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The truth About Allergic Rhinitis
1. A Quick Tour Of
ALLERGIC RHINITIS
Manjul Dixit, M.D.
2. Allergic Rhinits: Definition
Allergic rhinitis is clinically defined as a symptomatic
disorder of the nose induced by an IgE-mediated
inflammation after allergen exposure of the membranes
lining the nose
3. Interesting Facts
• 10% to 20% of population have intermittent rhinitis
• 30% to 50% of patients have persistent rhinitis
• Up to 15% of patients are children 6 to 7 years of age
• Up to 40% of patients are adolescents 13 to 14 years of age
• 18% to 21% of patients are young adults 15 to 24 years of age
• less than 8% of patients are adults over 65 years of age
• Allergic rhinitis is one of the major 10 conditions that lead to
medical consultation in U.S. managed-case populations
5. Quality Of Life
• Fatigue
• Sleep Disorders
• Learning Problems
• Chronic Rhinosinusitis
• Dental Abnormalities
• Speech Disorders
• Emotional problems
• Impaired activity and social functioning
• Poor perception of general health
• > 800,000 missed days of work, school, and
decreased productivity days
• $5.4 to $7.7 billion dollars lost
9. ARIA Classification
Intermittent Persistent
• < 4 days per week • ≥ 4 days per week
• or < 4 weeks • and ≥ 4 weeks
Mild Moderate-severe
normal sleep one or more items
& no impairment of daily abnormal sleep
activities, sport, leisure impairment of daily
& normal work and school activities, sport, leisure
& no troublesome symptoms abnormal work and school
troublesome symptoms
ARIA Report 2001
10. Diagnosis of AR
History
Physical / Nasal Examination
Laboratory Testing
- Skin Prick Test
- Peak Nasal Inspiratory Flow Rate
- Rhinomanometry
11. PHYSICAL EXAMINATION
Allergic shiner
Dennie Morgan line
Allergic crease
Allergic salute
Nasal mucosa may appear normal or pale bluish,
swollen with watery secretions but only if patient is
symptomatic
Exclude structural problems (polyps, deflected nasal
septum)
Others:
nasal voice, constant mouth breathing, frequent
snoring, coughing, repetitive sneezing, chronic open
gape of the mouth, weakness, malaise, irritability
12. Why?
-Trees: Spring and Fall
Oak, Maple, Cedar, Olive and Elm
- Grasses: Early Summer and Fall
Kentucky Blue Grass, Orchard, Redtop, Timothy, and Bermuda
-Weed: Late Summer and Fall
Pigweed, Sage, Mugwort, lamb’s quarters
-Outdoor Molds: Summer and Early Fall
Alternaria and Cladosporium
Dry and Windy days
-Indoor Molds:
Aspergillus and Penicillium
-Pets
-Cockroaches
13. Management of AR
Allergen Avoidance
Pharmacotherapy
Immunotherapy
- Subcutaneous
- Sublingual
15. Actions of Various Nasal Preparations in
the Treatment of Rhinitis
Nasal Sneezing Itching Rhinorrhea Congestion
Preparation
Antihistamines +++++ ++++ +++ 0
Anticholinergics 0 0 +++++ 0
Corticosteroids +++++ +++++ +++ +++
Decongestants 0 0 + +++++
Antileukotrienes +++ ++ 0 ++++
16. The “Ideal” Drug For Allergic Rhinitis
Should Have The Following Features:
Inhibit both early and late phases
Be an H1 blocker
Counter effects of other mediators
Fast-acting, to control the early phase
Dosing-od or bd for compliance
No side effects
Manage all symptoms
Intranasal administration
17. The “Ideal” Drugs Are……
“Corticosteroids are undoubtedly the
pharmacotherapeutic agents with the broadest
application for the treatment of many types of
rhinitis”
18. Intranasal corticosteroid therapy
Potent topical activity
Administration of low doses directly at site of action
Considerable efficacy at low doses
High topical: systemic activity ratios
Rapid first-pass hepatic metabolism of any systemically
absorbed drug, to compounds with negligible activity
Markedly greater inhibition of EAR than with oral
steroids
19. THANK YOU!!!!
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