ALLERGIC RHINITIS

RHINITIS Inflammation of the mucosal lining of the nose. ALLERGIC RHINITIS Hypersensitivity respons to allergens mediated by IgE antibodies Seasonal / Perennial NON -ALLERGIC RHINITIS Congenital etc………

EXAMINATION Obvious signs of allergic rhinitis ENT system Systemic (exclude other diseases)

Allergic Symptoms and Signs Nose –Itching –Allergic Salute and supratip crease associated with itching and rubbing –Facial grimace –Nasal obstruction due to mucosal oedema and excess mucus –Sneezing

-Watery rhinorrhoea might be seen -Mucosa is oedematous and has a blue-grey appearance -Swollen inferior turbinates often appear polypoid due to oedema -Nasal polyps Allergic Symptoms and Signs

TURBINATE: Tender, non mobile, lateral POLYP: Not tender, mobile, between septum and turbinate

Allergic Symptoms and Signs Mouth –Chronic mouth breathing due to nasal obstruction –Palatal itching –Nocturnal tooth grinding

Allergic Symptoms and Signs Pharynx –Dry, irritated, frequently sore throat due to allergen exposure, chronic mouth breathing or both –Repeated throat clearing –Lymphoid aggregates or patches on posterior pharyngeal wall

SPECIAL INVESTIGATIONS NASAL CHALLENGE TEST NASAL SMEARS PHADIOTOP IgE SKINPRICK TEST RAST RADIOLOGY

NASAL CHALLENGE TESTING A specific allergen is introduced into the nose to assess the changes -the organ directly affected by the allergy is tested instead of an indirect action tested during skin tests Rhinomanometry and acoustic rhinometry can be used for the challenge test Both methods yielded comparative results

NASAL SMEARS Excludes bacteria Exclude malignant cells Detect eosinophils (Normal in babies < 6/12)

PHADIOTOP TEST 1st line test Screening inhalant allergens 96% accurate

IgE Normal values in 20% of allergic people Race differences Increased in parasite infections What is the “increase” value?

SKIN PRICK TEST CI Kids <2yrs Old people Eczema Dermographia Discontinue antihistamine before test Method important Gives qualitative measure of allergy only Will miss low degree of allergy (false negatives) Grading of skin test is subjective

Specific IgE tested Inhalation & diet allergies tested Safe Not necessary to discontinue antihistamines before test Eczema not a contraindication Does not test colourants & preservatives EXPENSIVE RADIOALLERGOSORBENT TEST ( RAST TEST)

TREATMENT AVOIDANCE MEDICAL SURGICAL

ANTICHOLINERGICS DECONGESTANTS ANTIHISTAMINES CORTICOSTEROIDS DESENSITISATION MEDICAL TREATMENT

EMERGING ALLERGIES Nuts Ginseng caps Atjar Cockroaches Latex. Bananas, Avocado, Nuts, Kiwi fruit, Raw potatoes

EXOGENOUS 1.Seasonal 2.Climate 3.Humidity 4.Pollution 5.Medication 6.Food 7.Allergens 8.Noise 9.Aircon 10.Trauma

Perennial Inhalant Allergens Animal Danders –Cats Fel D1 antigen produced by sebaceous glands in skin Found on cat skin scales that are shed Particles remain airborne for long periods –Dogs Allergen not understood

Allergic Symptoms and Signs Larynx and lungs –Hoarseness –Asthma with cough, wheezing and expiratory slowing –Wet cough ( especially with mould allergy)

Allergic Symptoms and Signs Eyes –Allergic Shiners –Long, silky eyelashes –Dennie’s Lines – fine horizontal lines in lower lids –Conjunctivitis, burning, itching –Lymphoid aggregates on palpebral conjunctiva –Injection of bulbar conjunctiva

POLYPS =?Cystic fibrosis