1. Allergic Rhinitis Richard Douglas

2. Prevalence Most common disease 20% adult population

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

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

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

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

7. Examination Headlight, Thuddicum’s speculum Nasendoscope Otoscope

8. Investigations Skin prick tests

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

10. Non-atopics Atopics Allergic Rhinitis

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

12. Treatment Drugs Allergen avoidance Immunotherapy Surgery

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

14. Nasal Obstruction

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

16. 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

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