Nasal Allergy

Brig Anwar ul Haq

Allergic rhinitis

Brig. Anwar ul Haq

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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

Aetiology• 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 allergens

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

Bronchospasm

Late or Delayed Phase

• 2-8 hours

• Infiltration of inflammatory cells

• Charactristics

–Swelling

–Congestion

–Thick secretions

EosinophilsNeutrophilsBasophilsMonocytesCD + T Cells

Repeated / Continuous Exposure

Late

Or

Delayed phase

Acute

or

early

phase

symptoms 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 - ostiaobstruction

• Nasal polypi

• Serous otitis media

• Orthodontic problems

• Bronchial asthma

Treatment• Avoidance of allergens – if only one allergen

–Most successful•Removal of pet

•Removal of carpet

•Change of work place

•Change of job

•Avoidance of food

• Drugs

• Immunotherapy

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

• Phenylpropanolamine

Corticosteroids

• Systemic

–Prolonged Use - Side Effects

• Topical

–Inhibit Recruitment of Inflammatory Cells

–Suppress Late Phase Reaction

–Fewer Side Effects

Sodium Chromoglycate

• Stabilizes Mast Cells

• Prevents Degranulation–Despite Formation of IgE-antibody Complex

• 2% Solution Drops / Spray

Immunotherapy

• If Drug Treatment Fails

• Intolerable Side Effects

• Suppresses Formation Of IgE Antibodies

• For 1-3 Years