery
 Electrocautery
 Chemical cautery
 Submucous diathermy.

32.  THANKYOU