Allergic rhinitis

Anna Sztafińska, MD, PhD

Department of Allergy and Pediatrics, Copernicus Memorial Hospital,
Lodz
 Definition
Rhinitis is an inflammation of the mucous membranes of
the nose. Allergic rhinitis involves reactions in the nasal
mucosa from repeated allergen exposures that causes
hypersensitivity. These reactions may be seasonal or
perennial.

2
 Introduction
Allergic rhinitis is a form of atopy characterized by an acute irritative
inflammation of the mucous membranes of the eyes and upper
respiratory passages accompanied by itching and profuse watery
secretion, followed occasionally by bronchitis and asthma; the episode
recurs annually at the same or nearly the same time of the year, in
spring, summer, or late summer and autumn, caused by an allergic
reaction to the pollen of trees, grasses, weeds, flowers, etc.

3
 Introduction
Allergic rhinitis is a response of the immune system to airborne allergens, including
mold, animal dander, dust mites and feathers.
It occurs year-round or seasonally and symptoms are most like those of the common
cold.
Symptoms include stuffy nose, watery eyes, sneezing, coughing and runny nose.
Allergic rhinitis is often referred to as hay fever and affects approximately 35 million
people in the US.
 Allergic rhinitis may predispose patients to the development of chronic rhinitis.

4
 Seasonal rhinitis
Common allergens:
• Grass pollens
• Tree pollens
• Weed pollens
• Mold spores

5
 Seasonal rhinitis
Symptoms:
• Watery nasal drainage
• Nasal congestion
• Repetitive sneezing
• Itchy eyes, nose, ears, and throat
• Nose rubbing
• Allergic salute

6
 Perennial allergic rhinitis
• Little or no seasonal variation
• Symptoms are intermittent or continuous throughout the year
• Watery nasal drainage and sneezing are less prominent than
seasonal allergic rhinitis
• Nasal congestion is often the primary symptom

7
 Signs and symptoms
Signs and symptoms can range from mild to severe
If the condition is mild, may have brief, infrequent episodes of a runny
nose and itchy, watery eyes
At the other extreme, may experience persistent, severe symptoms that last
more than four days a week or longer than four weeks at a time
Chronic congestion may cause facial pressure and pain, alter the sense of
taste and smell, and affect the appearance

8
 Signs and symptoms
The skin beneath the eyes may swell and turn blueish as
develops what are sometimes called "allergic shiners."

9
 Signs and symptoms
Runny nose Frequent sneezing
Sleeplessness Facial pressure and pain
Watery eyes Postnasal drip
Fatigue Cough
Congestion Irritability
Itchy eyes, nose, roof of mouth or throat

10
Complications due to chronic nasal congestion
• Dry irritated or sore throat
• Snoring
• Pain around eyes
• Mouth breathing
• Orthodontic disturbances
• Frontal headaches/sinusitis
• Chronic cough

11
Complications due to chronic nasal congestion
• Otitis media/possible hearing loss
• Altered smell and/or taste
• Sleep disturbance, with or without daytime fatigue
• Asthma exacerbation

12
Differentiation of allergic rhinitis and the common cold
Hay fever Colds
Signs and Runny nose with thin, Runny nose with
watery discharge; no watery to thick
symptoms fever yellow discharge;
low-grade fever

Onset Immediately after One to three days after

exposure to allergens exposure to cold virus

Duration As long as exposed to 5-7 days

allergens
13
 Allergic triggers
• Dust mites – carpeting, upholstered furniture
• Animals – furry or feathered
• Pollens – physical education, recess
• Cockroaches
• Molds
• Foods

14
 Dust mites
Dust mites are one of the most common allergens throughout
the world. They grow best indoors in warm, humid
environments. Their growth is hindered in very dry climates.
Carpeting and upholstered furniture are the major sources in
the classroom, but mattress and pillows are the major source
in the home.

15
 Pet allergies
Cats and dogs are the most common cause of pet allergies.
In cats, the allergen is present in skin secretions and saliva,
and isn’t part of the hair. In the case of the dog, the allergen is
contained in skin scales and hair. Pet allergens are very tiny
particles and they float in the air for prolonged periods of
time, and stick to whatever they contact.

16
 Pollens
Pollens are usually encountered outdoors. The types of pollen
varies by the time of year. Tree pollen is usually present in the
early spring, grass pollen in the late spring and early
summer, and weed pollens in late summer and early fall.
Children participating in PE or recess during high pollen
days can have allergy problems.

17
Pollen calendar

18
 How does it happen?
During a process called sensitization, the immune system mistakenly identifies
the allergen as an invader and produces an antibody against it called
immunoglobulin E, or IgE.
The next time if exposed to the allergen, the immune system launches an allergic
reaction.
The IgE antibodies trigger the release of an inflammatory chemical called
histamine, which swells the mucous membranes in the nose, sinuses and eyes,
causing a runny nose, watery eyes and sneezing.

19
 Risk factors
Family history of allergies
Male sex
Firstborn
Exposure to cigarette smoke in the first year of life
Exposure to indoor allergens, such as dust or pet dander

20
 Diagnosis
 Personal and family medical history, signs and symptoms
 Physical examination to look for additional clues about the causes of
signs and symptoms
 Additional tests – skin or blood tests

21
 Skin tests
During skin testing, small amounts of purified allergen extracts are
pricked into the skin of the arm or upper back and observed for signs
of an allergic reaction.
A small area of swelling with surrounding redness is typical of a positive
allergy skin test

22
Skin tests

23
 Treatment

 Allergen avoidance
 Oral medication, nasal spray, eyedrops – alone or
in combination
 Allergy shots

24
 Avoidance of triggers
• No carpeting or upholstered furniture
• No furry or feathered pets
• Perform maintenance chores requiring use of irritating
chemicals/cleaners when children not present
• No smoking

25
 Medications
Nasal corticosteroids
Antihistamines
Decongestants
Cromolyn sodium
Leukotriene modifier
Allergen immunotherapy

26
 Immunotherapy
Immunotherapy is the closest thing to a cure for allergic rhinitis.
Immunotherapy is a well-established treatment for certain severe
allergies, and involves the administration of gradually increasing
doses of allergen extracts over a period of years, given to patients by
injection or drops/tablets under the tongue (sublingual).

27
28