Allergic Rhinitis

Yucheng Yang Ph.D. Prof.

Department of Otolaryngology
The First Affiliated Hospital
Chongqing Medical University
2020
• Have you suffered from watery
discharge, nasal obstruction,
sneezing and itching?
 Definition
• Allergic Rhinitis:
It is an IgE-mediated immunologic
response of nasal mucosa to allergens

allergen exposure
Ig E
nasal mucosa
 Classification
pollinosis

• Seasonal classify traditionally

• Perennial

ARIA classification
• duration: intermittent
• continued
• severity: mild
• moderate-severe
 Causes
Inhalant allergens are often the cause：
pollen, animals, house dust, debris from insects
and house mite……
Genetic predisposition:
 Clinical Features

• The main symptoms include suddenly

sneezing, nasal obstruction, watery nasal
discharge and itching in the nose.
 Clinical Features
• Others:
persistently stuffy nose, lose of sense of
smell, postnasal drip, chronic cough, hearing
lose……
 Physical examination
• Signs of allergy may be seen in the nose, eyes,
ears, pharynx and larynx.
• Nose:
✔ pale and edematous of nasal mucosa
✔ swollen turbinate
✔ thin, watery or mucoid discharge
 Physical examination
• Ocular signs: conjunctivitis
edema of lid, congestion
• Otologic signs:
retracted tympanic membrane or
secretory otitis media
• Pharyngeal signs:
granular pharyngitis
 Lab tests
• Skin test : prick, scrach, intradermal
tests

use standard allergen, place a drop of extract

on the forearm skin, pricking a needle
through the epidermis under the drop,
observe the result 15-20minutes later.

notice: positive and negative controls

must be used.
 Lab tests

• IgE antibody concentration on serum.

an elevated total/specific IgE level
not used alone to establish allergic rhinitis
• Total blood eosinophilia count:
an elevated eosinophilia count
 Diagnosis

• Detailed history and physical examination

• Possible allergen
 Complications
• Recurrent sinusitis because of obstruction
to the sinus ostia
• Nasal polyp
• Secretory otitis media
• Bronchial asthma: one airway, one
disease!
• Most patients with allergic (80%) and non-allergic (50%)
asthma have rhinitis, and many patients with rhinitis (20–30%)
also have asthma.
 Treatment
• Treatment can be divided into:
avoidance of allergen
treatment with drugs
immunotherapy

The best treatment is to avoid the allergen

remove of a pet ,encasing the pillow, change
a place of work……
 Treatment
• Drugs
✔ antihistamine: oral or nasal
✔ corticosteroids: oral
nasal steroids
(budesonide, fluticasone, mometasone)
✔ decongestant drug:
 Treatment
•Drugs
These medications are used to treat allergic
rhinitis:
a. Antihistamines: Antihistamines block
the action of the histamine. They compete with
histamine for histamine receptor type 1.
b. Decongestants: Decongestants
stimulate vasoconstriction by directly activating
alpha-adrenergic receptors of the respiratory
mucosa, can give short-term relief from nasal
stuffiness.
 Treatment
c. Corticosteroids: Corticosteroids may
lessen allergic reaction by preventing body
cells from responding to inflammatory
mediators (histamine).
Nasal corticosteroids: Nasal steroid
sprays are highly efficacious in treating
allergic rhinitis. They are safe to use and not
associated with significant systemic adverse
effects in adults.
 Treatment
. Immunotherapy
In the past, Immunotherapy (or
allergy shots) is used in cases
whose symptoms are not well
controlled with avoidance measures
and pharmacotherapy.
But nowadays, it can be used as
first-line treatment.
 Treatment
• Immunotherapy
✔ allergen is given in gradually increasing
doses till the maintenance dose is reached
✔ suppresses the formation of IgE
✔ long time
 Prevention
• Confine your pet to a particular area of
your home
• Avoiding outside activity during pollen
season
• Check the material of your home supplies
• Avoid dust and mold
• Exercise regularly
 Review
• What are the typical symptoms of AR?
nasal obstruction, watery discharge, sneezing,
itching

• How to diagnosis the disease of AR?

history+ lab examination

• How to cure the disease of AR?

avoid allergen, drugs, immunotherapy
Thanks