Allergic Rhinitis

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.
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 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.
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
Complication
 Allergic sinusitis
过敏性鼻窦炎
 Asthma
哮喘
 Secretory otitis media
分泌性中耳炎
Treatment
 Medical Care
(1) Avoidance
Environmental controls and
allergen avoidance
(2) Pharmacotherapy
(3) Immunotherapy
Treatment
 (2) Pharmacotherapy
a. Steroid: topical—nasal steroid sprays
general
b.Antihistamines: H
1
-receptor antagonist
First-generation: toldrin (drowsiness )
Second-generation:clarity (don’t cross the
blood- brain barrier)
c.Mast cell stabilizing drug:disodium cromoglycate
d. Decongestants


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. )
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)

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