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Allergic rhinitis

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Allergic rhinitis

  1. 1. Allergic Rhinitis prepared by : Zirgham Hafeez
  2. 2. Background Rhinitis is defined as inflammation of the nasal membranes and is characterized by a symptom complex that consists of any combination of the following: sneezing, nasal congestion, nasal itching, and rhinorrhea. Allergic rhinitis is the most common cause of rhinitis.
  3. 3. Background Total cost $5.3 billion per year. (in America) Morbidity 10%-40% ( in China) Classification Perennial allergic rhinitis Seasonal allergic rhinitis (pollinosis)
  4. 4. Pathophysiology Allergic reaction is an exaggerated or inappropriate immune reaction and causes damage to the host Type I immediate hypersensitivity reaction mediated by IgE antibodies, which trigger the mast cells and basophils to release pharmacologically active agents.
  5. 5. CLINICAL History: Obtaining a detailed history is important in the evaluation of allergic rhinitis. Allergy history environmental exposures occupational exposures effects on quality of life Family history• Past medical history
  6. 6. CLINICAL Signs and Symptoms of Allergic Rhinitis Sneezing Itching (nose, eyes, ears, palate) Rhinorrhea ( watery secretions) Congestion Hyposmia (嗅觉下降)
  7. 7. CLINICAL "Allergic shiners" "Nasal crease" (allergic salute). Nasal examination :swollen (boggy), pale, blue-gray mucosa
  8. 8. Lab Studies Total serum IgE Finding allergen Common allergen: page 58 Perennial: house dust ,mite ,fungus, pollen chemical material Seasonal: pollen ( sunflower, corn , glass )
  9. 9. Lab StudiesFinding allergen a. Skin testing: prick test (点 刺试验) intracutaneous test (皮内试验)
  10. 10. Diagnosis history Clinical manifestation Allergy diagnosis
  11. 11. Differential Diagnosis Nonallergic rhinitis with eosinophilia 嗜酸粒细胞增多性非变应性鼻炎 Vasomotor rhinitis 血管运动性鼻炎
  12. 12. Complication Allergic sinusitis  过敏性鼻窦炎 Asthma  哮喘Secretory otitis media   分泌性中耳炎
  13. 13. Treatment Medical Care (1) Avoidance Environmental controls and allergen avoidance (2) Pharmacotherapy (3) Immunotherapy
  14. 14. Treatment (2) Pharmacotherapya. Steroid: topical—nasal steroid sprays generalb.Antihistamines: H1-receptor antagonist First-generation: toldrin (drowsiness ) Second-generation:clarity (don’t cross the blood- brain barrier)c.Mast cell stabilizing drug:disodium cromoglycated. Decongestants
  15. 15. Treatment (3) Immunotherapy Exact mechanism unknown Decrease allergen-specific IgE levels Increase allergen-specific IgG levels IgG molecules ( blocking antibodies that are important in impeding the allergic reaction. )
  16. 16. Treatment (3) Immunotherapymethod: increasing doses of injected allergen until the maximum tolerated dose is reachedmaintenance dose(maximum tolerated dose )course: 2 years or more
  17. 17. Treatment Surgical Care: Surgical care is not indicated for allergic rhinitis but may be indicated for comorbid or complicating conditions.
  18. 18. Patient Education Educate patients on environmental control measures, which involve both the avoidance of known allergens (substances to which the patient has IgE-mediated hypersensitivity) and the avoidance of nonspecific, or irritant, triggers
  19. 19. Question What are the major symptoms of allergic rhinitis? The main complications of allergic rhinitis are: The indication of the immunotherapy?(p60)

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