ALLERGIC RHINITIS 3600.pptx

allergic rhinitis ent perspective

1. ALLERGIC RHINITIS 360

2. INTRODUCTION Allergic rhinitis is characterized by inflammatory changes in the nasal mucosa caused by exposure to inhaled allergens. It is a common disease, affecting between 0.8 and 39.7% of the world population There may be co-morbidities with other organs being involved, commonly the eyes causing allergic conjunctivitis and the lungs with allergic asthma These diseases are increasingly considered to be a single entity, with a spectrum of respiratory allergic response, termed the unified allergic airway .

3. DEFENITION Rhinitis is defined clinically as having two or more symptoms of anterior or posterior rhinorrhoea , sneezing, nasal blockage and/or itching of the nose during two or more consecutive days for more than one hour on most days. Allergic rhinitis is diagnosed when these symptoms are caused by allergen exposure leading to an IgE mediated reaction.

4. PATHOGENESIS

5. CLASSIFICATION

6. CLINICAL FEATURES

7. ALLERGIC SALUTE

8. SKIN PRICK TESTING

9. RADIOALLERGOSORBENT TEST

10. NASAL ALLERGEN CHALLENGE TEST

11. TREATMENT ASPECTS Methods of reducing allergen exposure Pharmacological treatment of allergic rhinitis Immunotherapy for allergic rhinitis Surgical treatment

12. METHODS TO REDUCE ALLERGEN EXPOSURE House dust mite allergen reduction aims to reduce the amount of mite allergens in the home: Wash bedding regularly (every 1–2 weeks) at 55 –60 °C to kill mites (washing with cold water removes 90% of mite allergens; washing at 55 –60 °C kills mites) Wash pillows and duvets in hot water (55 –60 °C) and encase pillows and mattresses with protective coverings that have a pore size of 6 μm or less Sufficient ventilation of dwellings to decrease humidity; aim to reduce indoor relative humidity to below 50% and avoid damp housing conditions.

13. PHARMACOTHERAPY OF ALLERGIC RHINITIS

14. ANTIHISTAMINES(H1 BLOCKER) Oral H 1 -antihistamines Second generation Acrivastine Azelastine Bilastine Cetirizine Desloratadine Ebastine Fexofenadine Levocetirizine Loratadine Mequitazine Mizolastine Rupatadine  

15. First generation Chlorphenyramine Clemastine Dimethindene maleate Hydroxyzine Ketotifen Oxatomine

16. TOXICITY AND SIDE EFFECTS Cardiotoxic * Astemizole Terfenadine Blockage of H 1  receptor Some antiallergic activity Old generation Sedation is common And/or anticholinergic effect

17. ADVANTAGES OF NEWER ANTI HISTAMINES New generation drugs can be used OD New generation oral H 1 -antihistamines should be preferred for their favorable efficacy/safety ratio and pharmacokinetics No development of tachyphylaxis No sedation for most drugs No anticholinergic effect No cardiotoxicity

18. Local H 1 -antihistamines (intranasal, intraocular) Azelastine Levocabastine Olapatadine

19. Leukotriene antagonists(Block CystLT ) Montelukast Pranlukast Zafirlukast

20. INTRANASAL GLUCOCORTICOIDS Potently reduce nasal inflammation Reduce nasal hyperreactivity Beclomethasone dipropionate Budesonide Ciclesonide Flunisolide Fluticasone propionate Fluticasone furoate Mometasone furoate Triamcinolone acetonide

21. BENEFITS The most effective pharmacologic treatment of allergic rhinitis Minor local side effects Wide margin for systemic side effects Effective on nasal congestion Effective on smell Effect observed after 12 h but maximal effect after a few days

22. IMMUNOTHERAPY

23. ANTI- IgE ANTIBODY (OMALIZUMAB) Omalizumab is a monoclonal antibody that binds to circulating IgE preventing it from binding to mast cells and causing degranulation . Omalizumab reduces all nasal symptoms and improves asthma control but has the risk of causing anaphylaxis and is expensive. It is administered by monthly injection. Currently it is recommended only for patients with severe allergic asthma with or without rhinitis symptoms.

24. Surgical Interventions-Indications drug-resistant inferior turbinate hypertrophy; anatomical variations of the septum with functional relevance; anatomical variations of the bony pyramid with functional/aesthetic relevance; secondary or independently developing chronic sinusitis different forms of nasal unilateral polyposis ( choanal polyp, solitary polyp and allergic fungal sinusitis) or therapy-resistant bilateral NP fungal sinus disease ( mycetoma , invasive forms) or other pathologies unrelated to allergy (cerebrospinal fluid leak, inverted papilloma , benign and malignant tumors, Wegener’s disease, etc.).

25. TURBINECTOMY

26. Vidian Neurectomy

27. Posterior Nasal Neurectomy

28. OTHER MANIFESTATIONS OF ALLERGY

29. ALLERGIC CONJUNCTIVITIS

30. ALLERGIC FUNGAL RHINOSINUSITIS

31. SINONASAL POLYPOSIS

32. ADENOID HYPERTROPHY

33. EUSTACHIAN TUBE DYSFUNCTION

34. OTITIS MEDIA WITH EFFUSION

35. CHRONIC COUGH

36. LARYNGITIS

37. GASTRIC ESOPHAGEAL REFLUX DISEASE

38. THANK YOU