In day to day life, we encounter this form of allergy...we see our friends and family members suffering from this. Out of agony and apprehension, plenty questions arise in our minds. This presentation is a brief explanation about the disease medically but in common man language. Seek your answers . Feel free to ask any other related question.

1. DR.SUSHMITA PAL
@ theAurals: your ENT destination

4.  Productivity
i. Work/school days lost to absenteeism
ii. Days of reduced activity
 Treatment expenses
 Comorbid diseases
i. Sinusitis
ii. Asthma

6. Many patients have both
AR and asthma
Upper airway symptoms of
AR can exacerbate
asthma
AR patients without asthma
often have bronchial
hyperactivity
Asthma leads to AR in 40 %
cases
AR leads to asthma in 80 %
of cases
Treatment of AR can
improve asthma in many
patients
Treatment of AR can
reduce the bronchial
hyperactivity

7. PATHOPHYSIOLOGY
HISTORY
TREATMENT

9.  SYMPTOMS
1. Headache
2. Nasal --sneezing, pruritis, congestion,post nasal drip ,
rhinorrhea
3. Ocular–lacrymation, injection and swelling of
palpebral conjunctiva
4. Aural – itching in ears, blocked ear, diminished
hearing

10.  FREQUENCY
o Seasonal rhinitis: trees, pollens, grass,
weeds
o Perennial rhinitis : pets , dust mite , animal
dander, cockroaches , molds, fumes.
 SEVERITY
o Absence from work/school
o Behavioral changes
o Loss of smell
o Comorbid conditions

11. SEASONALAR
PERENNIALAR

12. EYES
EARS
NOSE
OROPHARYNX
LUNGS

18.  Mild intermittent
 Moderate severe intermittent
 Mild persistent
 Moderate severe persistent

19.  INTERMITENT
1. Less than 4 days in a week
2. And , for less than 4 consecutive weeks
 PERSISTENT
1. More than 4 days a week
2. AND, for more than 4 weeks

20.  MILD
When none of the following are present
1. Sleep impairment
2. Impairment in daily activities, leisure and/or sport
3. Impairment of school or work
4. Troblesome symptoms
 MODERATE- SEVERE
When one/more of the following are present
1. Sleep impairment
2. Impairment in daily activities, leisure and/or sport
3. Impairment of school or work
4. Troblesome symptoms

21.  Upper respiratory tract infection
 Chronic sinusitis
 Anatomical nasal obstruction d/t
i. Concha bullosa
ii. Nasal polyp
iii. DNS
iv. Adenoid hypertrophy

23.  EnvironmEntal control mEasurEs
and avoidancE of “allErgEns” or
“triggErs”
 Pharmacological managEmEnt
 immunothEraPy

24. Wash sheets in hot boiling water every week.
Feathers, foam rubber, or pillows more than five years old are
often allergens.
Keep windows closed, so that there will not be so many pollens
and molds in the house
Wearing a mask when cleaning the house
Rid your home of indoor plants
Sleep with the head of bed elevated to relieve nasal
congestion
Stop smoking
Observe good health by exercising daily, eating balanced
food and avoiding pollutants

25.  H 1 antagonists : is the cornerstone of its
treatment, for eg:
CPM, Cetrizine, Loratidine, desloratidine,
hydoxyzine, fexofenadine.
 Mast cell stabilizers viz. Monteleukast,
cromoglycate
 Decongestants : oral or topical
 Steroids : systematic and/ or
topically

26. DEFINITION:
Medical procedure that uses controlled exposure to
known allergens to reduce the severity of allergic
disease.
Causes a rise in IgG “blocking” antibodies
ADVANTAGE OF IMMUNOTHERAPY:ADVANTAGE OF IMMUNOTHERAPY:
 prevent progression of rhinitis to asthma inprevent progression of rhinitis to asthma in
children.children.
 prevent onset of new sensitization in allergicprevent onset of new sensitization in allergic
patients.patients.

27.  Subcutaneous and sublingual immunotherapy
are the only approved routes of
administration.
 Subcutaneous immunotherapy normally
involves a weekly subcutaneous injection of an
extract of the allergen, in solution in increasing
doses until a standard maintenance dose is
reached.
 This dose is then injected subcutaneously on a
regular basis (at intervals of approximately 20 –
30 days) for not less than 2 years for perennial
allergens.

28. 1. Scratch test
2. Prick test
3. Intra cutaneous test
An immediate wheal & erythema is
characteristic .

30. The tests are read after 20 minutes
and are scored 0 to 4 depending on
the size of the wheal & flare and
the presence of pseudopod
formation of the wheal.

31.  Proven allergy with skin test or RAST
 Attempts to avoid allergens fail or impractical
 Treatment with medicine is not fully successful or
when medication is not well tolerated.
 Young patients without chronic irreversible
changes in the upper airways

33. YES
 Poor response to
therapeutic trial
 Drastic
environmental
changes are
considered
NO
 History suggestive
for AR
 Trial of appropriate
therapy successful
 Symptoms mild and
easily managed
 Mechanical,
anatomical, or
infectious causes

34. Pts with moderate severe
symptoms ONLY, should be
given nasal steroids

37. When should
be a nasal
decongestant
used?
 Should be AVOIDED to treat
rhinitis as far as possible.
 And if given, patient should be
emphasized and explained …not
to use it more than 5 – 7 days at
a stretch….if possible explain its
adverse effects and also the
disease “rhinitis
medicamentosa”.

38. In acute
exacerbations of
ALLERGIC
RHINITIS….

40. ALLERGIC
FUNGAL
RHINO - SINUSITIS

41.  An allergic reaction to the aerosolized
environmental fungi , especially ,
dematiaceous fungi( Alternaria,Fusarium,
Chrysosporum), in an immuno
competent host…
 Whereas, invasive fungal rhinosisnusitis
developes in immuno compromised pts.
Allergic (eosinophillic)mucin , mucostasis
and thick fungal debris are found in the
nasal and sinus cavities

42. AllergicAllergic mucin is the most
reliable indicator for AFRS.
It is thick , tenacious color ranging
from tan to green , brown or black,
with eosinophils and Charcot
Leyden crystals. The mucin becomes
more tenacious after treatment with
steroids.

44. AFRS causing right proptosis,
telecanthus and malar flattening.
The position of eyes is not
Symmetrical.
Right nasal ala pushed inferiorly on
Left side