Allergic rhinitis is an IgE-mediated immunologic response in the nasal mucosa triggered by airborne allergens. It can be seasonal, caused by pollen grains, or perennial, caused by indoor allergens like dust mites. Symptoms include sneezing, nasal obstruction, rhinorrhea, and itching. Diagnosis involves patient history, physical exam showing signs like nasal crease or swollen turbinates, and allergy tests. Treatment includes avoidance of triggers, antihistamines to reduce symptoms, nasal steroids to reduce inflammation, and immunotherapy for long-term management.

1. ALLERGIC
RHINITIS

2. ALLERGIC RHINITIS
• IgE – mediated immunologic response to nasal mucosa to air-borne
allergens.

3. Allergic
rhinitis
seasonal
perennial
Symptoms appear in or around a
particular season.
Pollen grains
Symptoms are present
throughout the year
dust mites,insect
parts,cockroaches,animal
danders

4. AETIOLOGY :
• Inhalant allergens –
• Seasonal
• perennial
• Genetic predisposition

5. pathogenesis
In a genetically predisposed individual
Inhaled allergen
IgE production
IgE binds to basophils & mast cells by its Fc end
On subsequent exposure allergen binds to Fab fragment
Degranulation
Chemical mediators (preformed & newly synthesized)

7. Sensitized
Mast cell
Antigen
Release of mediators
Performed
• Histamine
• ECF –A
• NCF –A
• Heparin
•Others
Newly synthesized
• Prostaglandins e.g. PGD2
• Leukotrienes e.g. SRS-A
• PAG
• ThromboxaneA
• TNFa

8. CHEMICAL MEDIATORS
SYMPTOMATOLOGY
• VASODILATION
• MUCOSAL EDEMA
• INFILTRATION WITH E.PHILS
• EXCESSIVE SECRETION
• SMOOTH MUSCLE CONTRACTION

9. 2 PHASES OF ALLERGIC IMMUNE RESPONSE
Acute or early phase
• Within 5-30 min,
• Due to release of vasoactive amines like histamine
• sneezing, rhinorrhea nasal blockage and/or bronchospasm.
Late or delayed phase
• : 2-8 hours after exposure to allergen without additional exposure.
• Due to infiltration of inflammatory cells at the site of antigen deposition ( E
phils, N phils, B phil, monocytes and CD4+ T cells)
• swelling.,congestion, thick secretion

10. Clinical features
• No age or sex predilection
• Symptoms of seasonal nasal allergy.
• Paroxysmal sneezing (10-20 sneezes at a time),
• nasal obstruction,
• watery nasal discharge and
• itching in the nose.
• Symptoms of perennial allergy.
• Frequent colds,
• persistently stuffy nose,
• loss of sense of smell due to mucosal oedema,
• postnasal drip,
• chronic cough.
• Itching in the nose, eyes, pharynx or larynx.

11. Signs

12. Nasal signs :
• Transverse nasal crease
• Black line in dorsum of nose due to constant upward rubbing
of nose (Allergic salute )
• Pale and oedematous nasal mucosa
• Swollen turbinates
• Thin, watery or mucoid discharge

13. • Ocular signs
• edema of lids
• Congestion
• Cobble stone appearance of conjunctiva
• Dark circles under eyes (allergic shiners)

14. • Otologic signs
E tube blockage
↓
Retracted T M
&
Serous otitis medis

15. • Pharyngeal signs
Hyperplasia of submucosal lymphoid tissue
↓
Granular pharyngitis

16. • Mouth breathing
• Ortho dontic changes

17. • Laryngeal signs
• Hoarseness of voice
• Edema of vocal cords

18. Diagnosis :
• Detailed history and physical examination.

19. Investigations :
1. Total and differential count.
• Peripheral eosinophilia.
2. Nasal smear
• large number of eosinophils.
• Also seen in NARES
3. Skin tests.
• Prick, scratch and intradermal tests.
4. Radioallergosorbent test (RAST).
• Measures specific IgE antibody concentration in the
patient’s serum.
5. Nasal provocation test.

21. Complications :
1. Obstruction of sinus ostia Recurrent sinusitis.
2. Nasal polyp
3. Blocking of E tube  Serous otitis media
4. Bronchial asthma.
5. Mouth breathing  orthodontic changes

22. Treatment :
1. Avoidance of allergen.
2. Treatment with drugs.
a. Antihistaminics
• Decrease rhinorrhea ,sneezing ,nasal itch
• A/E :drowsiness
b. Sympathomimetics
a. topically / orally
b. Oral pseudoephedrine & phenylephrine in combn with antihistamines
c. Cause vasoconstriction  ↓ nasal congestion & edema
d. CNS activation  ↓dowsiness due to antihistamines
e. Topical aerosols } phenylephrine , xylometazoline & oxymetazoline
a. ↓ nasal obstruction
b. A/E rebound congestion  RHINITIS MEDICAMENTOSA
c. Corticosteorids
• Oral corticosteorids
• acute episodes not relieved by other drugs
• Topical steroids } aerosols }beclomethasone budesonide, flunisolide , fluticasone
• Inhibit recruitment of inflammatory cells  trt of late allergic phase
• Trt of RHINITIS MEDICAMENTOSA

23. a) Sodium chromoglycate
• Stabilizes the mast cells & prevents degraulation.
• 2% solution for nasal drops or spray or as an aerosol powder
• anticholinergics  ↓rhinorrhea
• Ipratropium bromide
• Trt of allergic & nonallergic
• leukotriene receptor antagonist
• monteleukast
• anti ig E  ↓igE
• omalizumab
3. Immunotherapy
• Allergen is given in gradually increasing doses till the
maintenance dose is reached.
• ↓ formation of IgE & ↑ IgG
• Upto 3 years