ALLERGIC RHINITIS
● DEV DEVRAJ (18-0334-979)
● CHOUDHARY AYUSHI (18-0819-756)
● CHOUDHARY NEERAJ (18-0947-957)
● DARANDALE PRAJAKTA NARAYAN (18-1145-339)
DEFINITION EPIDEMIOLOGY
• Allergic rhinitis is defined as • Allergic rhinitis occurs in over 500 million people
chronic or recurrent IgE- around the world.
mediated (Allergen mediated) • In the Philippines, prevalence ranges from 18%
inflammation of the nasal in urban areas to 22.1% in rural areas and from
mucosa. 26% in young children to 32% in adolescents.
• Symptoms commonly develop before the age of
20 years in 80% of cases.
• Approximately 30% develop symptoms during
adolescence.
COMMON ALLERGENS:
● Tree, grass (predominant pollen in the Philippines) &
weed pollen
● House dust mites
● Molds
● Cat and dog dander
● Ingestants like nuts, fish, eggs, milk etc.
● Insects like Cockroaches, bed bugs etc.
Signs and Symptoms:
Primary symptoms include: Primary signs of AR:
● rhinorrhea, • Presence of facial grimaces
● Sneezing, • Nasal creases
● nasal itching, • allergic shiners
● nasal congestion • Dennie-Morgan lines
● postnasal drainage.
● It may be associated with other
symptoms such as :
● frequent throat clearing
● eye itching
● Tearing
● eye redness
● palatal itching
● impaired sense of smell (and taste)
● Fatigue
● impaired concentration & reduced
productivity
Classification:
● Using the internationally accepted ARIA standard for the management of allergic rhinitis, patients
are classified based on the duration and severity of symptoms:
PATHOPHYSIOLOGY
DIAGNOSIS
● The diagnosis of Allergic Rhinitis is strongly considered in the presence of the following
symptoms: nasal itching, sneezing, rhinorrhea, and/or nasal congestion or obstruction, triggered
by allergen exposure.
● The diagnosis of allergic rhinitis should begin with a thorough history and complete physical
examination.
● Parameters to be considered while eliciting the history are:
● (1) allergy triggers
● (2) presence of nasal symptoms and watery-itchy eyes
● (3) positive personal history
● (4) positive family history of atopy
● A complete Ear, Nose and Throat (ENT) examination must be performed on all patients suspected
to have AR.
● Anterior rhinoscopy must be performed to support the diagnosis. The following findings may be
observed:
● a. Pale gray, dull red, or red turbinates.
● b. Boggy turbinates.
● c. Minimal to profuse, watery to mucoid nasal discharge.
● Nasal endoscopy is strongly recommended for selected patients.
● CBC (During an allergic flare)
● Allergic work-up in selected cases like:
● a. Skin prick test
● b. Nasal provocation test
● c. Serum specific lgE test
VAS SCORING
● Should be done periodically to assess symptom severity and monitor response to therapy.
● Patients with VAS score <5 is classified as mild rhinitis and those with VAS score >6 is classified
as moderate severe rhinitis
MANAGEMENT
● Avoid or minimize exposure to allergens.
● Nasal saline irrigation (NSI) or douching is recommended as an
adjunctive treatment for patients with allergic rhinitis.
● Oral antihistamines is the first line of treatment.
● Second-generation antihistamines – mostly preferred
● Intranasal antihistamines alternative therapy to oral
antihistamines - intermittent symptoms and short term exposure to
allergens.
● Intranasal corticosteroids (INCS) - intermittent moderate-severe
symptoms, persistent symptoms, and long-term exposure to
allergens.
● INCS + Topical antihistamines = for inadequate control and
exacerbation of symptoms
● Oral antihistamines may be considered when topical antihistamines
are unavailable.
Oral corticosteroids (5 to 7 days) - with moderate-severe and persistent symptoms not responsive to
INCS.
AR especially in the presence of asthma :
● Oral anti-leukotriene agents alone,
● Oral anti-leukotriene agents + antihistamines,
● Oral anti-leukotriene agents + INCS
Intranasal cromolyn sodium - lesser side effects. However, it is less effective than corticosteroids.
Oral and topical decongestants - prominent nasal obstruction.
● Oral decongestants - reduce nasal decongestion but can result in side effects such as insomnia,
irritability and palpitations.
● Topical decongestants - short-term or possibly intermittent or episodic therapy of nasal
congestion, but are inappropriate for long-term daily use because of the risk for the development
of rhinitis medicamentosa.
Allergen specific immunotherapy (SIT)
● Development of new allergen sensitizations
● Reduce the risk for the future development of asthma in patients with AR.
● It may be used in the following select group of AR patients:
● Patients who did not benefit from avoidance therapy and pharmacotherapy.
● Patients who cannot tolerate or who refuse pharmacotherapy
● Patients who are chronically exposed to allergens
● Patients with rhinitis and symptoms from the lower airways during peak allergen exposure.
● SIT should not be used in patients with uncontrolled asthma.
● VAS scoring - simple and quantitative method should be done periodically to assess symptom
severity, and monitor response to treatment.
THANK YOU!
