Allergic rhinitis is an inflammatory disease of the nasal mucosa caused by exposure to inhaled allergens, affecting 0.8-39.7% of the world's population. It is commonly associated with allergic conjunctivitis and asthma as part of the unified allergic airway. Diagnosis is based on symptoms of sneezing, nasal congestion or obstruction, rhinorrhea, and nasal itching occurring in response to allergen exposure. Treatment involves reducing allergen exposure, pharmacological treatment with oral or intranasal antihistamines and intranasal corticosteroids, immunotherapy, and in some cases surgery.

1. ALLERGIC RHINITIS 3600

2. INTRODUCTION
 Allergic rhinitis is characterized by inflammatory
changes
in the nasal mucosa caused by exposure to inhaled
allergens.
 It is a common disease, affecting between 0.8 and
39.7% of the world population
 There may be co-morbidities with other organs being
involved, commonly the eyes causing allergic
conjunctivitis and the lungs with allergic asthma
 These diseases are increasingly considered to be a
single entity, with a spectrum of respiratory allergic
response, termed the unified allergic airway.

3. DEFENITION
 Rhinitis is defined clinically as having two or more
symptoms of anterior or posterior rhinorrhoea,
sneezing, nasal blockage and/or itching of the nose
during two or more consecutive days for more than
one hour on most days.
 Allergic rhinitis is diagnosed when these symptoms
are
caused by allergen exposure leading to an IgE
mediated
reaction.

4. PATHOGENESIS

5. CLASSIFICATION

6. CLINICAL FEATURES

7. ALLERGIC SALUTE

8. SKIN PRICK TESTING

9. RADIOALLERGOSORBENT TEST

10. NASAL ALLERGEN CHALLENGE TEST

11. TREATMENT ASPECTS
 Methods of reducing allergen exposure
 Pharmacological treatment of allergic rhinitis
 Immunotherapy for allergic rhinitis
 Surgical treatment

12. METHODS TO REDUCE ALLERGEN
EXPOSURE
 House dust mite allergen reduction aims to reduce
the
amount of mite allergens in the home:
 Wash bedding regularly (every 1–2 weeks) at 55–60
°C
to kill mites (washing with cold water removes 90%
of
mite allergens; washing at 55–60 °C kills mites)
 Wash pillows and duvets in hot water (55–60 °C)
and
encase pillows and mattresses with protective
coverings
that have a pore size of 6 μm or less
 Sufficient ventilation of dwellings to decrease

13. PHARMACOTHERAPY OF ALLERGIC
RHINITIS

14. ANTIHISTAMINES(H1 BLOCKER)
 Oral H1-antihistamines
 Second generation
Acrivastine
Azelastine
Bilastine
Cetirizine
Desloratadine
Ebastine
Fexofenadine
Levocetirizine
Loratadine
Mequitazine
Mizolastine
Rupatadine

15.  First generation
Chlorphenyramine
Clemastine
Dimethindene maleate
Hydroxyzine
Ketotifen
Oxatomine

16. TOXICITY AND SIDE EFFECTS
 Cardiotoxic*
Astemizole
 Terfenadine
Blockage of H1 receptor
Some antiallergic activity
Old generation
Sedation is common
And/or anticholinergic effect

17. ADVANTAGES OF NEWER ANTI
HISTAMINES
 New generation drugs can be used OD
 New generation oral H1-antihistamines should be
preferred for their favorable efficacy/safety ratio and
pharmacokinetics
 No development of tachyphylaxis
 No sedation for most drugs
 No anticholinergic effect
 No cardiotoxicity

18. Local H1-antihistamines (intranasal,
intraocular)
 Azelastine
 Levocabastine
 Olapatadine

19. Leukotriene antagonists(Block CystLT)
 Montelukast
 Pranlukast
 Zafirlukast

20. INTRANASAL GLUCOCORTICOIDS
 Potently reduce nasal inflammation
Reduce nasal hyperreactivity
 Beclomethasone dipropionate
Budesonide
Ciclesonide
Flunisolide
Fluticasone propionate
Fluticasone furoate
Mometasone furoate
Triamcinolone acetonide

21. BENEFITS
 The most effective pharmacologic treatment of
allergic rhinitis
 Minor local side effects
 Wide margin for systemic side effects
 Effective on nasal congestion
 Effective on smell
 Effect observed after 12 h but maximal effect after
a few days

22. IMMUNOTHERAPY

23. ANTI-IgE ANTIBODY (OMALIZUMAB)
 Omalizumab is a monoclonal antibody that binds to
circulating IgE preventing it from binding to mast
cells and causing degranulation.
 Omalizumab reduces all nasal symptoms and
improves asthma control but has the risk of causing
anaphylaxis and is expensive.
 It is administered by monthly injection.
 Currently it is recommended only for patients with
severe allergic asthma with or without rhinitis
symptoms.

24. Surgical Interventions-Indications
 drug-resistant inferior turbinate hypertrophy;
 anatomical variations of the septum with functional
relevance;
 anatomical variations of the bony pyramid with
functional/aesthetic relevance;
 secondary or independently developing chronic sinusitis
 different forms of nasal unilateral polyposis (choanal
polyp, solitary polyp and allergic fungal sinusitis) or
therapy-resistant bilateral NP
 fungal sinus disease (mycetoma, invasive forms) or other
pathologies unrelated to allergy (cerebrospinal fluid leak,
inverted papilloma, benign and malignant tumors,
Wegener’s disease, etc.).

25. TURBINECTOMY

27. Vidian Neurectomy

28. Posterior Nasal Neurectomy

30. OTHER MANIFESTATIONS OF
ALLERGY

31. ALLERGIC CONJUNCTIVITIS

32. ALLERGIC FUNGAL RHINOSINUSITIS

33. SINONASAL POLYPOSIS

34. ADENOID HYPERTROPHY

35. EUSTACHIAN TUBE DYSFUNCTION

36. OTITIS MEDIA WITH EFFUSION

37. CHRONIC COUGH

38. LARYNGITIS

39. GASTRIC ESOPHAGEAL REFLUX DISEASE

40. THANK YOU