Allergic Rhinitis
 

Background
 Rhinitis is defined as inflammation of
the nasal membranes and is
characterized
characterize d 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.
 

Background
 Total cost $5.3 billion per year. (in
 America)
 Morbidity 10%-40% ( in China)

 Classification

Perennial allergic rhinitis

Seasonal allergic rhinitis (pollinosis)
 

Pathophysiology 
  Allergic reaction
reaction is an exaggerated
exaggerated or
inappropriate
causes damage immune
to the reaction
host and
 Type I immediate hypersensitivity

reaction
mediated by IgE antibodies,
which trigger the mast cells and
basophils to release pharmacologically
active agents.
 

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
 

CLINICAL
 Signs and Symptoms of Allergic Rhinitis

Sneezing
Itching (nose, eyes, ears, palate)
Rhinorrhea（watery secretions)
Congestion

Hyposmia （嗅觉下降） 
 

CLINICAL
 "Allergic shiners"
 "Nasal crease"

(allergic salute).


 Nasal
examination :swol
len (boggy), pale,
blue-gray mucosa
 

Lab Studies 

Total serum IgE

 Finding allergen 
Common allergen: page 58
Perennial: house dust ,mite ,fungus, pollen
chemical material
Seasonal: pollen ( sunflower, corn , glass )
 

Lab Studies
Finding allergen
a. Skin testing: prick test
（点刺试验） 
intracutaneous test
（皮内试验） 
b. Nasal allergen challenge test
c. Serum special IgE determination
 

Diagnosis

 history

 Clinical manifestation

 Allergy diagnosis
 

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 
血管运动性鼻炎 
 

Complication


Allergic sinusitis
过敏性鼻窦炎  
过敏性鼻窦炎
 Asthma
哮喘 
 Secretory otitis media
泌性 耳炎 
 

Treatment

 Medical Care 
(1) Avoidance 
Environmental controls and

allergen avoidance
(2) Pharmacothera
Pharmacotherapy
py
(3) Immunotherapy 
 

Treatment
 (2) Pharmacotherapy
a. Steroid: topical—nasal steroid sprays
general
b.Antihistamines: H1-receptor antagonist
First-generation:: toldrin (drowsiness )
First-generation
Second-generation:cl
generation:clarity
arity (don’t cross the 
blood- brain barrier)
c.Mast cell stabilizing drug:disodium cromoglycate
d. Decongesta
Decongestantsnts
 

Treatment
 (3) Immunothera
Immunotherapy
py
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. )
 

Treatment
 (3) Immunotherapy
method: increasing doses of injected allergen
until the maximum tolerated dose is
reached
maintenance dose(maximum tolerated dose )

course: 2 years or more

 

Treatment


Surgical Care: Surgical care is not
indicated for allergic rhinitis but may be
indicated for comorbid or complicating
conditions.
 

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
 

Question
 What are the major symptoms of allergic
rhinitis?

 The main complications of allergic rhinitis are:

 The indication of the immunotherapy?(p60)