1. Allergic Rhinitis
prepared by :
Zirgham Hafeez

2. Background
 Rhinitis is defined as inflammation of
the nasal membranes and is
characterized by a symptom complex
that consists of any combination of the
following: sneezing, nasal congestion,
nasal itching, and rhinorrhea. Allergic
rhinitis is the most common cause of
rhinitis.

3. Background
 Total cost $5.3 billion per year. (in
America)
 Morbidity 10%-40% ( in China)
 Classification
Perennial allergic rhinitis
Seasonal allergic rhinitis (pollinosis)

4. Pathophysiology
 Allergic reaction is an exaggerated or
inappropriate immune reaction and
causes damage to the host
 Type I immediate hypersensitivity
reaction
mediated by IgE antibodies,
which trigger the mast cells and
basophils to release pharmacologically
active agents.

6. CLINICAL
 History: Obtaining a detailed history is
important in the evaluation of allergic rhinitis.
Allergy history
environmental exposures
occupational exposures
effects on quality of life
Family history
• Past medical history

7. CLINICAL
 Signs and Symptoms of Allergic Rhinitis
Sneezing
Itching (nose, eyes, ears, palate)
Rhinorrhea （ watery secretions)
Congestion
Hyposmia （嗅觉下降）

8. CLINICAL
 "Allergic shiners"
 "Nasal crease"
(allergic salute).
 Nasal
examination
:swollen (boggy),
pale, blue-gray
mucosa

9. Lab Studies
 Total serum IgE
 Finding allergen
Common allergen: page 58
Perennial: house dust ,mite ,fungus, pollen
chemical material
Seasonal: pollen ( sunflower, corn ,
glass )

10. Lab Studies
Finding allergen
a. Skin testing: prick test
（点
刺试验）
intracutaneous test
（皮内试验）

11. Diagnosis
 history
 Clinical manifestation
 Allergy diagnosis

12. Differential Diagnosis
 Nonallergic rhinitis with eosinophilia
嗜酸粒细胞增多性非变应性鼻炎
 Vasomotor rhinitis
血管运动性鼻炎

13. Complication
 Allergic sinusitis
过敏性鼻窦炎
 Asthma
哮喘
Secretory otitis media
分泌性中耳炎

14. Treatment
 Medical Care
(1) Avoidance
Environmental controls and
allergen avoidance
(2) Pharmacotherapy
(3) Immunotherapy

15. Treatment
 (2) Pharmacotherapy
a. Steroid: topical—nasal steroid sprays
general
b.Antihistamines: H1-receptor antagonist
First-generation: toldrin (drowsiness )
Second-generation:clarity (don’t cross the
blood- brain barrier)
c.Mast cell stabilizing drug:disodium cromoglycate
d. Decongestants

16. Treatment
 (3) Immunotherapy
Exact mechanism unknown
Decrease allergen-specific IgE levels
Increase allergen-specific IgG levels
IgG molecules ( blocking antibodies
that are important in impeding the
allergic reaction. )

17. Treatment
 (3) Immunotherapy
method: increasing doses of injected allergen
until the maximum tolerated dose is
reached
maintenance dose(maximum tolerated dose )
course: 2 years or more

18. Treatment
 Surgical Care: Surgical care is not
indicated for allergic rhinitis but may be
indicated for comorbid or complicating
conditions.

19. Patient Education
 Educate patients on environmental
control measures, which involve both
the avoidance of known allergens
(substances to which the patient has
IgE-mediated hypersensitivity) and the
avoidance of nonspecific, or irritant,
triggers

20. Question
 What are the major symptoms of allergic
rhinitis?
 The main complications of allergic rhinitis
are:
 The indication of the immunotherapy?(p60)