Allergic Rhinitis and Sinusitis
1. RHINITIS:
- Occurs most commonly as allergic rhinitis.
- Allergic and non-allergic rhinitis is classified as Noninfectious rhinitis.
- Allergic rhinitis is define as immunologic nasal response, primary mediated by immunoglobulin E (IgE)
- Non-allergic rhinitis is defined as rhinitis symptoms in the absence of identifiable allergy, structure abnormality or sinus disease.
- Defined as an inflammation of the nasal mucous, caused by an allerge
ETIOLOGY
- Classified as:
- precipitating factors
- predisposing factors
PRECIPITATING FACTORS
- Allergens present in the environment
- House dust and dust mites
- Feathers
- Tobacco smoke
- Industrial chemicals
- Animal waste
- Disturbances in normal nasal cycle
- Puberty
- Pregnant states and postpartum stages
- Menopausal
- 50% of allergic rhinitis patients have a positive family history of allergic rhinitis
- Psychological: Focal sensitivity states
- Infection: fungal infections
- Age and sex
- IgA deificiency
COMMON ALLERGEN
- Pollens
- spring tree pollen's (maple alder,birch)
- Summer : grass pollent (bluegrass,sheep, shorell etc)
- Autumn: weed pollent(ragweed)
- Insects
- Cockroaches,house,files,fleas,bed bugs,
- Animals
- Cats,Dogs,Horse, monkeys,Rats,Rabbits etc
- Dust mite
- Dermatophagoides,Ingestants,nuts,fish,eggs,milk etc
PATHOPHYSIOLOGY
- Immunoglobulin (Ig) E mediated type 1 hypersensitivity response to an antigen ( allergen) in a genetically susceptible person.
- Type 1 Hypersensitivity causes local vasodilatioon and increase capillary permeability.
CLASSIFICATION
- Intermittent
- Symptoms present less than 4 days per week and less than 4 weeks per year
- Persistent
- Symptoms present more than 4 days per week and more than 4 weeks per year
COMPLICATIONS
- Allergic asthma
- Chronic otitis media
- Hearing loss
- Chronic nasal obstruction
- Sinusitis
- Orthodontic malocclusion in children
SIGN AND SYMPTOMS
- Sneezing
- Rhinorrhoea
- Headache
- Tearing of eyes
- Swollen eyes
- Drowsiness
- Itchy nose, ears, eyes and palate
- Post nasal drip
- Read eyes
- Anosmia
- Fatigue
- Malaise
PHYSICAL EXAMINATION
- Nasal crease
- Horizontal crease across the lower half of the bridge of the nose
- Rhinorrhoea
- Thin watery secretions
- Deviated or perforated nasal septum
EXTRA NASAL MANIFESTATIONS
- Retraced and abnormal flexibility of TM
- Inflammation and swelling of the papebral conjunctiva with excess tearing
- Cobblestone appearance on oropharynx
CLASSICAL SIGNS
![](https://images-prod.healthline.com/hlcmsresource/images/topic_centers/What_are_the_Symptoms_of_Hay_Fever-_732x549-thumbnail.jpg)
![](https://entkent.com/images/orbital-cellulitisc200pxw.jpg)
- Over bite
- High arched palate
- Allergic shiners
- Allergic salute
- Transverse crease over tip of nose and lower eye lid
- Conjunctiva congestion
- Periorbital oedema
INVESTIGATION
- History
- Histamine test
- Nasal smear
- Intranasal provocation test
- Skin tests
- Nasal cytology
- RAST ( radio allergo sorbant test)
- FAST ( fluro allergo sorbant test)
- PRIST( paper immuno allergo sorbant test)
- Xray PNS
- CT PNS (for complicated cases with polyposis)
- Nasal endoscopy ( under local or GA)
- Evaluate for asthma
MANAGEMENT
- AVOIDANCE
- Minimize contact with offending allergens
- Reduce dust mite exposure by encasing bed
- Pillows and mattresses in allergen proof covering
- Use of allergen proof bedding
ACUTE PHASE MEDICATIONS
- Antihistamines
- Decongestants
- Anticholinergenic agents
- Inhibit mucous secretions,act as drying agent
- Topical eye preparations
- Reduce inflammation and relieve itching and burning
- Oral mast cell stabilizer
- Intranasal corticosteroids
- Leukotriene receptor antagonists
- Montelukast and Zafirlukast
SURGICAL THERAPY
- Submucosal turbinectomy- reduces size of boggy turbinates
- Septoplasty- correction of deviation of the septum
- Sinus surgery- Clearance of simuses if sinusitis is present
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