This document discusses allergic and intrinsic rhinitis. It defines allergic rhinitis and describes its prevalence, classifications, etiology, clinical features, investigations, and treatment including immunotherapy. Intrinsic rhinitis is also discussed, focusing on vasomotor rhinitis including its pathogenesis, clinical features, and treatment with medications and surgery. Rhinitis medicamentosa caused by overuse of decongestants is also summarized.
Allergic Rhinitis ppt.
by Vishnuvardhan Thotakura [vishnutv9@gmail.com]
3yr MBBS
i have put BASICS to know all ABOUT ALLERGIC RHINITIS in this ppt. and hope you understand it!
ref: ENT books - Dhingra, Hazarika , pics and video from the internet.
Allergic Rhinitis ppt.
by Vishnuvardhan Thotakura [vishnutv9@gmail.com]
3yr MBBS
i have put BASICS to know all ABOUT ALLERGIC RHINITIS in this ppt. and hope you understand it!
ref: ENT books - Dhingra, Hazarika , pics and video from the internet.
Allergic rhinitis is a very common disorder that affects people of all ages. It is frequently ignored, under diagnosed, misdiagnosed, and mistreated, which not only is detrimental to health but also has societal costs. Although allergic rhinitis is not a serious illness, it is clinically relevant because it underlies many complications, is a major risk factor for poor asthma control, and affects quality of life and productivity at work or school. Hidden direct costs include the treatment of co-morbid asthma, chronic sinusitis, otitis media, upper respiratory infection, and nasal polyp. Nasal congestion, the most prominent symptom in AR, is associated with sleep-disordered breathing, a condition that can have a profound effect on mental health, including increased psychiatric disorders, depression, anxiety, and alcohol abuse. Furthermore, sleep-disordered breathing in childhood and adolescence is associated with increased disorders of learning performance, behavior, and attention. Management of allergic rhinitis is best when directed by guidelines. At this juncture Homoeopathic system of medicine offers a safe and effective solution of the illness if followed under the guidance of expertise. This article provides an overview of the patho-physiology, diagnosis, and appropriate homoeopathic management of this disorder.
Dr. Smita Brahmachari
M.O., Dept. of AYUSH, Govt. of NCT Delhi.
Allergic rhinitis-Allergic rhinitis is an allergic inflammation of the nasal airways.
In this slide we can get info about its causes,symptoms,prevention & treatment.This slide helps people to know about this disease.
Allergic rhinitis is a very much prevalent condition in the community. This presentation hopes to spread a ray of hope in treating allergic and intrinsic rhinitis.
Allergic rhinitis is a very common disorder that affects people of all ages. It is frequently ignored, under diagnosed, misdiagnosed, and mistreated, which not only is detrimental to health but also has societal costs. Although allergic rhinitis is not a serious illness, it is clinically relevant because it underlies many complications, is a major risk factor for poor asthma control, and affects quality of life and productivity at work or school. Hidden direct costs include the treatment of co-morbid asthma, chronic sinusitis, otitis media, upper respiratory infection, and nasal polyp. Nasal congestion, the most prominent symptom in AR, is associated with sleep-disordered breathing, a condition that can have a profound effect on mental health, including increased psychiatric disorders, depression, anxiety, and alcohol abuse. Furthermore, sleep-disordered breathing in childhood and adolescence is associated with increased disorders of learning performance, behavior, and attention. Management of allergic rhinitis is best when directed by guidelines. At this juncture Homoeopathic system of medicine offers a safe and effective solution of the illness if followed under the guidance of expertise. This article provides an overview of the patho-physiology, diagnosis, and appropriate homoeopathic management of this disorder.
Dr. Smita Brahmachari
M.O., Dept. of AYUSH, Govt. of NCT Delhi.
Allergic rhinitis-Allergic rhinitis is an allergic inflammation of the nasal airways.
In this slide we can get info about its causes,symptoms,prevention & treatment.This slide helps people to know about this disease.
Allergic rhinitis is a very much prevalent condition in the community. This presentation hopes to spread a ray of hope in treating allergic and intrinsic rhinitis.
Define allergic rhinitis
Pathophysiology of allergic rhinitis
Signs/symptoms of allergic rhinitis
Diagnosis
Investigations
Complications
Treatment
Non allergic rhinitis
Pathogenesis
Signs/symptoms
Treatment
“It is an IgE-mediated immunologic response of nasal mucosa to airborne allergens and is characterized by watery
nasal discharge, nasal obstruction, sneezing and itching
in the nose. This may also be associated with symptoms
of itching in the eyes, palate and pharynx”
. Two clinical types have been recognized:
1. Seasonal. Symptoms appear in or around a particular
season when the pollens of a particular plant, to whic
the patient is sensitive, are present in the air.
2. Perennial. Symptoms are present throughout the year
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Acute suppurative otitis media and and cortical mastoidectomykrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
This presentation gives a lucid idea about different neoplasms of nose like inverted papilloma, ca maxilla, ethmoid and so on.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
Epistaxis is one of the commonly encountered problem in day to day life by the otolaryngologists. Most of the times, it is mild , but sometimes, it is very difficult to manage and there may be mortality, too.
This presentation gives a lucid idea of causes of epistaxis, emergency treatment options and operative treatment of epistaxis, too.
Deviated nasal septum and other septal conditionskrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides were prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. • Definition
– IgE mediated hypersensitivity disease of the mucous
membrane of nasal airways characterized by sneezing ,
itching, watery nasal discharge, sensation of nasal
obstruction, postnasal discharge and hyposmia
• Associations
– Allergic conjunctivitis
– Bronchial asthma
• Prevalence
– Peak age - Young adulthood
– 10-20% with a male predominance
3. Classification of Allergic Rhinitis
• Old : Seasonal, Perennial, Occupational
• ARIA (Allergic Rhinitis and its impact on Asthma)
4. Etiology
• Atopy (Hereditary)
– Represents a predisposition to develop allergic disease
• Allergens
– Seasonal rhinitis : Grass and tree pollens
– Perennial allergic rhinitis
• House dust mite – Digestive enzymes excreted in faeces
• Domestic pets – Cats, dogs, rabbits, guinea pigs
• Cockroaches
– Occupational Rhinitis : Flours, laboratory animals,
biological washing powders, latex, smokes and fumes
5. • Food and drug induced rhinitis
– More common in children
– Foods
• Milk ,eggs, cheese in children
• Nuts ,fish ,citrus fruits in adults
– Drugs
• Aspirin
• Antihypertensives ( beta blockers, ACE inhibitors )
• Antipsychotic
• Topical nasal decongestants (Rhinitis medicamentosa)
• Pollution
– Perfumes, tobacco smoke, traffic fumes, domestic sprays
6.
7.
8. Diagnosis
• History
– Seasonality, frequency and severity of symptoms
– Patient’s dominant symptoms
– History of potential allergic triggers
– Personal/ family h/o atopic disease
– H/o trauma
– H/o mucopurulent rhinorrhea, facial pain, fever
– Drug allergy and food provoking factors
9. Clinical features
Symptoms
• Seasonal rhinitis
– Sneezing : paroxysmal, frequent
intervals throughout the day,
more in the morning times
– Nasal discharge : watery,
mucoid, yellowish
– Nasal obstruction / blockage
– Itching of nose, eyes, palate
– Tearing/redness of the eyes,
periorbital edema
– Burning/raw sensation of throat
– Wheezing/chest tightness
• Perennial Rhinitis
– Long standing nasal
congestion and PND
– Viscous/ purulent rhinorrhea
– Conjunctivitis less frequent
– Secondary symptoms : loss
of smell and taste, sinusitis,
ETD
– Sneezing less common
10. Signs
• Nose
– Transverse crease at the dorsum of
the nose ( Darrier’s line)
– Allergic salute
– Pale /bluish nasal mucosa
– Boggy and swollen turbinates
– Watery nasal discharge
– Polyps/ hypertrophied turbinates
– Septal deviation
Allergic salute
Darrier’s line
11. • Eyes
– Periorbital edema, conjunctival congestion ,watering
– Marked erythema of palpebral conjunctivae and papillary
hypertrophy of tarsal conjunctivae ( cobblestone)
– Dark circles under the eyes ( allergic shiners)
• Repetitive vigorous rubbing in the peri - orbital region
• Impaired venous return from the
skin and subcutaneous tissues
– Extra skin fold or line under the
lower eyelids ( Denni - Morgan lines)
Denni - Morgan lines
13. Investigations
• Complete Blood Count ,ESR, Absolute Eosinophil Count
• Serum IgE measurements
• Nasal smear for cytology : eosinophils, neutrophils, basophils,
mast cells , epithelial cells and bacteria
• Nasal swabs for bacteriology or viral studies
• Skin prick tests
• RAST (Radioallergosorbent Test)
• ELISA
• Nasal provocation (challenge) test
• Diagnostic Nasal Endoscopy (DNE)
• X-Ray PNS OM view
• CT scan of nose and PNS : coronal/axial /sagittal cut
14. Skin Prick Tests
• Prick or scratch test
– Pricking the skin with a needle or pin containing a small amount of the
allergen
• Patch test
– Applying allergen containing patch to the skin
– If response is seen in the form of a rash, urticaria or
anaphylaxis -- patient has a hypersensitivity to that allergen
• Intradermal test
– A small amount of the allergen solution is injected into the
skin and response is seen
15. • The negative control
– Saline (salt-water) solution
– Response not expected
– If however a patient reacts to a negative control --- the skin
is for whatever reason extremely sensitive
• The positive control
– Histamine, to which everyone is expected to react
– Failure to do so -- medicines the sufferer is taking could
block the response to the histamine and allergens
21. • Allergen avoidance
– Useful for a single/ unusual allergen
– Identification of relevant aeroallergens and complete/
partial avoidance of allergens
• Elimination of occupational allergen exposure
• Elimination of pet allergen exposure
• Mite antigen control measures
• Frequent pet washings
• Cockroach control measures
• Closed windows in homes / cars
• Central heating and cooling
• Central air filtering system
22. Pharmacotherapy
• Primary therapy for seasonal / perennial allergic rhinitis
• Corticosteroids
– Topical: Sprays and drops
• Extremely effective for all nasal symptoms of allergy
• Beclomethasone, budesonide, fluticasone, mometasone
– Oral
• Prednisolone 1 mg /kg / day in tapering dose for 2
weeks
– Depot intramuscular route - not recommended
23. • Mast cell stabilizers
– Eg. Sodium chromoglycate drops and sprays
– Less effective than topical corticosteroids
– Treatment of first choice in young children
• Antihistamines
– Eg. Chlorpheniramine, Terfenadine, Astemizole, Loratadine, Cetrizine,
Fexofenadine, Ebastine
– Effective for sneezing, itching, watery rhinorrhea and eye , palate and
throat symptoms
– Less effective in nasal congestion and blockage
– Mainly taken at bedtime
– Newer generations less sedative than older ones
24. • Topical vasoconstrictors
– Xylometazoline, oxymetazoline, ephedrine
– Effective against nasal blockage
– To be used for short period only, prolonged use >2 wks may
lead to Rhinitis medicamentosa (Rebound hyperemia,
nasal congestion and obstruction that occurs following
prolonged and repeated use of topical vasoconstrictors)
• Topical anticholinergics
– Ipratropium Bromide (0.03% nasal spray) for watery
rhinorrhea
• Leucotriene inhibitors
– Montelukast, zafirlukast
25. Allergen Specific Immunotherapy ( SIT)
• Practice of administering gradually increasing quantities of an
allergen extract to an allergic subject to eradicate the allergic
symptoms by subsequent exposure to the causative allergen
• Indications
– Pollen sensitive patients having single allergen, failing to
respond to conventional treatment , having intolerable side
effects of treatment, unable to avoid the allergens
• Contraindications
– Patients with multiple allergies , significant medical illness
and taking drugs likely to impair the treatment of
anaphylaxis
26. • Procedure:
– Allergen injected subcutaneously in increasing doses till
maximum tolerated response is reached
– May also be delivered by the oral, nasal or sublingual routes
– The monoclonal anti - IgE antibody
• Induces the reduction of serum-free IgE levels
• Reduces the symptoms mediated by IgE
• Reduces the severity of the symptoms of seasonal
allergic rhinitis
– Success rates - as high as 80 -90% for certain allergens
– Course : 2 years or more
36. General Measures
• Sleep with head end elevated by 30
0
• Sleep + work in a cool environment (not cold)
• Keep body warm
• Regular exercise program to improve vasomotor
tone
• Avoidance of trigger factors
41. Surgical Treatment
1. To reduce size of nasal turbinates thus to relieve
nasal obstruction
2. Sectioning parasympathetic secreto - motor fibers of
nose (vidian neurectomy) to relieve excessive
rhinorrhoea
42. Surgeries to reduce the size of turbinate
• For mucosal hypertrophy
– On surface: Electrocautery , Laser
– Submucosal: Electrocautery (Submucosal diathermy),
cryotherapy, radiofrequency ablation
• For bony hypertrophy
– Submucous resection of inferior concha
• For mucosal + bony hypertrophy
– Partial / total turbinectomy
47. Clinical Features
• Chronic nasal block requiring increased dose & frequency of topical
decongestants after its prolonged use
• Nasal mucosa appears hyperemic, granular & boggy in early stages and
pale & anemic in later stages
Treatment
• Immediate withdrawal of topical decongestant - Substitute with systemic
nasal decongestants
• Nasal corticosteroid sprays (Oral corticosteroids for severe cases only)
• Rhinostat system
• Patient Education: Avoid topical decongestant use for > 10 days