Allergic rhinitis is an IgE-mediated inflammatory disorder of the nose induced by exposure to allergens like pollen, mold, dust mites, etc. It is characterized by symptoms of sneezing, rhinorrhea, nasal itching and congestion. It can be seasonal or perennial depending on the allergen. Diagnosis is based on history, examination and allergy testing. Treatment involves allergen avoidance, intranasal corticosteroids, oral antihistamines, immunotherapy for severe cases. Non-allergic rhinitis like vasomotor rhinitis can present similarly but tests are negative for allergies. Prolonged use of decongestants can cause

1. Allergic Rhinitis

2. ABOUT IT
• Symptomatic disorder of the nose induced by an Ig-E
mediated inflammation after allergen exposure
• Symptoms: rhinorrhoea
itching (eyes, nose, palate)
sneezing
nasal congestion/obstruction
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3. Classification

4. Types:
• Seasonal (summer/ spring/ early autumn)
tree pollens, grass pollens, mold spores
lasts for several weeks, disappears and recurs following
year at the same time
• Perennial
-inhaled: house dust, wool, feathers, foods, tobacco
-ingested: wheat, eggs, milk, nuts
 occurs intermittently for years with no pattern or may be
constantly present
Allergic Rhinitis

5. Etiology
• Inhalant allergens
– Pollen, mould spores, house dust, debris from
insect and house mites
• Genetic predisposition
– Gene-5q, 11q, 12q

6. Pathogenesis

8. • Four phases
– Sensitization
– Subsequent reaction to allergen-early phase
– Late phase reaction
– Systemic activation

9. Clinical features
• Nasal obstruction with pruritis, sneezing
• Clear rhinorrhoea (containing increased
eosinophils)
• Itching of eyes with tearing

10. ON EXAMINATION
• Mucosa  edematous, pale or bluish in color
• Thin watery or mucoid discharge
• long-standing - enlarged inferior turbinates
• Allergic salute  transverse nasal skin crease from rubbing
the nose
• Retracted TM-ETD
• Eye-odema of eyelids, congestion and cobble stone
appearance of conjuctiva
• Pharynx-granular pharyngitis.

11. Diagnosis
• Hx- some/all classical Sx
- Px of other atopic disorders
- Fam Hx allergy/allergic rhinitis
• Examination
– Pale or bluish edematous nasal mucosa
– conjunctivitis, granular pharyngitis
– long-standing - enlarged inferior turbinates
This Photo by Unknown
Author is licensed under CC
BY-SA

12. Investigations
• Blood tests
– total serum IgE
– RAST for specific IgE
• Nasal smear-clinically active disease.
• Skin prick Test
– simple cheap n safe
– Identify the specific allergen.

13. Treatment
• Allergen avoidance
– best way – antigen involved is single.
– impractical

14. Treatment
Intranasal Corticosteroids
• spray/drops
• anti-inflammatory FX, inhibit mediator release from mast cells
• use as first line Rx esp. if mod- severe Sx
• SE: irritation, crusting, epistaxis
Oral corticosteroids
• limited use because of SE
• useful if immediate symptoms relief required e.g. for
important event

15. Treatment
Anti-histamines
• 1st line for mild Sx/add-on for severe
disease inadequately controlled by I-N
steroids.
• more beneficial for sneezing, rhinorrhoea,
itching nose.

16. Oral Antihistamines
1st Generation
Chlorpheniramine (Piriton)
• SEDATING
2nd Generation
• MUCH LESS SEDATING
Loratadine, Cetirizine, Fexofenadine
Terfenadine

17. Treatment
Mast Cell Stabilisers
Sodium Cromoglycate
stabilises mast cells and prevents degranulation
2% drop or spray
Decongestants
Xylometazoline (Otrivine)- available as nasal
drops/sprays
Relieves nasal obstrution
If used > 1/52- rebound congestion

19. ADVANCEMENT
Immunotherapy
• Repeated administration of an allergen extract in
order to induce a state of immunological tolerance.
• Indication
– Severe symptoms who fail to respond
adequately to usual treatment.
– Inability to avoid allergen
– Limited spectrum of allergen

20. The way it works..
• Results in blunting of seasonal increases in allergen specific Ig
E
• Increase in blocking Ig G antibodies
• Inhibition of recruitment and activation of inflammatory cells
to mucosal surfaces including mast cells
• Practical immunotherapy
– Updosing phase-weekly injection for 8-16 wks
– Maintenance phase- (4-8)wkly injection for 3-5 yrs.
– Hospital based clinics by trained staff.

21. Nonallergic perennial rhinitis
• Idiopathic rhinitis (vasomotor rhinitis) or nonallergic
noninfectious perennial rhinitis(NANIPER)
• Occupational
• Hormonal
• Drug induced
• NARES-non allergic rhinitis with eosinophilia syndrome
• Others-atrophic rhinitis, food induced rhinitis, emotion
induced rhinitis, rhinitis due to physical n chemical factors

22. Vasomotor rhinitis
• Nonallergic rhinitis
• Symptoms persists throughout the year
• Tests of nasal allergy-negative
• Etiology
– Idiopathic
– Triggered by irritants and changes in atmospheric
condition
• Pathophysiology-imbalance between sympathetic
and parasympathetic NS

23. C/F
• Symptoms
– Paroxysmal sneezing
– Excessive rhinorrhoea
– Nasal obstruction
– Nasal itching
• signs
– Congested and hypertrophic nasal mucosa

24. m/m
• Medical
– Avoidance of physical factors
– Antihistaminics
– Decongestants
– Topical steroids
• Surgical
– Reduction of size of turbinate-SMD, turbinectomy
– Vidian neurectomy

25. Rhinitis medicamentosa
• Prolonged use of topical decongestants
• Rebound congestion
• Treatment
– Withdrawal of nasal drps
– Short course of systemic steroid therapy
– Surgical reduction of turbinates-hypertrophied
turbinates.

26. THE
END