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Allergic Rhinitis

Allergic Rhinitis. Definition Hypersensitivity of the nasal mucosa due to exposure to allergens Acute and seasonal or chronic and perennial. Allergic Rhinitis. What happens in allergic rhinitis? Exposure to allergen IgE production by the body Formation of allergen IgE complex

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Allergic Rhinitis

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  1. Allergic Rhinitis • Definition Hypersensitivity of the nasal mucosa due to exposure to allergens • Acute and seasonal or chronic and perennial

  2. Allergic Rhinitis What happens in allergic rhinitis? • Exposure to allergen • IgE production by the body • Formation of allergen IgE complex • Binding of the complex to mast cells • Degranulation of the mast cells and release of inflamatory mediators including histamine. • Vasodilation • Increase in capillary permability.

  3. Allergic RhinitisFirst exposure – Phase of sensitizationOn re-exposure- Mast cell degranulation Exposure of genetically predisposed individuals to allergens (pollen, animal dander, fur) Activation of T-lymphocytes Stimulates IgE production by B-lymphocytes IgE coat mast cells [on re-exposure mast cell degranulation]

  4. Allergin Rhinitis: Inflammatory cells • Mast cells • Contain • Granules (histamine) • Other mediators (leukotrienes and PGs) • Lymphocytes • T cells • Increased mobilisation of inflammatory cells • Eosinophils, macrophages, neutrophils • Eosinophils • Major basic protein, Eosinophilic Cationic Protein (epithelial injury, nasal block)

  5. Allergic Rhinitis: Inflammatory mediators Released by inflammatory cells (mast cells, eosinophils, lymphocytes) • Leukotrienes • hypersecretion of mucus • oedema (Increased vascular permeability) • Histamine • itching, rhinorrhea (Allergic rhinitis) • Cytokines • Interleukins (IL) • IL-4 (IgE production) • IL-3 and IL-5 (eosinophil, mast cell recruitment / activation)

  6. CLASSIFICATION OF ALLERGIC RHINITIS (AR) • Intermittent AR • < 4 days per week • or < 4 weeks Mild Intermittent AR Moderate-Severe Intermittent AR • Normal Sleep • No impairment of daily activities • Normal work and school • No troublesome symptoms • Abnormal Sleep • Impairment of daily activities • Problem at work and school • Troublesome symptoms

  7. CLASSIFICATION OF ALLERGIC RHINITIS (AR) • Persistent AR • > 4 days per week • or > 4 weeks Mild Persistent AR Moderate-Severe Persistent AR • Normal Sleep • No impairment of daily activities • Normal work and school • No troublesome symptoms • Abnormal Sleep • Impairment of daily activities • Problem at work and school • Troublesome symptoms

  8. Allergic Rhinitis 2 Types: • Seasonal (summer, spring, early autumn) tree pollens, grass pollens, mold spores lasts several weeks, disappears and recurs following year at the same time • Perennial -inhaled: house dust, wool, feathers, foods, tobacco, hair -ingested: wheat, eggs, milk, nuts  occurs intermittently for years with no pattern or may be constantly present

  9. Allergic Rhinitis • Clinical features • Nasal obstruction with pruritis, sneezing • Clear rhinorrhea (containing increased eosinophils) • Itching of eyes with tearing • Frontal headache and pressure • Mucosa  edematous, pale or violet in color • Allergic salute  transverse nasal skin crease from rubbing the nose

  10. Allergic Rhinitis • Diagnosis History (don’t forget to ask about atopy & family history) Physicalexamination: 1. look for redness ,swelling of the mucosa (particularly the turbinates) &mucoid discharge. 2.check for structural anomalies such as septal deviation or nasl polyps. Sensitivity test for specific allergen ( skin prick tests)

  11. Allergic Rhinitis • Treatment 1. identification and avoidance of allergen 2.during the acute attach: -antihistamine (systemic or intranasal) -local steroids -decongestant( ephedrine) 3.sodium cromoglycate mast cell stabilizer used as prophyaxis 4. desensitization we keep exposing the body to gradually increased amounts of allergen until the body fails to produce IgE as a result to exposure.

  12. Drug options for Allergic Rhinitis

  13. Treatment Options: Allergic Rhinitis • Antihistamines • Oral: Most common form of Treatment. (Drowsiness / Dryness of mouth / Urinary retention / Blurred vision / appetite +).Cetrizine, Rupatidine • Nasal Spray : Azelastine. Potent H1 blocker with immediate effect / Also blocks other mediators (LT, PAF) • Corticosteroids • Nasal Sprays: Most effective treatment of AR / certain types of perennial rhinitis (Beclomethasone / Budesonide / Fluticasone / Mometasone. • Block both EAR / LAR : Reduce swelling & secretions in nasal mucosa (anti-inflammatory) • Oral Corticosteroids: Short term

  14. Allergic Rhinitis • Complications - chronic sinositis - polyps( swollen edematous nasal mucosal tissue , they can cause complete nasal obstruction) - serous otitis media

  15. Vasomotor Rhinitis - It is a very common type of non-inflammatory, non-allergic rhinitis -Characterized by a combination of symptoms that includes nasal obstruction and rhinorrhea -vasomotor rhinitis is a diagnosis of exclusion reached after taking a careful history, performing a physical examination, and, in select cases, testing the patient with known allergens

  16. Vasomotor Rhinitis • Caused by: -temperature change -alcohol, dust, smoke -stress, anxiety, neurosis -endocrine – hypothyroidism, pregnancy, menopause -parasympathomimetic drugs

  17. Vasomotor Rhinitis • Clinical features: -Chronic intermittent nasal obstruction -Rhinorhea (thin, watery) -Mucosa and turbinates : swollen, pale between exposure We have 2 types ; eosinophilic & non eosinophilic (according to the number of eosinophils found in the nasal secretion)

  18. Vasomotor Rhinitis • TYPES • Eosinophilic & • Non eosinophilic (according to the number of eosinophils found in the nasal secretion)

  19. Vasomotor Rhinitis • Treatment: -Elimination of irritant factor -Parasympathetic blocker -Steroids -Surgery -Symptomatic relief with exercise

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