1. دکتر افشین شیرکانی فوق تخصص آسم و آلرژی و بیماری های نقص ایمنی استادیار دانشگاه عضو آکادمی آسم و آلرژی و ایمونولوژی آمریکا

2.  Prevalence is 15%-25%. Uncommon in less than two years of age  Boys outnumber girls, but then there is no gender disparity by adulthood.  Mean age of onset is 10 years.  80% of cases develop before 20 years of age.  20% of AR is seasonal, 40% is perennial, and 40% is mixed  Increasing in prevalence as parallel with other atopic disease.

3.  industrialized countries  younger age groups  Maternal smooking

4.  Nasal congestion, headache, and post-nasal drip were rated the most bothersome symptoms  AR is the most common, chronic disease of childhood

6. 1.Immediate Allergic Response(Mast Cell): A.Histamin o Itch o Sneeze o Rhinorrhea o Nasal congestion B.PGD2 C.Leukotrienes D.Kinins: nasal congestion and/or blockage.

7. 2. Late Allergic Response A.Eosinophil B.Basophil C.Lymphocyte Th2 D.Nutrophil E.IL4,IL13  Predominant symptoms include nasal congestion and mucus production  80% of Asthma have AR and 40% of AR have asthma  FeNo increase in AR and allergic asthma and decrease in sinusitis

8.  Classically, symptoms of AR include: a.Rhinorrhea b.Nasal pruritus c.Nasal congestion d.Sneezing.

9.  Signs of AR include: a.Allergic shiners b.Allergic crease c.Dennie-Morgan lines (ie, linear creases or furrows underneath the lower eyelids) d.Pale nasal mucosa e.Turbinate hypertrophy f.Mouth breathing g.Cobblestoning of the oropharynx.  Allergic conjunctivitis, sinusitis, and asthma (present in up to 40% of patients with AR) are common comorbid conditions.

14.  Hx.  skin testing (prick or intradermal)  serum-specific IgE (RAST)

15.  Nasal antihistamines (nonsedating)  Antileukotriene therapy  Intranasal decongestants (short-term use only)  Oral decongestants or chromones  Immunotherapy Intranasal steroids are the most effective medication for AR and, therefore, are the medication treatment of choice

17.  NARES Eosinophilia on nasal smear(Rare in child)  Vasomotor: Irritant, gustatory, cold (Skier Nose),Light(Reflex rhinitis),Rx:Ipratropum  Medications : ASA, NSAID’s, topical decongestants, β blockers, other anti-hypertensives  Hormonal : OCPs, pregnancy, menstrual associations, hypothyroidism  Atrophic: Elderly or surgery  Infectious: Common cold viruses  Occupational : Flour (Baker), latex (health care workers), pet dander (animal handlers)  Miscellaneous :Anatomical, tumor, systemic disease, CSF rhinorrhea

18. No ninflammatory cause of the disease that is associated with the loss of the normal secretory function of the nose  Nasal congestion  Nasal pain upon inspiration from excess mucosal dryness  Nasal crusting  A foul smell in the nasal vault (ozena: Klebsiella Ozaenae) ) Treatment may include nasal saline irrigation and topical antibiotics

19. Rare in child  ASA and NSAIDs (as a feature of AERD)  β blockers,  Prolonged use of intranasal decongestants (rebound rhinitis)  ACE inhibitors  Oral contraceptive pills (OCPs)  Sildenafil  Cocaine Treatment:DC of drugs

20.  Approximately 60% of children with allergic rhinitis have symptoms of reactive airways disease/asthma  otitis media, sinusitis, tonsillar and adenoid hypertrophy  sleep disturbances, limitations of activity and school performance, irritability, and mood and cognitive disorders

21.  Seasonal allergic rhinitis:Outdoor Allergen(Trees,weeds,grasses,fungi)  Perennial allergic rhinitis:Indoor Allergen(Pets,dander:HEPA,mites,mold, coackroach)