ALLERGIC RHINITIS
This is a disorder in which there are episodes of nasal congestion, watery nasal discharge and sneezing
It may be seasonal or perennial
Aetiology
Allergic rhinitis is due to an immediate hypersensitivity reaction in the nasal mucosa. Seasonal antigens include pollens from grasses, flowers, weeds or trees. Grass pollen is responsible for hay fever, the most common type of seasonal allergic rhinitis in northern Europe, which is at its peak between May and July. Allergic rhinitis due to pollens is, however, a world-wide problem which may be aggravated during harvest seasons.Perennial allergic rhinitis may be a specific reaction to antigens derived from house dust, fungal spores or animal dander but similar symptoms can be caused by physical or chemical irritants-for example, pungent odours or fumes, including strong perfumes, cold air and dry atmospheres. The term 'vasomotor rhinitis' is often used because in this context the term b is a misnomer
Signs and Symptoms
History
Signs and symptoms of allergic rhinitis include the following
Sneezing
Itching: Nose, eyes, ears, palate
Rhinorrhea
Postnasal drip
Congestion
Anosmia
Headache
Earache
Tearing
Red eyes
Eye swelling
Fatigue
Drowsiness
Malaise
Diagnosis
Laboratory tests used in the diagnosis of allergic rhinitis include the following
Allergy skin tests (immediate hypersensitivity testing): An in vivo method of determining immediate (IgE-mediated) hypersensitivity to specific allergens
Fluorescence enzyme immunoassay (FEIA): Indirectly measures the quantity of immunoglobulin E (IgE) serving as an antibody to a particular antigen
Total serum IgE: Neither sensitive nor specific for allergic rhinitis, but the results can be helpful in some cases when combined with other factors
Total blood eosinophil count: Neither sensitive nor specific for the diagnosis, but, as with total serum IgE, can sometimes be helpful when combined with other factors
Imaging studies used in the diagnosis and evaluation of allergic rhinitis include the following
Radiography: Can be helpful for evaluating possible structural abnormalities or to help detect complications or comorbid conditions, such as sinusitis or adenoid hypertrophy
Computed tomography scanning: Can be very helpful for evaluating acute or chronic sinusitis
Magnetic resonance imaging: Also can be helpful for evaluating sinusitis
Management
The following symptomatic measures, singly or in combination, are usually effective in both seasonal and perennial allergic rhinitis
antihistamine drug such as loratadine 10 mg daily by mouthsodium cromoglicate nasal spray, one metered dose of a 2% solution into each nostril 4-6-hourly
beclometasone dipropionate or budesonide aqueous nasal spray, one or two doses of 50 μg into each nostril 12-hourly
In patients whose symptoms are very severe and seriously interfere with school, business or social activities, systemic corticosteroids are occasionally indicated, but side-effects limit their usefulness
Vasomotor rhinitis is often difficult to treat, but may respond to ipratropium bromide, administered into each nostril 6-8-hourly
DR:Khalid Alshameri
Davidson's clinical medicin.
Medical Wikipedia.
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