Allergic rhinitis is an inflammatory response of the nasal mucosa triggered by inhaled allergens, with types classified as seasonal or perennial. It presents symptoms such as sneezing, nasal congestion, and conjunctivitis, and is influenced by factors like genetics and environmental exposures. Management involves avoiding allergens, using antihistamines and corticosteroids, and potential immunotherapy, with the aim to minimize symptoms and maintain normal lifestyle.

1. Allergic Rhinitis
ABDUR RAHMAN
115

2. Allergic Rhinitis
 Inflammation of the nasal mucosa in response to inhaled allergenic
materials in a sensitized individual
 Type-
 Seasonal (Intermittent )
 Perennial (Persistent)

3. Predisposing Factors
 Genetics
 Asthma
 Atopic dermatitis
 Exposure to protein that elicits a response
 Microbial exposure in earl life
 Higher socioeconomic class
 Suburban living
 Eczema
 Second hand smoke exposure

4. Complications
 ↓ activities of daily life
 ↓ social interactions
 Alters emotional well-being
 Poor work performance
 Missed work days
 Loss of sleep
 Chronic fatigue
 Irritability
 Hyposmia
 ↑ risk otitis media
 Facial abnormalities

5. Autonomic nervous system
controls blood flow
 PNS (muscarinic) causes vasodilation
 Airway narrowing
 Secretory glands
 Sensation of itching & sneezing
 Olfactory nerve stimulation salivation, gastric & pancreatic gland
→
secretion
 SNS (α-adrenergic) causes vasoconstriction
 Airway widening

6. Inflammation of the nasal mucous membranes
leads to:
 Nasal mucosal edema, discharge,
sneezing, conjunctival itching

7. Allergic Rhinitis:
Immune Response
 Allergen Sensitization
 Nasal mucosa exposed to allergenic materials
 Memory B cells are created against antigen
 Lymphocytes produce antigen-specific IgE

8.  Allergic Response (Immunologic Memory)
 Reexposure causes interaction between IgE bound mast cells and allergen
= degranulation
 Histamine, cytokines, arachidonic acid products

9. Early Phase
 Histamine released
 Symptoms appear 2-10 minutes after exposure
 30-90 minutes in duration
 Vasodilatory actions nasal secretions
↑
 Histamine binding to H1 receptors causes:
 Activation of parasympathetic nerves, leading to vasodilation and
capillary permeability (edema and rhinorrhea)
 Stimulation of mucus secretion from goblet cells
 Activation of nociceptive nerves, leading to sneezing and itching

10. Late phase reaction
 50% AR patients affected
 Inflammatory mediators reappear
 Symptoms recur 4-8 hours after exposure
 Duration of 12-24 hours
 Linked to chronic disease
 Typified by nasal congestion

11. symptoms
 Sneezing
 Rhinorrhea
 Congestion
 Scratchy throat
 Nasal itching
 Conjunctivitis

12. Diagnosis
 Skin tests
 Scratch test (epicutaneous)
 Make superficial wound on outermost layer of the skin
 A drop of antigen is then placed in the wound
 Intradermal
 Diluted allergen injected between layers of the skin

13. Diagnosis
 Positive result
 Both tests
 Wheal and flare reaction within 15 to 30 minutes
 Patient history
 Physical exam
 Laboratory tests

14. General Management Principles
 Avoid factors that cause symptoms
 Use appropriate treatments
 Evaluate for immunotherapy
 Educate and follow-up

15. Avoidance Measures
 Avoidance of allergens
 Awareness of pollen count
 Exclude animals from bedroom
 Control indoor environment (HEPA filters)
 Minimize outdoor time

16. treatment
 Goal of Therapy
 Minimize or prevent Allergic Rhinitis symptoms
 Goal should be achieved with
 No or minimal adverse medication effects
 Reasonable expense
 Maintain normal lifestyle

17. Persistent sxs; Mild to moderate
severity
Daily medication
Oral nonsedating H1-antihistamine  decongestant
OR:
Topical nasal corticosteroid
CONSIDER:
Topical nasal antihistamine; nasal cromolyn sodium for
children.
If there are prominent eye symptoms:
topical ocular antihistamine, vasoconstrictor, mast cell
stabilizer, and/or topical ocular NSAID.

18. Severe symptoms
Topical nasal corticosteroid
 AND:
 Oral nonsedating H1-antihistamine (with or without a decongestant
combination).
 CONSIDER:
 Topical nasal antihistamine; nasal cromolyn sodium for children.
 AND, if needed:
 A short course (3- to 10-day) of oral corticosteroids.
 If there are prominent eye symptoms:
 topical ocular antihistamine, vasoconstrictor, mast cell stabilizer, and/or
topical ocular NSAID.

19. Treatment: Antihistamines
 First line agents
 Antihistamines
 Histamine H1 receptor competitive antagonists
 ↓ itching, sneezing, rhinorrhea, conjunctivitis
 Prevention > reversal of symptoms
 Drying action responsible for efficacy

20.  Metabolism
 Primarily liver
 Dosing
 1-2 hours prior to exposure
 Tolerance
 Change to an agent in a different chemical class

21. thankyou