Allergic Rhinitis

1. ALLERGIC RHINITIS

2. ALLERGIC
RHINITIS
Allergic rhinitis is the inflammation inside the nose
caused by an allergen, such as pollen,
dust, mold or flakes of skin from certain animals
Hay fever is an allergy caused by pollen or dust in
which the mucous membranes of the eyes and nose
are inflamed, causing running at the nose and watery
eyes
 Although allergic rhinitis itself is not life-threatening
(unless accompanied by severe asthma or
anaphylaxis), morbidity from the condition can be
significant

4. CLASSIFICATON
Seasonal : Symptoms appear in or around a
particular season when the pollens of a particular
plant, to which the patient is sensitive, are present
in the air. They usually occur in spring, late
summer, and fall.
Perennial: Caused by other allergens such as
dust mites, pet hair or dander, or mold. Symptoms
occur year-round.

5. CAUSES
 Common allergens
• Dust mites, pollen and spores, and animal skin, urine and saliva.
 House dust mites
• They are tiny insects that feed on the dead flakes of human skin
that can be found in mattresses, carpets, soft furniture, pillows
and beds.
• Rhinitis is not caused by the dust mites themselves, but by a
chemical found in their excrement.
• Dust mites are present all year round, although their numbers
tend to peak during the winter.
 Pollen and spores
• Tiny particles of pollen produced by trees and grasses can
sometimes cause allergic rhinitis.
• Most trees pollinate from early to mid-spring, whereas grasses
pollinate at the end of spring and beginning of summer.

6.  Animals
• The allergic reaction is not caused by animal fur, but flakes of
dead animal skin and their urine and saliva.
 Work-related allergens
• Some people are affected by allergens found in their work
environment, such as wood dust, flour dust or latex.

7. CLINICAL
MANIFESTATIONS
 Runny nose with clear
discharge
 Sneezing
 Itchy nose
 Nasal or sinus congestion
 Headache
 Postnasal drip
 Scratchy throat
 Red, inflamed skin and
mucous membranes
 Red eyes
 Itchy eyes
 Watery eyes
 Difficulty breathing, wheezing
 Cough
 Asthma (in severe cases)
 Hives (itchy skin rash)
 Anaphylactic shock

8. PATHOGENESIS
 If you have allergic rhinitis, your natural defense against infection and
illness will react to an allergen as if it were harmful.
 If your immune system is oversensitive, it'll react to allergens by
producing antibodies to fight them off.
 Allergic reactions do not happen the first time you come into contact with
an allergen.
 The immune system has to recognize and "memorise" it before
producing antibodies to fight it. This process is known as sensitization.

9.  After you develop sensitivity to an allergen, it'll be detected by
antibodies called immunoglobulin E (IgE) whenever it comes into
contact with the inside of your nose and throat.
 These antibodies cause cells to release a number of chemicals,
including histamine, which can cause the inside layer of your nose (the
mucous membrane) to become inflamed and produce too much mucus.
 This is what causes the typical symptoms of sneezing and a blocked or
runny nose.

10. RISK
FACTORS
Some external factors can trigger or worsen this
condition, including:
• Cigarette smoke
• chemicals
• cold temperatures
• humidity
• wind
• air pollution
• hairspray
• perfumes
• colognes
• wood smoke
• fumes

11. COMPLICATIONS
Allergic rhinitis can lead to
complications in some cases.
These include:
 Nasal polyps– abnormal but non-
cancerous (benign) sacs of fluid
that grow inside the nasal
passages and sinuses
 Sinusitis – an infection caused
by nasal inflammation and
swelling that prevents mucus
draining from the sinuses
 Middle ear infection– infection of
part of the ear located directly
behind the eardrum
These problems can often be treated
with medication, although surgery is
sometimes needed in severe or long-
term cases.

12. DIAGNOSIS
 The 2 main allergy tests are:
• Skin prick test – where the allergen is placed on your arm and the
surface of the skin is pricked with a needle to introduce the allergen to
your immune system; if you're allergic to the substance, a small itchy
spot (welt) will appear
• Blood test – to check for the immunoglobulin E (IgE) antibody in your
blood; your immune system produces this antibody in response to a
suspected allergen
Further tests
In some cases further hospital tests may be needed to check for
complications, such as nasal polyps or sinusitis
For example, you may need:
• Nasal endoscopy – where a thin tube with a light source and video
camera at 1 end (endoscope) is inserted up your nose
• Nasal inspiratory flow test – where a small device is placed over your
mouth and nose to measure the air flow when you inhale through your
nose
• CT-scan

13. TREATMENT
 Cleaning your nasal passages
• Regularly cleaning your nasal passages with a salt water
solution, known as nasal douching or irrigation, can also help by
keeping your nose free of irritants.
 Antihistamines
• Antihistamines relieve symptoms of allergic rhinitis by blocking
the action of a chemical called histamine, which the body
releases when it thinks it's under attack from an allergen.
• Antihistamines can sometimes cause drowsiness.
 Corticosteroids
• Corticosteroids help reduce inflammation and swelling. They
take longer to work than antihistamines, but their effects last
longer.
• Side effects from inhaled corticosteroids are rare, but can
include nasal dryness, irritation and nosebleeds.

14. MANAGEMENT
 Environmental control measures and allergen
avoidance:
These include keeping exposure to allergens such as pollen,
dust mites, and mold to a minimum
 Pharmacologic management:
Patients are often successfully treated with oral
antihistamines, decongestants, or both; regular use of an
intranasal steroid spray may be more appropriate for patients
with chronic symptoms
 Immunotherapy:
This treatment may be considered more strongly with severe
disease, poor response to other management options, and the
presence of comorbid conditions or complications;
immunotherapy is often combined with pharmacotherapy and
environmental control