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