ALLERGIC RHINITIS

Dr. N. Kumarjit Singh ENT Surgeon JNIMS, Porompat Imphal East IgE-mediated immunologic response of nasal mucosa to air-borne allergens Characteristics: Watery nasal discharge Nasal obstruction Sneezing Itchy nose, (eyes palate, pharynx)

Clinical Types
Seasonal Perennial

Aetiology Inhaled allergens

Exogenous : external agents Inhalants (commonest allergens) Ingestants Contactants Irritants Drugs Infections Endogenous : within body Genetic predisposition: 29% & 49%

Pathogenesis

IgE production through inhaled allergens Antibodies fixed to blood basophils or tissue mast cell Subsequent exposure antigens combined with IgE antibody De-granulation of mass cells releasing chemical mediators Vasodilatation mucosal oedema, eosonophils Excessive secretion Smooth muscle contraction

Priming Effect
Acute or early phase Late or delayed phase

CLINICAL FEATURES
No age bar 12-16 years of age

Cardinal Symptoms

Seasonal:
Sneezing

Perennial
Not so severe Frequent colds Stuffy nose Lose of smell Post nasal drip Chronic cough Hearing impairment

Nasal obstruction
Watery nasal discharge Itching nose

Sign of allergy may be seen

Nose Eyes Ears Pharynx larynx

Diagnosis
Detail history and physical examination

INVESTIGATIONS
Total and differential count Nasal smear Skin test Radioallergosorbent test (RAST) Nasal provocation test

COMPLICATIONS
Sinusitis Nasal polyp Serous otitis media Orthodontic problem Bronchial asthma

TREATMENT
Avoidance of allergens Treatment with drugs Immuno therapy

o TREATMENT WITH DRUGS Anti histaminics Cetrizine, levocetrizine, loratidine, des loratidine, terfenadine, fexofenadine, Rupatadine, cyproheptadine, azatadine maleate, ebastine,clemastine,mizolastine,azelastine Astemizole,diphenhydramine,hydroxyzine,chlorpheniramine,pheniramine maleate Ketotifen, sodium cromoglycate, dimethindene maleate, bresol, misc.allergic preparation

Sympathomimetic drugs(oral or topical)

Constrict blood vessel and reduce nasal congestion and oedema CNS stimulation Pseudoephedrine Phenylpropanolemine

Topical use Phenylephrine, oxymetazoline, xylometazoline, naphazoline Rebound congestion leading to rhinitis medicamentosa

CORTICOSTEROIDS
ORAL USE Use in acute episode

TOPICAL STEROIDS Beclomethasone dipropionate,budesomide,flunisolide,acetate,fluticasone,mometasone Treatment for rhinitis medicamentosa 3 weeks not recommended Growth of fungus Break for 1-2 weeks every 2-3 months
SODIUM CHROMOGLYCATE Stabilises mast cells and prevent degranulation 2% solution as drops or spray or an aerosol powder Use both in seasonal and perennial

IMMUNOTHERAPY
When drug fail Allergen given in gradual increasing dose Suppresses formation of IgE Raises titre of specific IgG antibody Given for 1 year Discontinued if uninterrupted treatment for 3 year fails