A Quick Tour Of

ALLERGIC RHINITIS

Manjul Dixit, M.D.

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

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

Clinical Manifestations

Nasal congestion

Postnasal drainage Nasal pruritus

Ear symptoms Watery rhinorrhea

Eye symptoms Repetitive sneezing

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

Types of Rhinitis

Conditions that mimic rhinitis

The Allergic Reaction

Moderate-severeone or more items

abnormal sleep

impairment of daily activities, sport, leisure

abnormal work and school

troublesome symptoms

Persistent • ≥ 4 days per week

• and ≥ 4 weeks

Mildnormal sleep

& no impairment of daily activities, sport, leisure

& normal work and school

& no troublesome symptoms

Intermittent• < 4 days per week

• or < 4 weeks

ARIA Classification

ARIA Report 2001

Diagnosis of AR

History

Physical / Nasal Examination

Laboratory Testing

- Skin Prick Test

- Peak Nasal Inspiratory Flow Rate

- Rhinomanometry

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

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

Management of AR

Allergen Avoidance

Pharmacotherapy

Immunotherapy

- Subcutaneous

- Sublingual

Pharmacotherapy

Actions of Various Nasal Preparations in

the Treatment of Rhinitis

Nasal

Preparation

Sneezing Itching Rhinorrhea Congestion

Antihistamines +++++ ++++ +++ 0

Anticholinergics 0 0 +++++ 0

Corticosteroids +++++ +++++ +++ +++

Decongestants 0 0 + +++++

Antileukotrienes +++ ++ 0 ++++

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

The “Ideal” Drugs Are……

“Corticosteroids are undoubtedly the

pharmacotherapeutic agents with the broadest

application for the treatment of many types of

rhinitis”

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

THANK YOU!!!!For more information please visit

http://athertonallergists.com/