Allergic Rhinitis Richard Douglas

Prevalence Most common disease 20% adult population

Diagnosis What’s the problem? nasal blockage clear rhinorrhoea sneezing itchy eyes

Diagnosis When during the year do you get these symptoms? perennial worse in springtime

Pathogenesis IgE mediated hypersensitivity to common aeroallergens Release of histamines, leukotrienes

More history Previous medications occasional antihistamine, Otrivine spray Past medical history mild asthma as child Drug allergies nil

Examination Headlight, Thuddicum’s speculum Nasendoscope Otoscope

Investigations Skin prick tests

Atopy Atopy is an inherited predisposition to produce IgE to environmental allergens

Non-atopics Atopics Allergic Rhinitis

Differential diagnosis Allergic rhinitis Non-allergic rhinitis with eosinophilia Vasomotor rhinitis

Treatment Drugs Allergen avoidance Immunotherapy Surgery

Drugs Antihistamines Intermittent symptoms Work quickly Expensive Intranasal steroids Constant symptoms Slow onset of action Inexpensive

Nasal Obstruction

Allergen avoidance Grass pollen difficult to avoid Best trial of dust mite avoidance shows no effect on allergic rhinitis

Immunotherapy Repeated exposure to high doses of allergen causes anergy Low dose to high dose Three year course Risk of anaphylaxis Highly effective when the allergen is known

What is the role of surgery? Highly effective Submucosal resection for good long term results