3. ARIA
What is ARIA?
ARIA (Allergic Rhinitis and its
Impact on Asthma) is a non-
governmental organization which
collaborates with the World
Health Organization (WHO)
through the Global Alliance
Against Chronic Respiratory
Diseases (GARD).
Mission of ARIA
The purpose and mission of ARIA is to
educate and implement evidence-
based management for allergic
rhinitis and asthma worldwide
through:
Planning and managing pilot projects
to improve the health of broad
sectors of the population throughout
the world
Setting up rural healthcare activities
Providing support for preventive,
diagnostic, and therapeutic measures
as part of basic healthcare
4. • Allergic
• Infectious: Viral (acute), bacterial, fungal
• Non-Allergic, Non-Infectious, Rhinitis
• Non-Allergic Rhinitis with Eosinophilia Syndrome
(NARES)
• Chronic Rhinosinusitis with or without Polyps:
Hypertrophic, inflammatory disorder that can affect
allergic or non-allergic individuals
Phenotypes
5. • Occupational: May be allergic or non-allergic
• Drug-induced: Aspirin, some vasodilators
• Hormonal: Pregnancy, menstruation, hormonal
contraceptives, thyroid disorders
• Food-induced (gustatory)
• Cold air-induced (skier’s nose)
• Atrophic (rhinitis of the elderly)
Phenotypes
6. Allergic Rhinitis
• Seasonal allergic rhinitis (hay fever) is most often caused by plant
allergens, which vary by season. Common plant allergens include:
Spring: Tree pollens (eg, oak, elm, maple, alder, birch, juniper, olive)
Summer: Grass pollens (eg, Bermuda, timothy, sweet vernal, orchard,
Johnson) and weed pollens (eg, Russian thistle, English plantain)
Fall: Other weed pollens (eg, ragweed)
7. Allergic Rhinitis
• Perennial rhinitis is caused by year-round exposure to indoor inhaled
allergens (eg, dust mite feces, cockroaches, animal dander) or by
strong reactivity to plant pollens in sequential seasons.
8. Classifications of allergic rhinitis
• Intermittent (seasonal - acute - occasional)
• Occasional symptoms lasting <four days per week or ≤
four weeks
• Persistent (perennial - chronic - long duration)
• Symptoms lasting > four days per week and > four
weeks
9. Intermittent
• < 4 days per week
• or < 4 weeks
Mild
• Normal sleep
• No impairment of daily
activities, sport, leisure
• Normal work & school
• No troublesome symptoms
in untreated patients
Persistent
• > 4 days per week
• and > 4 weeks
Moderate-Severe
one or more items
• Abnormal sleep
• Impairment of daily
activities, sport, leisure
• Abnormal work and school
• Troublesome symptoms
J Allergy Clin Immunol 2001;108:S147-336.
Classification
14. Symptoms
• Patients have itching (in the nose, eyes, or mouth), sneezing, rhinorrhea,
and nasal and sinus obstruction. Sinus obstruction may cause frontal
headaches; sinusitis is a frequent complication. Coughing and wheezing
may also occur, especially if asthma is also present.
• The most prominent feature of perennial rhinitis is chronic nasal
obstruction, which, in children, can lead to chronic otitis media; symptoms
vary in severity throughout the year. Itching is less prominent than in
seasonal rhinitis. Chronic sinusitis and nasal polyps may develop.
• Signs include edematous, bluish-red nasal turbinates, and, in some cases of
seasonal allergic rhinitis, conjunctival injection and eyelid edema.
15. Diagnosis
• Skin prick test. You're watched for an allergic reaction after small
amounts of material that can trigger allergies are pricked into the skin
of your arm or upper back. If you're allergic, you develop a raised
bump (hive) at the site of that allergen. Allergy specialists usually are
best equipped to perform allergy skin tests.
• Allergy blood test. A blood sample is sent to a lab to measure your
immune system's response to a specific allergen. Also called the
radioallergosorbent test (RAST), this test measures the amount of
allergy-causing antibodies in your bloodstream, known as
immunoglobulin E (IgE) antibodies.
25. Common seasonal allergy
with asthma symptoms are
coughing, shortness of
breath, wheezing and chest
tightness. These can be
similar to symptoms from
the new coronavirus. What
to do if you have
symptoms: aafa.org/covid19
27. Allergic conjunctivitis:
• Inflammation of conjunctiva due to allergicor hypersensitive
reaction which may be immediate (humoral ) or delayed
(cellular) to specific antigens
