Clinical features and investigations of allergic rhinitis

a ppt only on investigations available for allergic rhinitis. Undergraduate level. first used in 2009

1. Clinical Features and Clinical Features and
Investigations of Allergic Investigations of Allergic
RhinitisRhinitis
--
Malarvizhi.RMalarvizhi.R

2. Allergic RhinitisAllergic Rhinitis

DefinitionDefinition

An IgE mediated Type 1 hypersensitivity rxn of An IgE mediated Type 1 hypersensitivity rxn of
mucous membrane of nasal airway asso with mucous membrane of nasal airway asso with
symptoms of nasal itch, congestion, watery symptoms of nasal itch, congestion, watery
rhinorrhoea and sneezing.rhinorrhoea and sneezing.

May affect PNS mucosal continuityMay affect PNS mucosal continuity

May also b asso with allergic conjunctivitis & May also b asso with allergic conjunctivitis &
bronchial asthmabronchial asthma

3. 
EtioEtio

As name implies As name implies ALLERGENSALLERGENS

PathologyPathology

The role of chemical mediators of inflammation The role of chemical mediators of inflammation

Allergic rhinitis can be seasonal or perennialAllergic rhinitis can be seasonal or perennial

4. Clinical FeaturesClinical Features

SymptomsSymptoms

Seasonal vs PerennialSeasonal vs Perennial

Signs Signs

5. SymptomatologySymptomatology

SeasonalSeasonal

SneezingSneezing

Watery RhinorrhoeaWatery Rhinorrhoea

Nasal obstructionNasal obstruction

Itching of eyes & noseItching of eyes & nose

Itching of throat Itching of throat

PerennialPerennial

Viscous purulent Viscous purulent
rhinorrhoearhinorrhoea

Loss of smell & tasteLoss of smell & taste

Symptoms of asso Symptoms of asso
sinusitissinusitis

Symptoms of Eustachian Symptoms of Eustachian
tube dysfunctiontube dysfunction

Sneezing & itching are Sneezing & itching are
less commonless common

7. 
Remember :Remember :

C R I S TC R I S T

CCongestion - Nasal & sinus ongestion - Nasal & sinus

RRhinorrhea hinorrhea

IItchy and Watering Eyes tchy and Watering Eyes

SSneezing, neezing,

Throat -ScratchyThroat -Scratchy

8. SignsSigns

Crease on tip of nose with crusting – Darrier’s lineCrease on tip of nose with crusting – Darrier’s line

Periorbital puffinessPeriorbital puffiness

Dark circles around eye- allergic shinersDark circles around eye- allergic shiners

Creases in lower eyelids due to spasm of Muller’s muscle- Creases in lower eyelids due to spasm of Muller’s muscle-
Dennis Morgan linesDennis Morgan lines

Conjuctival congestionConjuctival congestion

EpiphoraEpiphora

Allergic salute- child pushes tip of nose up with base of palm Allergic salute- child pushes tip of nose up with base of palm
as an attempt to control itchingas an attempt to control itching

Allergic Gape- mouth breathing from nasal Allergic Gape- mouth breathing from nasal
obstructionobstruction

11. O/EO/E

Anterior rhinoscopyAnterior rhinoscopy

Asymptomatic - normal mucosaAsymptomatic - normal mucosa

Active stage – PALE , boggy, edematous Active stage – PALE , boggy, edematous
nasal mucosa with watery dischargenasal mucosa with watery discharge

Bulky inferior & middle turbinates- Bulky inferior & middle turbinates-
mulberry shapedmulberry shaped

Smtimes polyps Smtimes polyps
may b seenmay b seen

12. O/EO/E

Posterior rhinoscopyPosterior rhinoscopy

Post nasal dripPost nasal drip

13. InvestigationsInvestigations

HisoryHisory

Nasal smears – eosinophiliaNasal smears – eosinophilia

Blood eosinophiliaBlood eosinophilia

Skin testsSkin tests

RASTRAST

PRISTPRIST

Nasal provocative testsNasal provocative tests

X ray nose & PNSX ray nose & PNS

14. 
Skin tests – intro Ag into skin & checkin site after Skin tests – intro Ag into skin & checkin site after
10-15 min for an immediate local allergic rxn – 10-15 min for an immediate local allergic rxn –
erythema & oedema erythema & oedema

Prick test- subcuticular; outer layer; 14ºPrick test- subcuticular; outer layer; 14º

Scratch test- scratch with dropScratch test- scratch with drop

Intradermal test- dermis Intradermal test- dermis

Positive skin tests only give a guide to degree of atopy Positive skin tests only give a guide to degree of atopy
& not implies nasal allergy to same allergen& not implies nasal allergy to same allergen

16. RASTRAST

Radio Allergo Sorbent Test (RAST)Radio Allergo Sorbent Test (RAST)

11
stst
test for IgE detection test for IgE detection

ProcedureProcedure

Specific allergen bound to paper discSpecific allergen bound to paper disc

Test serum added to it & incubatedTest serum added to it & incubated

Specific IgE Ab , if present in serum will bind to allergens Specific IgE Ab , if present in serum will bind to allergens
& form complexes.& form complexes.

Radioisotope labeled anti-IgE Ab then introduced to Radioisotope labeled anti-IgE Ab then introduced to
medium which binds to pre-existing complexes on paper medium which binds to pre-existing complexes on paper
disc.disc.

17. 
Resultant “ allergen-IgE –anti-IgE” then Resultant “ allergen-IgE –anti-IgE” then
measured in a measured in a γγ counter & the amt of Ab counter & the amt of Ab
calculated.calculated.

Test may giv false positive of false negative Test may giv false positive of false negative
results.results.

Simpler tests – ELISA or Passive Simpler tests – ELISA or Passive
Agglutination testAgglutination test

18. 
ScaleScale

The RAST test is scored on a scale from 0 to 6:The RAST test is scored on a scale from 0 to 6:

RAST rating IgE level (KU/L) commentRAST rating IgE level (KU/L) comment

0< 0.35 ABSENT OR UNDETECTABLE ALLERGEN SPECIFIC IgE0< 0.35 ABSENT OR UNDETECTABLE ALLERGEN SPECIFIC IgE

0.35 - 0.69 LOW OF ALLERGEN SPECIFIC IgE0.35 - 0.69 LOW OF ALLERGEN SPECIFIC IgE

0.70 - 3.49 MODERATE LEVEL OF ALLERGEN SPECIFIC IgE0.70 - 3.49 MODERATE LEVEL OF ALLERGEN SPECIFIC IgE

3.50 - 17.49 HIGH LEVEL OF ALLERGEN SPECIFIC IgE3.50 - 17.49 HIGH LEVEL OF ALLERGEN SPECIFIC IgE

17.50 - 49.99 VERY HIGH LEVEL OF ALLERGEN SPECIFIC IgE17.50 - 49.99 VERY HIGH LEVEL OF ALLERGEN SPECIFIC IgE

55.00 - 100.00 VERY HIGH LEVEL OF ALLERGEN SPECIFIC IgE55.00 - 100.00 VERY HIGH LEVEL OF ALLERGEN SPECIFIC IgE

> 100.00 EXTREMELY HIGH LEVEL OF ALLERGEN SPECIFIC> 100.00 EXTREMELY HIGH LEVEL OF ALLERGEN SPECIFIC

19. PRISTPRIST

Paper Radio Immunosorbent TestPaper Radio Immunosorbent Test

PrinciplePrinciple

incubating the IgE containg serum with incubating the IgE containg serum with
radioactively labeled anti-IgE radioactively labeled anti-IgE

Total conc of IgE is then proportional to measured Total conc of IgE is then proportional to measured
radioactivityradioactivity

20. Nasal challenge testsNasal challenge tests

Also known as Nasal provocative testAlso known as Nasal provocative test

Sniff suspected allergen and the no. & severity of Sniff suspected allergen and the no. & severity of
symptoms noted.symptoms noted.

21. X-RAYX-RAY

Low density haziness seen in PNS Low density haziness seen in PNS

Occasionally polypsOccasionally polyps

22. Thank you