• It is a systemic disease affecting the

upper respiratory system with

prominent nasal symptoms in
response to second exposure to
allergens.
1- Outdoor aeroallergens
i.e. pollutants(diesel exhaust particles)
Outdoor aeroallergens
i.e pollen,mold spores
Indoor aeroallergens
i.e house dust mites
Indoor aeroallergens
i.e. mold spores
The pathogenesis of allergic rhinitis is complex.
Classification of allergic rhinitis
Causes of non allergic rhinitis

Environmental or occupational rhinitis strong odors or cold air

Infectious rhinitis a)acute sinusitis viral infection last up

to 10 days
b)chronic sinusitis it is bacterial
infection lasts up to12 weeks
Hormonal Pregnancy, puberty, thyroid disorders

Drug Induced Cocaine, beta blockers, ACEIs,

chlorpromazine, clonidine, reserpine,
hydralazine, oral contraceptives,
aspirin or other NSAIDs, overuse of
topical decongestants
Structural Septal deviation, adenoid hypertrophy
Traumatic Recent facial or head trauma
Gustatory rhinitis hot or spicy foods
• Allergic rhinitis cannot be cured. The goal of
therapy is to reduce symptoms and improve
the patient’s functional status .

• Allergic rhinitis is treated in three steps:

• allergen avoidance
• pharmacotherapy
• immunotherapy
• 1-reducing the mite population in
mattress,pillows
• 2- lowering the household humidity to less
than 40%
• 3-applying acaricides
• 4-reducing mite harboring dust by removing
carpets, upholstered furniture.
• Ventilation systems with HEPA filters remove
pollen, mold spores, and cat allergens from
household air.
• Filters need to be changed regularly to
maintain effectiveness.
• HEPA filters are also found in some vacuum
cleaners. Weekly vacuuming of carpets,
drapes, and upholstery,
 *

• 1-Intranasal corticosteroids
• 2-Oral antihistamincs
• 3-Oral leukotrien receptor antagonist
• 4-Intranasal antihistaminics
• 5-Decongestants
• 6-Intranasal mast cell stabilizers
• 7-Intranasal anticholinergics
• 8-combination therapy

*2015 American academy of otolaryngology-head and neck surgery foundation(AAO-

HNSF) guidelines for allergic rhinitis
 )

• It is first line treatment for most

symptoms of allergic rhinitis such as
itching, rhinitis, sneezing, and
congestion.
 Intranasal corticosteroids
• Beclomethasone(Qnasal) dry nasal aerosol is
the first non aquous nasal formulation
available.
• are indicated for relief of symptoms of allergic
rhinitis (e.g., itching, sneezing, and rhinorrhea)
• Second generation, peripherally selective i.
• e.acrivastine,ebastine, loratadine,cetrizine
• Third generation i.e. levocetrizine
,desloratidine,fexofenadine
 Oral leukotriene receptor
antagonist
• Montelukast is the only approved oral leukotriene receptor
antagonist for use in seasonal and perennial allergic rhinitis
Intranasal antihistamines Decongestants
• i.e. Azelastine
• They ara targeted delivery
drugs
Intranasal mast cell stabilizers
• useful for patients with
specific known allergy and
are planning to be in contact
with that allergen so it is
given 30 minutes before
allergen exposure
Intra nasal anticholinergics
• Ipratropium (atrovent)
• relieving persistent
rhinorrhia and congestion
symptoms
 Nasal wetting agents
• relieve nasal mucosal irritation and dryness,
thus decreasing nasal stuffiness, rhinorrhea,
and sneezing.
Subcutaneous
immunotherapy SCIT
First allergen skin testing
identifies a person’s allergic
triggers. A personalized
vaccine is then formulated
using all natural protein
extracts. This extract is then
administered subcutaneously
with small doses by
developing immunity or
tolerance to the allergen.
• Another form of allergy immunotherapy was
recently approved in the United States called
sublingual immunotherapy (SLIT) allergy
tablets
• one is for dust mites and one is for short
ragweed and two for grass pollen allergy
tablets
• Omalizumab (Xolair)
• shown effectiveness in
reducing nasal symptoms
and improving quality of
life.
• It only limitation yet is its
high cost.