Allergic Rhinitis

Allergic Rhinitis
Author: Javed Sheikh, MD; Chief Editor: Michael A Kaliner, MD more... Updated: Sep 2, 2011

Rhinitis is defined as inflammation of the nasal membranes [1] and is characterized by a symptom complex that consists of any combination of the following: sneezing, nasal congestion, nasal itching, and rhinorrhea.[2] The eyes, ears, sinuses, and throat can also be involved. Allergic rhinitis is the most common cause of rhinitis. It is an extremely common condition, affecting approximately 20% of the population. Although allergic rhinitis is not a life-threatening condition, complications can occur and the condition can significantly impair quality of life,[3, 4] which leads to a number of indirect costs. The total direct and indirect cost of allergic rhinitis was recently estimated to be $5.3 billion per year.[5] A 2011 analysis determined that patients with allergic rhinitis averaged 3 additional office visits, 9 more prescriptions filled, and $1500 in incremental healthcare costs in 1 year than similar patients without allergic rhinitis.[6]

Allergic rhinitis involves inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, sinuses, and pharynx. The nose invariably is involved, and the other organs are affected in certain individuals. Inflammation of the mucous membranes is characterized by a complex interaction of inflammatory mediators but ultimately is triggered by an immunoglobulin E (IgE)–mediated response to an extrinsic protein.[7] The tendency to develop allergic, or IgE-mediated, reactions to extrinsic allergens (proteins capable of causing an allergic reaction) has a genetic component. In susceptible individuals, exposure to certain foreign proteins leads to allergic sensitization, which is characterized by the production of specific IgE directed against these proteins. This specific IgE coats the surface of mast cells, which are present in the nasal mucosa. When the specific protein (eg, a specific pollen grain) is inhaled into the nose, it can bind to the IgE on the mast cells, leading to immediate and delayed release of a number of mediators.[7, 8, 9] The mediators that are immediately released include histamine, tryptase, chymase, kinins, and heparin.[8, 9] The mast cells quickly synthesize other mediators, including leukotrienes and prostaglandin D2.[10, 11, 12] These mediators, via various interactions, ultimately lead to the symptoms of rhinorrhea (ie, nasal congestion, sneezing, itching, redness, tearing, swelling, ear pressure, postnasal drip). Mucous glands are stimulated, leading to increased secretions. Vascular permeability is increased, leading to plasma exudation. Vasodilation occurs, leading to congestion and pressure. Sensory nerves are stimulated, leading to sneezing and itching. All of these events can occur in minutes; hence, this reaction is called the early, or immediate, phase of the reaction. Over 4-8 hours, these mediators, through a complex interplay of events, lead to the recruitment of other inflammatory cells to the mucosa, such as neutrophils, eosinophils, lymphocytes, and macrophages.[13] This results in continued inflammation, termed the late-phase response. The symptoms of the late-phase response are similar to those of the early phase, but less sneezing and itching and more congestion and mucus production tend to occur.[13] The late phase may persist for hours or days. Systemic effects, including fatigue, sleepiness, and malaise, can occur from the inflammatory response. These symptoms often contribute to impaired quality of life.

United States Allergic rhinitis affects approximately 40 million people in the United States.[14] Recent US figures suggest a 20%

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Beth Israel Deaconess Medical Center Javed Sheikh. Prevalence of allergic rhinitis seems to vary among different populations and cultures. such as asthma. Allergic rhinitis can frequently lead to significant impairment of quality of life. Sex In childhood.[15. including asthma. allergic conjunctivitis. Allergic rhinitis often coexists with other disorders. 24] or atopic dermatitis. 25] It may also contribute to learning difficulties.[1. Brainerd Medical Center. and chronic sinusitis. 27. Brainerd. with a mean age of onset 8-11 years. atopic dermatitis.Allergic Rhinitis http://emedicine.medscape. and nasal polyps. and fatigue. Coauthor(s) Umer Najib. Allergic rhinitis can be associated with a number of comorbid conditions. Asthma and Immunology Disclosure: Nothing to disclose. allergic rhinitis is more common in boys than in girls. geographic factors or environmental differences. 2 of 7 30-12-2011 21:11 . adolescence. or other population-based factors.[29] The prevalence of allergic rhinitis has been reported to be as high as 40% in children.[22. but in adulthood. 2.[18.[5] Race Allergic rhinitis occurs in persons of all races. Minnesota William F Schoenwetter. Evidence now suggests that uncontrolled allergic rhinitis can actually worsen the inflammation associated with asthma[22. MD Clinical Research Fellow. 21] This may be due to geographic differences in the types and potency of different allergens and the overall aeroallergen burden. MD Assistant Professor of Medicine. Clinical Director. drowsiness (due to the disease or to medications). Specialty Editor Board William F Schoenwetter. 28] Numerous complications that can lead to increased morbidity or even mortality can occur secondary to allergic rhinitis. Beth Israel Deaconess Medical Center Disclosure: Nothing to disclose. eustachian tube dysfunction. 16] In the geriatric population. Center for Eosinophilic Disorders. and may be associated with asthma exacerbations.[25] This could lead to further morbidity and even mortality. morbidity from the condition can be significant. MD Consultant in Allergic Diseases. American College of Allergy. 23. Division of Allergy and Inflammation. and traffic accidents. Harvard Medical School.3 billion per cumulative prevalence rate.[15. 19. nasal polyps. Department of Medicine. Age Onset of allergic rhinitis is common in childhood. allergic rhinitis develops by age 20 years. which may be due to genetic differences.[17] The prevalence of allergic rhinitis may vary within and among countries. subsequently decreasing with age. and early adult years. Symptoms such as fatigue. MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology. 16] International Scandinavian studies have demonstrated a cumulative prevalence rate of 15% in men and 14% in women. sleep disorders. Possible complications include otitis media. acute sinusitis. Division of Allergy and Inflammation. but allergic rhinitis may occur in persons of any age. eustachian tube dysfunction. 24] Allergic rhinitis is also associated with otitis media. Asthma and Immunology. The overall cost (direct and indirect) of allergic rhinitis was recently estimated to be $5.[26. MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American College of Allergy. Contributor Information and Disclosures Author Javed Sheikh. missed school or work days. Clinical Director. American College of Physicians. 20. rhinitis is less commonly allergic in nature. and atopic dermatitis. 23. and malaise can lead to impaired work and school performance. In 80% of cases. the prevalence is approximately equal between men and women. sinusitis. Mortality/Morbidity While allergic rhinitis itself is not life-threatening (unless accompanied by severe asthma or anaphylaxis).

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