Allergic rhinitis is a common inflammatory disease of the nose induced by an IgE-mediated response to allergens. It affects over 50% of the population. Common symptoms include sneezing, rhinorrhea, nasal congestion and itching. Allergens such as dust mites, animal dander, pollen and mold are common triggers. Treatment involves identification and avoidance of triggers, pharmacotherapy including antihistamines and nasal corticosteroids, and immunotherapy for refractory cases.

2. ALLERGICRHINITIS
PRESENTER:
• DR QAZI AKHTAR LAKHIAR
SENIOR REGISTRAR
DEPT OF E.N.T-LUMHS ,jamshoro Sindh Pakistan
qaziakhtar007@gmail.com

3. ALLERGIC RHINITIS
clinically defined as:
 A symptomatic
disorder of the nose
induced by an IgE-
mediated
inflammation after
allergen exposure to
the membranous
linning the nose

4. ALLERGIC RHINITIS
Most common type of rhinitis.
Most common atopic allergic reaction.
Affects >50% of the population.
50% of rhinitis in field of E.N.T is A.R
Commonly seen in young children and
adolscents.

5. ETIOLOGY
1. Precipitating factors.
2. Predisposing factors.

6. Precipitating factors
Aerobiological flora.
 Allergens present in the environment
 house dust and dust mites.
 feathers
 tobacco smoke
 Industrial chemicals
 animal dander
Nasal physiology:
 Disturbance in normal nasal cycle.

7. Predisposing factors
1. Genetic:
 50% of A.R patients have a positive family
history of Allergic Rhinitis.
 Multiple gene interactions are responsible for
allergic phenotype
 Chromosomes 5,6,11,12 & 14 control
inflammatory process in atopy.

8. Predisposing factors
2. Endocrine :
Puberty
Pregnancy
Post partum state
Menopause
3. psychological state
4. focal sensitivity state

9. Predisposing factors
5. Age & Sex
6. IgA Deficiency
7. fungal infections
8. physical:
 degree of pollution of air
 humidity & temperature differences
 temperature changes

10. Common allergens

11. Pathophysiology

12. How the symptoms are
produced?
Irritation of free
nerve endings---- Itching and sneezing
Increased
mucus production ------ Rhinorrhoea
Vasodilation -------- Congestion
Increased
vascular permeability---- Oedema

13. Symptoms
• Nose: swelling of the nasal
mucosa (allergic
rhinitis)
• Eyes: redness and itching
(allergic conjunctivitis)
• Airways:
bronchoconstriction,
wheezing, itchy or sore
throat, post nasal drip,
and cough
• Ears: feeling of fullness,
possibly pain, and
impaired hearing due to
the lack of eustachian tube
drainage.

14. CLINICAL SIGNS
Nasal crease/ allergic
salute
Allergic shiners
Rhinorhea
High arched palate
Over bite
Congestion of
conjunctiva

15. Classification of A.R- former
 Seasonal:
Hay fever
Summer cold
Rose fever
Perennial:
Allergens present throughout the year.

16. Moderate-severe
 one or more among
following
 abnormal sleep
 impairment of daily
activities, sport, leisure
 abnormal work and school
 troublesome symptoms
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
Intermittent
• < 4 days per week
• or < 4 weeks
ARIA – newer Classification
ARIA Report 2001

17. Complications
Allergic asthma
Chronic otitis media
Hearing loss
Chronic nasal obstruction
Sinusitis
Orthodontic maloclussion in children

18. Diagnosis of A.R
 History
 Physical / Nasal
Examination.
 Histamine test
 Nasal smear test
 Intranasal provocation test
 Nasal challenge test
 Nasal cytology
 S. Ig E level
 Skin tests-
 subcuticular tests
 Intradermal tests
 skin end point titration test
 other investigations
 RAST (Radio allegro sorbent
test),
 FAST (fluro allegro sorbent
test)
 PRIST ( paper immune
allegro sorbent test)
 Rhinomanometry
 Serum Ig E level
 Xray P.N.S
 C.T- P.N.S
 NASAL ENDOSCOPY

19. Managing allergic rhinitis
Pharmacotherapy Immunotherapy
Allergen avoidance
Patient education

20. Pharmacotherapy
Medications used to treat allergic rhinitis:
 Antihistamines
 Decongestants
 AH-D combinations
 Corticosteroids
 Mast Cell stabilizers
 Anticholinergics
 Antileukotrienes

21. Actions of Various Nasal Preparations
in the Treatment of Rhinitis
Nasal
Preparation
Sneezing Itching Rhinorrhoea Congestion
Antihistamines +++++ ++++ +++ 0
Anticholinergics 0 0 +++++ 0
Corticosteroids +++++ +++++ +++ +++
Decongestants 0 0 + +++++
Mast cell stabiliser +++++ +++ + 0
Antileukotrienes +++ ++ 0 ++++

22. Moderate/
severe
intermittent
Mild
persistent
Moderate/
severe
persistent
Nasal corticosteroids
Nasal cromone
Anti-histamine (oral or local)
Oral or nasal decongestant (<10 days)
Allergen avoidance
Specific Immunotherapy
Mild
intermittent
Stepwise approach of allergic
rhinitis according to the ARIA
guidelines

23. Immunotherapy
If allergic rhinitis is refractory to
pharmacotherapy or severe,
 helps in reducing the specific serum Ig E level
 Decreases basophil sensitivity
 increases IgG blocking antibody level, thus
preventing allergen from reaching mast cells
and subsequent mast cell degranulation.

24. surgery
Limited role:
Submucosal turbinectomy.
Septoplasty
Sinus surgery