This document provides information on allergic rhinitis (AR), including its definition, pathophysiology, classification, diagnosis and management. AR results from an IgE-mediated inflammatory response to allergens that causes nasal congestion, rhinorrhoea, sneezing and itching. It affects 10-25% of the global population and involves inflammation of the nose and other respiratory organs in some individuals. Diagnosis is based on patient history, examination, skin prick tests and blood tests to detect allergen-specific IgE. Management focuses on allergen avoidance, pharmacotherapy and immunotherapy.
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 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-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 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.
This presentation includes Investigations and basic as well recent advances in management of allergic rhinitis. Starting from antihistamines, steroid (systemic and topical), Immunotherapy. Hope its helpful for some Undergraduates and postgraduates
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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
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
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
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
2. Allergic Rhinitis
Rhinitis is defined as inflammation of the lining of the
nose, characterized by one or more of the following
symptoms:
nasal congestion,
rhinorrhoea,
sneezing
itching.
Allergic rhinitis involves inflammation of the mucous
membranes of the nose, eyes, eustachian tubes, middle ear,
sinuses, and pharynx.
Rhinitis due to IgE mediated inflammation following
exposure to allergen.
Affects 10-25% of global population .
The nose invariably is involved, and the other organs are
affected in certain individuals.
3. The International Study of Asthma and Allergies in
Childhood noted the of rhinitis with itchy watery eyes, in
six to seven year olds as 0.8 to 14.9 percent and in 13-14 year
olds from 1.4 to 39.7 %.
4. Classification based on ARIA guidelines
Allergic rhinitis and its impact on asthma
Intermittent
. < 4 days per week
. or < 4 weeks
Persistent
. > 4 days per week
. and > 4 weeks
Mild
-normal sleep
- no impairment of daily
activities, sport,
leisure
- normal work and
school
- no troublesome
symptoms
Moderate-severe
one or more of
following
. abnormal sleep
. impairment of daily
activities, sport,
leisure
. abnormal work and
school
. troublesome
symptoms
5. Classification Duration
Acute(ARS) 7 Days to ≤ 4 Weeks
Subacute 4-12 weeks
Recurrent acute ≥4 episodes of ARS per year
Chronic ≥ 12Weeks
Acute exacerbation of chronic SuddenWorsening Of CRS With
Return To Baseline After
6. Allergic Rhinitis - Causes
Seasonal/ Intermitant
Pollen from trees,
grasses, and weeds
Perennial/ Persistant
House dust, mites
Mold and fungus spores
Cockroaches
Animal danders
Food
chemicals
7. Risk factors
Genetics and family history
The best established risk factor for allergic rhinitis is a
family history of allergy, especially of allergic rhinitis.
Genes which appear to be involved in atopy include an
area on the 5q chromosome.
Other possible susceptibility loci exist on chromosome
11q, chromosome 13 in the Japanese population and
chromosome 12q.
8. Environment-
Lifestyle changes, increased exposure to allergen, pollution
and irritants, dietary modifications leading to a reduction
in Th 1-type immune response and stress.
Pollution increases symptomatic rhinitis.
Living in developed countries, pollution, climate
interaction and good hygiene all seem to be risk factors.
Co-morbidities-
Conditions associated with allergic rhinitis are asthma,
sinusitis, otitis media, sleep disorders, LRTI & dental
occlusion.
9. PATHOPHYSIOLOGY
Allergic reaction occurs in four phases-
1. Sensitization
2. Subsequent reaction to allergen-early phase.
3. Late phase reaction.
4. Systemic activation.
10. Sensitization
In atopies, allergen molecules are inhaled and
presumably not completely cleared by the mucociliary
system.
They reach antigen presenting cells in the nose, the
most important of which are dendritic cells /
Langerhans cells.
They capture antigen, process it and present it to naive
T cells in the local lymph nodes.
If no additional signal is present then a T-cell response
will not ensue.
In atopic individuals, Th2 cells predominate at the
sites of allergic response.
11. Sensitization
In the secondary immune response, any cell expressing
surface MHC class 2 may serve as an antigen-presenting
cell, including the nasal epithelium.
Activated, Th2 cells secrete cytokines, (IL-4, IL- 13 , IL-
5).
They also activate B lymphocytes in the local
lymphoid tissues, encouraging them to proliferate,
migrate to the nasal lining and produce IgE antibody.
Once produced, the IgE is very rapidly taken up by
local cells possessing FcER 1, i.e. mainly mast cells.
Thus armed, mast cells are able specifically to respond
to subsequent allergen contact.
12. Subsequent reaction to allergen: early
phase
Mast cells are encouraged to degranulate once their
cell-bound IgE has been cross-linked by allergen.
Secretion of histamine, leukotriene C4 &
prostaglandin D2 in nasal mucus.
Histamine & cytokines are preformed while
leukotriene and PGs are manufactured from
membrane arachidonic acid.
13. Histamine causes
Rhinorrhoea, sneezing, pruritis and nasal obstruction.
(The response is of short duration)
Action on sensory nerves induces itching and sneezing.
Prostaglandins induces
Sustained nasal obstruction and is ten times more
potent than histamine.
Leukotrienes induce
Vascular permeability and oedema in the nose
Involved in eosinophil and neutrophil recruitment.
Cytokines are important in regulation of IgE response.
14. Late phase response
This is inflammatory in nature.
Involves the ingress of cells such as eosinophils, basophils,
mast cells, T lymphocytes, neutrophils and macrophages
into the local reaction site.
The main symptoms are nasal obstruction and hyper-reactivity.
Eosinophil products increase local vascular permeability
and mucus secretion and cause further inflammatory cell
influx
Endothelial cells, participate in the recruitment of
leukocytes to the site of the allergic response by releasing
chemotactic factors and modulating adhesion molecules.
15. Systemic activation
Upregulation of production and release of eosinophil
and basophil precursors from the bone marrow occurs
in response to allergen contact in the nose or lung.
The resultant circulating precursors are attracted to
the reaction site & other parts of respiratory tract.
Ig E-INDEPENDENT RESPONSES
Certain drugs, e,g. morphine, codeine and aspirin, can act
directly on the mast cell membrane causing degranulation.
House dust mite allergen is able to alter epithelial tight
junctions therefore increasing permeability.
Some allergens may produce direct response via enzymatic
proteolytic activity.
17. Diagnosis of Allergic Rhinitis
Most allergic rhinitis patients can be diagnosed by a
combination of
History,
Examination
SPT (Skin Prick Test )
Radioallergoabsorbent tests (RAST) for specific IgE.
18. Important elements in history include an evaluation of
the nature, duration, and time course of symptoms;
possible triggers for symptoms;
response to medications;
comorbid conditions;
family history of allergic diseases;
environmental exposures;
occupational exposures;
effects on quality of life.
19. Symptoms that can be associated with allergic rhinitis
include
sneezing,
itching (of nose, eyes, ears, palate),
rhinorrhea,
postnasal drip,
congestion,
headache,
earache,
tearing, red eyes, eye swelling,
fatigue, drowsiness, and malaise.
20. Examination
Look at the pt to assess any obvious external features,
such as an ” allergic crease or allergic salute.”
Atopic dermatitis or conjunctivitis should noted.
A full ENT examination should then be carried out
with particular emphasis on the nose.
Allergic nasal mucosa is usually bilaterally swollen pale
or bluish in colour, oedematous and covered with
watery secretions.
22. SPT(SKIN PRICK TEST)
Allergen introduced into the
skin causes degranulation of
IgE-sensitized mast cells with
mediator release and
formation of a wheal and flare.
Simple ,cheap & safe.
Low risk of systemic reactions.
Always undertaken where
emergency equipments and
resuscitation capable staff is
available
23. Should not be performed in pts on antihistamines or
with severe eczema, previous anaphylaxis or
dermagraphism.
Positive results- reaction >2mm in under fives
>3mm in adults.
Positive result should be atleast 2mm greater than the
negative control.
Positive SPT occurs in 20-30% of adults but only 10-
15% develop symptoms.
24. BLOOD TESTS FOR ALLERGY
Stabilized allergen is incubated with the patient's serum,
any specific IgE binds to allergen and is identified by a
second incubation with labelled anti-IgE.
This can be undertaken by RASTs or by fluorescent assays
and enzyme-linked immunosorbent assays (ELISA).
RAST involves
allergen bound to a solid phase, &
incubated with the patient's serum and
IgE molecules bind to the allergen.
After detailed washing, radio labelled anti-IgE is added
the radioactivity is measured.
.
25. CAP RAST is a recent improvement in which
the allergen is coupled to a cellulose carrier
anti-IgE is enzyme-labelled with a fluorescent substrate
acting as the developing agent.
This system has a higher sensitivity and specificity than
RAST test
ELISA test
allergen is in the fluid phase
IgE is enzyme-labelled.
The substrate for the enzyme is added and
the resulted colour change is detected photometrically.
26. Immunoassay vs Skin Test for Diagnosis of Allergy
Immunoassay
Not influenced by
medication
Not influenced by skin
disease
Does not require
expertise
Quality control possible
Expensive
Skin test
Higher sensitivity
Immediate results
Requires expertise
Cheaper
27. NASAL ALLERGEN CHALLENGE
Allergen is introduced into the nose and any reaction
is measured and compared to placebo.
This is the gold standard of allergy diagnosis, but is
rarely necessary.
The allergen should be applied in gradually increasing
concentrations with careful monitoring.
Nasal challenge testing is time-consuming, difficult
and requires extensive laboratory facilities.
28. Management of allergic rhinitis
The management of allergic rhinitis involves the
following
components:
Allergen avoidance
Pharmacotherapy.
Allergen immunotherapy
Surgery is rarely needed
30. Globally important sources of
allergens
House dust mites
Grass, tree and weed pollen
Pets
Cockroaches
Molds
31. Allergen Avoidance
Pets
Remove pets from bedrooms and, even better, from the entire home
Vacuum carpets, mattresses and upholstery regularly
Wash pets regularly (±)
Molds
Ensure dry indoor conditions
Use ammonia to remove mold from bathrooms and other wet spaces
Cockroaches
Eradicate cockroaches with appropriate gel-type, non-volatile, insecticides
Eliminate dampness, cracks in floors, ceilings, cover food; wash surfaces, fabrics to
remove allergen
Pollen
Remain indoors with windows closed at peak pollen times
Wear sunglasses
Use air-conditioning, where possible
Install car pollen filter
32. House dust mite allergen avoidance
Provide adequate ventilation to
decrease humidity
Wash bedding regularly at 60°C
Encase pillow, mattress and quilt in
allergen impermeable covers
Use vacuum cleaner with HEPA filter
Dispose of feather bedding
Remove carpets
Remove curtains, pets and stuffed toys
from bedroom
35. Newer Generation Oral Antihistamines
First line treatment for mild allergic rhinitis
Effective for
Rhinorrhea
Nasal pruritus
Sneezing
Less effective for
Nasal blockage
Possible additional anti-allergic and anti-inflammatory effect
In-vitro effect > in-vivo effect
Minimal or no sedative effects
Once daily administration
Rapid onset and 24 hour duration of action
39. Anti-Leukotriene Treatment in Allergic Rhinitis
Efficacy
• Equipotent to H1 receptor antagonists but with
onset of action after 2 days
• Reduce nasal and systemic eosinophilia
• May be used for simultaneous treatment of
allergic rhinitis and asthma
Safety
• Dyspepsia (approx. 2%)
41. Nasal Corticosteroids
• Most potent anti-inflammatory agents
• Effective in treatment of all nasal symptoms including
obstruction
• Superior to anti-histamines and anti-leukotienes
• First line pharmacotherapy for persistent allergic rhinitis
43. IMMUNOTHERAPY
Repeated administration of an allergen extract in order to
induce immunological tolerance,with a reduction in
clinical symptoms & requirements for medication during
subsequent natural allergen exposure.
Indicated in those pts of AR who fail to respond adequately
to usual t/t with antihistamines & topical corticosteroids.
In view of the side effects associated with subcutaneous
immunotherapy, alternative strategies have been
considered.
The sublingual route involves application of allergen as
drops or tablets under the tongue where they are retained
for several minutes.
44. Mech . Of immunotherapy
Immunotherapy results in a blunting of seasonal
increases in allergen-specific IgE.
Induces immune deviation from Th2- type T
lymphocyte response in favour of a protective Th1-type
response & also to induce a distinct population of T
regulatory cells which produce the inhibitory
cytokines IL-10, TGF B, both of which downregulate
Th2 responses to allergens.
45. Indications for immunotherapy in
AR
INCLUSION CRITERIA
IgE mediated
disease(+SPT/RAST)
Inability to avoid
allergen.
Inadequacy of drug
treatment.
Pts who understand risks
& limitations of t/t.
CONTRINDICATIONS
Coexistent asthma.
Pts taking beta-blockers.
Other
medical/immunological
dis.
Small children.(<5yrs)
pregnancy
46. Anti IgE - omalizumab
Could be considered in severe cases unresponsive to
conventional treatment
Could be an adjunct to immunotherapy in severe cases
Nasal Surgery
Nasal surgery may be needed where there is a marked
septal deviation or bony turbinate enlargement which
makes topical nasal sprays usage difficult
47. Health Effects of Allergic Rhinitis
Social inconvenience
Sleep disturbances/obstruction
Learning difficulties
Impaired maxillary growth
Dental problems
Infection: nose and sinuses
Co-morbidities: conjunctivitis, asthma, rhinosinusitis,
otitis media
48.
49. To Conclude…
Allergic rhinitis is very common and causes
considerable morbidity
Adequate and appropriate treatment leads to
significant improvement in quality of life
Co-morbid conditions are common and warrants
special attention and treatment for optimal results
Environmental manipulations is also important in the
control of disease
50.
51. The term Nonallergic rhinitis' is commonly applied to
a diagnosis of any nasal condition in which the
symptoms are identical to those seen in Allergic
rhinitis but an allergic aetiology has been excluded.
Occur more frequently in adults than in children,
More likely to be perennial than seasonal.
52. NON ALLERGIC PERENNIAL
RHINITIS
TYPES:
1.Vasomotor rhinitis
2.Infection
3.Rhinitis associated with physical or chemical
factors
4.Drug, food induced rhinitis
5.NARES, aspirin sensitivity
6.Rhinitis of pregnancy
7.Atrophic rhinitis
53. Vasomotor Rhinitis
Autonomic disturbance – excessive parasympathetic
activity
No specific cause found
Symptoms : rhinorrhoea, sneezing, nasal obstruction
54. Neurovascular disorder
No specific antibodies
Nonspecific reflex hypersensitivity
Caused by various influences
Change of temperature or humidity
Alcohol , dust, smoke, mechanical irritation, stress, anxiety
neurosis, endocrine disorders, rhinitis of pregnancy.
Drugs: (e.g., antihypertensive agents as reserpine or beta-blockers,
oral contraceptives)
Drug abuse: (imidazoline & catechol derivatives,
clomethiazole, etc.)
59. Atrophic rhinitis
Predominantly in women & is charaterised by
progressive atrophy of the nasal mucosa & underlying
bone of the turbinates.
Leads to formation of thick crusts, which leave a
constant foul smell ( ozaena) in nose.
Nasal cavities are enlarged & there is sensation of nasal
congestion.
Thought to be due to infection with klebsiella
ozaenae.
61. Atrophic Rhinitis
Pathogenesis
Unknown but is multifactorial
Common in orientals than in whites than in blacks
Abnormally wide nasal cavity
Mucosal atrophy& bony nasal skeleton.
Respiratory epith. keratinized sq. metaplasia
Destroyed mucociliary cleaning system
Bacterial proteolysis decomposed the thick & gluey
secretions
62. Secondary Atrophic Rhinitis
Nasal Trauma
Extensive surgery
Occupational exposure to:-
Glass, wood, asbestos, etc.
65. Atrophic Rhinitis
Operative Treatment
Bolstering of the Nasal Mucosa
by submucous injections of paraffin . Teflon strips,
powdered teflon in glycerine, plastipore, bone and
cartilage Insertion submucosally.
Median Displacement of the lateral nasal wall by
internal rotation of the mobilized lateral nasal wall.
66. Young’s operation
Both nostrils are closed completely just within nasal
cavity by raising flaps. Opened 6month or later.
Modified Young’s operation
to avoid discomfort of bilateral nasal obstruction,
nostrils are partially closed.
67. Hormonal rhinitis-a/w pregnancy.
Oestrogens cause vascular engorgement in the nose
leading to nasal obstruction and/or nasal hypersecretion.
EMOTIONALLY INDUCED RHINITIS
Emotional factors such as stress and sexual arousal have
been documented to affect the nose, as a result of
autonomic stimulation.
Drug induced- aspirin, other nsaids,B blockers,ACE
inhibitors,methyl dopa,OCPs, nasal topical decongestants
induce symptoms of rhinitis when administred either
topically or systemically.
68. FOOD-INDUCED RHINITIS
Certain foods and alcoholic beverages can induce
nonallergic rhinitis,
Underlying mechanisms are largely unknown.
Hot and spicy foods lead to a watery rhinorrhoea
termed 'gustatory rhinitis', probably as a result of the
capsaicin stimulating the sensory nerves to release
neuropeptides and tachykinins.
Alcoholic beverages are thought to induce symptoms
as a result of vasodilation.
69. RHINITIS DUE TO PHYSICAL AND CHEMICAL FACTORS
In individuals with sensitized nasal mucous membranes.
Cold, dry air has been shown to lead to a condition known
as skier's nose, in which rhinorrhoea features prominently.
Drug-induced rhinitis
Several commonly employed medications, such as aspirin,
other nonsteroidal anti-inflammatory drugs (NSAIDs),
beta-blockers, angiotensin-converting enzyme (ACE)
inhibitors, methyldopa, oral contraceptives, psychotropic
agents and nasal topical decongestants may induce
symptoms of rhinitis when they are administered either
topically or systemically.
70. Rhinitis medicamentosa
Persistent overuse of the topical nasal vasoconstrictors
also leads to nasal decongestion by a mechanism
involving a rebound effect following withdrawal of
these drugs, excessive use of these agents may also lead
to nasal hyper-reactivity and hypertrophy of the nasal
mucosa known as rhinitis medicamentosa.
71. NARES- condition where there is presence of >20%
eosinophils in nasal smears of symptomatic pts with
perennial sneezing attacks, profuse watery
rhinorrhoea, nasal pruritis, incomplete nasal
obstruction & often loss of smell.
Marked feature is lack of evidence of allergy, as
indicated by negative SPT &/or absence of serum IgE
antibodies to specific allergens.
Triad of nasal polyposis , intrinsic asthma, intolerance
to aspirin-sampter’s triad.
72. THERAPY FOR NONALLERGIC
PERENNIAL RHINITIS
Topical steroids & antihistamines are the two main
drugs used.
Use of fluticasone propionate, budesonide,
beclomethasone & azelastine has been approved by
the FDA.
Azelastine nasal spray is effective for control of
rhinorrhoea, postnasal drip, sneezing nasal
congestion.
73. Ocupational rhinitis
Episodic work related symptoms of rhinitis which
usually manifest on weekdays & abate during
weekends & holidays.
Risk factors for developing occupational rhinitis are:
o Exposure{intensity & duration}
o Atopy
o Smoking.
74. Pathological effects of various chemicals & organic
dusts are either due to an allergic reaction or irritation
of nasal mucosa.
Nose is the portal of entry & materials impact on the
mucous surface as a function of aerodynamic
equivalent diameter(AED).
Approx 80% of those that have an AED of more than 9
micrometre, 50% of those with 2-9 micrometre AED &
40% of material wth less than 2 micrometre stick to
the nasal wall.
75. Occupational rhinitis frequently coexists with asthma
& conjuctivitis.
Prevention is the best approach .
In medical therapy only non sedating antihistamines
should be used.