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Allergic rhinitis


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By:Sara Al-Ghanem

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Allergic rhinitis

  1. 1. Done By : Sara Ali Al-Ghanem 208009915
  2. 2. • What is rhinitis ?• Definition & pathophysiology of AR.• Symptoms & signs of AR .• AR in Saudi Arabia• Triggering factors of AR.• Investigations of AR.• Differential diagnosis of AR• the New Guidelines for Classifying AR.• Co morbidities of AR• Management of AR
  3. 3. Rhinitis RhinitisIdiopathic Infective Allergic seasonal perennial Non- esionphiliesionphilic c
  4. 4. In the ARIA guidelines, allergic rhinitis is clinically definedas :a symptomatic disorder of the nose induced by an IgE-mediated inflammation after allergen exposure of themembranes of the nose.ARIA = Allergic Rhinitis and its Impact on Asthma
  5. 5. symptoms & Signs:Symptoms include:Rhinorrhea Nasal obstruction Nasal itching Sneezing. These symptoms are all potentially reversible with treatment.Signs :1. bluish or pale oedematous nasal mucosa2. clear discharge3. Skin crease above nasal tip (allergic salute)4. nasal polyps grabe like masses5. Generalized puffiness around the eye6. Infra-orbital skin darkness (allergic shiners)
  6. 6. The WHO (World Health Organisation)now classifies allergic disease as thefourth most important chronic diseasein the world. AR affects 10  20% of population
  7. 7. Allergic Rhinitis is aMAJOR chronic respiratory disease ?
  8. 8. Allergic Rhinitis is aMAJOR chronic respiratory disease ?
  9. 9. Allergic Rhinitis in Saudi Arabia
  10. 10. 27.82% of Saudi children (1100) aged 6-14 years from Riyadh city were found to be allergically sensitive, with high prevalence rates for allergic rhinitis, asthma and atopic dermatitis The total prevalence of allergic rhinitis, asthma, eczema, food and drug allergies in the studied children were 12.7, 11.4, 5.6, 1.75 and 0.27%, respectivelySource :Decreased Prevalence of Allergic Rhinitis, Asthma and Eczema in Riyadh City,Saudi Arabia Harb Harfi, Kamel Al Abbad and Abbas H. AlsaeedTrends in Medical Research Year: 2010 | Volume: 5 | Issue: 2 | Page No.: 57-62DOI: 10.3923/tmr.2010.57.62
  11. 11. Allergic Rhinitis in Al-Ahsa No available Researches
  12. 12. Investigations:1) multi-allergen screening tests. The inhalant allergy screen is called an ImmunoCAP Phadiatop2) Skin test3) RAST (Radio-Allergo Sorbent Test): measures allergen- specific IgE
  13. 13. differential Diagnosis of AR -2 or more of the following :1 hr on most days: -Unilateral symptoms-Watery anterior rhinorrhea - Nasal obstruction wo other-Sneezing , especially symptomsparoxysmal-Nasal obstruction - Posterior rhinorrheal(post-Nasal pruritis nasal drip )+- conjunctivities •W thick mucous •&OR no ant. Rhinorrhea -Pain - recurrent epistaxias - anosmia
  14. 14. Symptoms Symptoms•< 4 days •>4 daysweek•Or < 4 consecutive weeks •And >4 consecutive weeks
  15. 15. 50% of pt.s with asthmaappear to have AR.20% of pt W AR are asthmaticAR account for 30% ofacute sinusitis &80% of chronic sinusitis cases
  16. 16. Believe on what you are doing & appreciate its value in your life written by :Sara Al-
  17. 17. Recognize AR• History AR questionnaire• Physical examination Investigations Classify AR & ttt
  18. 18. ARIA AR questionnaire
  19. 19. questionnaire of The InternationalStudy of Asthma and Allergies inChildhood ( ISAAC )
  20. 20. The management of ARThe management of AR consists of 3 major categories of treatment:• (1) environmental control measuresand allergen avoidance.• (2) pharmacological management• (3) immunotherapy.
  21. 21. “ not in preferred order “ •Oral H1- antihistamine •OR intranasal H1- antihistamineMILD •& OR decongestant • OR leukotriene receptor antagonist (LTRA) ** ** in particular , in patient with asthma
  22. 22. MODERATE - “ Not in preferred order “ SEVER •Oral H1-antihistamine •OR Intranasal H1- antihistamine •& OR decongestant •OR intranasal CS * •OR LTRA ( or cromone ) ** MILD If persistent rhinitis review the pt after 2-4Wks •If failure  step – up •If moderate : continue for 1 month• Total dose of topical CS should be considered if inhaled steroids are used for concomitantasthma
  23. 23. in preferred order “ Intranasal CS MILD – •H1- antihistamine orMODERATE •LTRA** SVERE Review the pt after 2-4 WKs Step –down &continue ttt for 1 1- increase intranasal •Review DX month CS dose •Review 2- itchsneeze  add H1 complianc antihistamine e 3- rhinorrhea  add •Query ipratropuim infections 4- blokage  add •OR other decongestant OR oral causes CS “short term “
  24. 24. OPD case : Monday 13-2-2012A middle aged , non Saudi patient, presented last Monday in the health center – ENT OPD with recurrent attacks of nasal obstruction since 3-4 months & associated with sneezing 2-3 times per day.The pt reported that there is no similar attacks in the past & He started suffering from theses symptoms when he became living and working in the Al-AhssaThese symptoms were relived by systemic decongestant , but the pt. stopped taken his medication after short period when he was improved.Examination revealed that he had eczematous left nostril “ vestibulitis “ & big tonsils.
  25. 25. • The ALLERGY ADVISOR contains: •Weather and Pollen forecasts in your area •Triggers and Symptoms logs for multiple locations •Customizable Alerts for Treatments, RX Refills, etc. •Healthcare Professionals Contact Storage
  26. 26. Points to Remember• AR is a major chronic respiratory disease• AR is associated with co morbidities such as conjunctivitis• AR should be considered as risk factor for asthma along with other known risk factors .• A stepwise therapeutic approach depends on Severity of AR.• The treatment of AR combines ( pharmacology , immunotherapy & education )• Pt with persistent AR should evaluate for asthma & Vice versa.
  27. 27. References• Books:1. Abou-Elhomad ENT book• Websites :1. Management of allergic rhinitis & its impact on asthma pocket guideline ( Decreased Prevalence of Allergic Rhinitis, Asthma and Eczema in Riyadh City, Saudi Arabia Harb Harfi, Kamel Al Abbad and Abbas H. Alsaeed ( )3. International study of asthma and allergies in childhood (ISAAC) OtoPhinolaryngology Portal ( )5.• Apple store medical app s1. Ear , Nose & throat (ENT) Miniatlas ( app)2. Allergy advisor