ENT allergic rhinitis
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Definition of rhinitis?
Rhinitis is defined clinically by a combination of two or more nasal symptoms: running, blocking, itching and sneezing.
Definition of allergic rhinitis?
Allergic rhinitis is a rhinitis as the result of IgE-mediated inflammation following exposure to allergen.
Types of allergic rhinitis?
- Intermittent symptoms• < 4 days per week• Or<4 weeks
- Persistent symptoms• >4 days per week and >4 weeks
classification of allergic rhinitis?
- ---Non specific
- NARES (non allergic rhinitis with eosinophilia syndrome)
- hormonaldrug-induced (Aspirin, NASAIDs,ACEi,)
How to define Moderate-severe allergic rhinitis?
- One or more items:
- Abnormal sleep
- Impairment of daily activities,sport, leisure
- Problems caused at school or work
- Troublesome symptoms
Risk factors fo allergic rhinitis?
- Family history (Genes involved in atopy include loci on Sq,lla, 12Q.)
- Environment (hygiene hypothesis)
- Co-morbidities: asthma, sinusitis, otitis media, sleep disorders, lowerrespiratory tract infection and dental occlusion.
Process of allergic rhinitis in brief?
- 1. sensitization;
- 2. subsequent reaction to allergen - early phase;
- 3. late phase reaction;
- 4. systemic activation.
What are the mediators of early phase?
histamine, leukotriene C4, prostaglandine D2
What is the action of prostaglandine D2?
It induces asustained nasal obstruction and is ten times more potent than histamine.
What is the action of histamine?
Histamine causes rhinorrhoea, sneezing, pruritis and nasal obstruction. It also increases ipsilateral glandular secretion by a direct effect on mucus cells and vessels and contralateral secretion through neural reflexes.
What is early phase in allergic rhinitis?
Symptoms of sneezing, rhinorrhoea and itch occur within minutes after exposure and are associated with increase in mediators such as histamine, leukotriene C4 and prostaglandin D2 in the nasal mucus.
What is late phase in allergic rhinitis?
This is inflammatory in nature and involves the ingress of cells such as eosinophils,basophils, mast cells, T lymphocytes, neutrophils and macrophages into the nose. The main symptoms are nasal obstruction and hyper-reactivity.
What is the action of eosinophils in the sensitized nose?
eosinophil products increase local vascular permeability and mucus secretion and cause further inflammatory cell influx. CT changes in rhinosinusitis have been linked to the number of eosinophils present in the mucosa.
What is the differential diagnosis of inflammatory rhinosinusitis?
Perennial allergic inflammation often presents as chronic inflammatory rhinosinusitis without acute allergic symptoms. Careful history taking and testing for atopy is necessary to make the diagnosis and obviate inappropriate surgical intervention.
What is the positive result for skin prick test?
Reactions greater than 2 mm in under fives and 3 mm in older subjects are regarded as positive. Positive results should be at least 2 mm greater than the negative control. The wheal size does relate to the amount of IgE, although the relationship is not linear.
When is skin prick test considered invalid?
Tests in which the negative control gives a positive reaction are invalid, as are those in which there is no positive reaction to histamine.
Exclusion criteriae for skin prick tests?
Skin prick tests should not be performed if the patient is on antihistamines, has severe eczema, has had previous life-threatening anaphylaxis or has dermagraphism. Oral corticosteroids do not interfere except at very high dosage, dermal corticosteroids may reduce reactivity.
What is Phadiatop test?
the use of several common allergens in the serum in a single test.
What is the most effective treatment of Allergic rhinitis?
Treatment plans for allergic rhinitis?
- pharmacotherapy: Antihistamines, Steroids,Na Cromoglycate, decongestants, ipratropium bromide, antileukotrienes
- nasal douching
- immunotherapy: subdermal, sublingual
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