Allergic

rhinitis
Nasal Allergy
Brig Anwar ul Haq

Nasal Allergy
IgE mediated immunological
response
Usually in response to Air born
allergens
Characteristics
Nasal obstruction
Nasal discharge
Sneezing
Itching

Types of Nasal Allergy

Seasonal
Particular
Allergy to specific pollen
Comes and goes with the
season

Perennial
Persists throughout the year

Etiology
Inhalants
Pollens
Grass
Trees

Mould spores
House dust
Debries
Inects
House Mite

Food
Rerely

Genetic Predisposition
Heredity --important role
One parent involvement
20%

Both parents
47%

Pathogens

Inhaled Allergen
Specific Antibodies
Antibody Fixed

Basophils - Fc End
Mast Cells - Fc End

Antigen - Antibody
Degranulation of Mast Cells
Release of Mediators
Presynthesized
Fresh Synthesis

Effects of Chemical
Mediators

Vasodilatation
Mucosal oedema
Eosinophil infiltration
Secretion of nasal glands
Smooth muscles contraction
Priming effects
Already sensitized - responds
to small doses

Primed to other non specific

Effects of chemical mediators

Acute or early phase

Late or delayed phase

Acute or Early Phase

5-30 min
Sneezing

Acute or Early Phase

5-30 min
Sneezing

Acute or Early Phase

5-30 min
Sneezing

Acute or Early Phase

5-30 min
Sneezing
Rhinorrhoea
Nasal blockage
Bronchospasm

Late or Delayed Phase

2-8 hours
Infiltration of
inflammatory cells Eosinophil
Charactristics
Swelling
Congestion

s
Neutrophil
s
Basophils
Monocytes
CD + T
Cells

Repeated / Continuous
Exposure
Acut
e
or
early
phas
e

Late
Or
Delaye
d
phase

sympto
ms
overlap

Symptoms
All ages (infant to older
people)
Usual onset (6-12 yrs)

Symptoms

- Seasonal Nasal Allergy

Paroxysmal sneezing (10-20)

Nasal Obstruction
Watery Nasal discharge
Itching
Nose
Eyes palate
Pharynx

Bronchospasm
Duration and severity
Varies with the season

Symptoms

- Perennial Nasal Allergy

Symptoms - usually not very severe

Frequent colds
Persistent stuffy nose
Loss of sense of smell
Mucosal oedema

Postnasal dripping
Chronic cough
Hearing impairment
Eustachian tube blockage
Middle ear Effusion

Signs of Nasal Allergy

Nose
Eyes
Ears
Pharynx
Larynx

Nasal Signs

Nasal rubbing
Allergic salute
Transverse nasal crease
Nasal mucosa

Pale
Oedematous
Bluish

Turbinates Swollen
Thin watery mucoid nasal
discharge

Ocular Symptoms
Oedema of lids
Congestion of conjuctiva
Cobble stone appearance

Dark circles

Otologic signs
Retracted tympanic
membranes
Serous Otitis Media
Glue ear
Eustachian tube Blockage

Pharyngeal Signs
Granular pharyngitis
Hyperplasia of lymphoid
tissue

Features of Nasal
Obstruction
Like adenoid hypertrophy

Laryngeal Signs
Hoarseness of voice
Oedema of Vocal Cords

Diagnosis
Detailed History
Usually sufficient

Physical Examination
Investigations

Investigations
TLC
Eosinophilia

Nasal Smear
Number of eosinophils
NARES - May be no Allergy
Non Allergic Rhinitis with
Eosinophilia Syndrome

Skin tests
To identify Specific Allergen

Investigations
RAST
Radiallergosorbant test
To measure specific
antibody concentration

Nasal provocation test

Allergen put in the nose

Complications
Recurrent Sinusitis- ostia
obstruction
Nasal polypi
Serous otitis media
Bronchial asthma

Treatment

Avoidance of allergens
one allergen

Most successful
Removal of pet
Removal of carpet
Change of work place
Change of job
Avoidance of food

Drugs
Immunotherapy

if only

Drugs
Antihistamines
Sympathmimetics
Systemic
Topical

Corticosteroids
Local
Systemic

Antihistamines
Control
Rhinorrhoea
Sneezing
Pruritis

Side effects
Drowsiness

Individualised
Dose
Type

Sympathomimetics

Constrict blood vessels

Reduce nasal congestion
Reduce mucosal oedema
CNS Stimulation
In combination of anti
histamines

Pseudoephedrine

Corticosteroids
Systemic
Prolonged Use
Effects

Side

Topical
Inhibit Recruitment of
Inflammatory Cells
Suppress Late Phase Reaction
Fewer Side Effects

Sodium Chromoglycate

Stabilizes Mast Cells

Prevents Degranulation
Despite Formation of IgEantibody Complex

2% Solution Drops /
Spray

Immunotherapy
If Drug Treatment Fails
Intolerable Side Effects
Suppresses Formation Of IgE
Antibodies
For 1-3 Years