Rhinitis.pptx

Define allergic rhinitis
Pathophysiology of allergic rhinitis
Signs/symptoms of allergic rhinitis
Diagnosis
Investigations
Complications
Treatment
Non allergic rhinitis
Pathogenesis
Signs/symptoms
Treatment
“It is an IgE-mediated immunologic response of nasal mucosa to airborne allergens and is characterized by watery
nasal discharge, nasal obstruction, sneezing and itching
in the nose. This may also be associated with symptoms
of itching in the eyes, palate and pharynx”
. Two clinical types have been recognized:
1. Seasonal. Symptoms appear in or around a particular
season when the pollens of a particular plant, to whic
the patient is sensitive, are present in the air.
2. Perennial. Symptoms are present throughout the year

1. Allergic/non allergic r h i n i t i s DR AWAIS IRSHAD

2. Learning objectives Define allergic rhinitis Pathophysiology of allergic rhinitis Signs/symptoms of allergic rhinitis Diagnosis Investigations Complications Treatment Non allergic rhinitis Pathogenesis Signs/symptoms Treatment

3. Allergic rhinitis “It is an IgE-mediated immunologic response of nasal mucosa to airborne allergens and is characterized by watery nasal discharge, nasal obstruction, sneezing and itching in the nose. This may also be associated with symptoms of itching in the eyes, palate and pharynx” . Two clinical types have been recognized: 1. Seasonal . Symptoms appear in or around a particular season when the pollens of a particular plant, to whic the patient is sensitive, are present in the air. 2. Perennial . Symptoms are present throughout the year

4. Etiology Inhalant Allergens . They may be seasonal or perennial. Seasonal allergens include pollens from trees, grasses and weeds. They vary geographically. The knowledge of pollen appearing in a particular area and the season in which they occur is important. Their knowledge also helps in skin tests. Perennial allergens are present throughout the year regardless of the season. They include molds, dust mites, cockroaches and dander from animals. Dust includes dust mite, insect parts, fibres and animal danders. Dust mites live on skin scales and other debris and are found in the beddings, mattresses, pillows, carpets and upholstery. Genetic Predisposition . Plays an important part. Chances of children developing allergy are 20 and 47%, respectively, if one or both parents suffer from allergic diath

5. Signs/symptoms Cardinal symptoms of seasonal nasal allergy include paroxysmal sneezing, 10–20 sneezes at a time, nasal obstruction, watery nasal discharge and itching in the nose. Itching may also involve eyes, palate or pharynx. Some may get bronchospasm. The duration and severity of symptoms may vary with the season. Symptoms of perennial allergy are not so severe as that of the seasonal type. They include frequent colds, persistently stuffy nose, loss of sense of smell due to mucosal oedema, postnasal drip, chronic cough and hearing impairment due to eustachian tube blockage or fluid in the middle ear.

6. S i g n s Nasal signs include transverse nasal crease—a black line across the middle of dorsum of nose due to constant upward rubbing of nose simulating a salute (allergic salute), pale and oedematous nasal mucosa which may appear bluish. Turbinates are swollen. Thin, watery or mucoid discharge is usually present. Ocular signs include oedema of lids, congestion and cobble-stone appearance of the conjunctiva, and dark circles under the eyes (allergic shiners). Otologic signs include retracted tympanic membrane or serous otitis media as a result of eustachian tube blockage.

7. Pharyngeal signs include granular pharyngitis due to hyperplasia of submucosal lymphoid tissue. A child with perennial allergic rhinitis may show all the features of prolonged mouth breathing as seen in adenoid hyperplasia. Laryngeal signs include hoarseness and oedema of the vocal cords.

8. •

9. Investigations Total and differential count Nasal smear Skin test A: Skin prick test B: specific IgE measurements 4.Radioallergosorbent test 5.Nasal provocation test

10. Complications Nasal allergy may cause: Recurrent sinusitis because of obstruction to the sinus ostia. Formation of nasal polyp in about 2%. Serous otitis media. Orthodontic problems and other ill-effects of prolonged mouth breathing especially in children. Bronchial asthma . Patients of nasal allergy have four times more risk of developing bronchial asthma. Twenty to thirty per cent of patients with rhinitis have asthma

11. Treatment Treatment can be divided into: • 1. Avoidance of allergen. • 2. Treatment with drugs. • 3. Immunotherapy

12. D r u gs Antihistamines Sympathomimetic drugs Corticosteroids Sodium chromoglycate Anticholinergics Leukotriene receptors antagonist Anti IgE

13. Non Allergic rhinitis VASOMOTOR RHINITIS (VMR) It is nonallergic rhinitis but clinically simulating nasal allergy with symptoms of nasal obstruction, rhinorrhoea and sneezing. One or the other of these symptoms may predominate. The condition usually persists throughout the year and all the tests of nasal allergy are negative .

14. PATHOGENESIS PATHOGENESIS Nasal mucosa has rich blood supply. Its vasculature is similar to the erectile tissue in having venous sinusoids or “lakes” which are surrounded by fibres of smooth muscle which act as sphincters and control the filling or emptying of these sinusoids. Sympathetic stimulation causes vasoconstriction and shrinkage of mucosa, while parasympathetic stimulation causes vasodilation and engorgement . Overactivity of parasympathetic system also causes excessive secretion from the nasal glands. Autonomic nervous system is under the control of hypothalamus and therefore emotions play a great role in vasomotor rhinitis. Autonomic system is unstable in cases of vasomotor rhinitis. Nasal mucosa is also hyper-reactive and responds to several nonspecific stimuli, e.g. change in temperature, humidity, blasts of air, small amounts of dust or smoke

15. SYMPTOMS 1. Paroxysmal sneezing . Bouts of sneezing start just after getting out of the bed in the morning. 2. Excessive rhinorrhoea . This accompanies sneezing or this may be the only predominant symptom. It is profuse and watery and may even wet several handkerchiefs. The nose may drip when the patient leans forward and this may need to be differentiated from CSF rhinorrhoea (see p. 183). 3. Nasal obstruction . This alternates from side to side. Usually more marked at night. It is the dependent side of nose which is often blocked when lying on one side. 4. Postnasal drip . SIGNS Nasal mucosa over the turbinates is generally congested and hypertrophic. In some, it may be normal

16. COMPLICATIONS • Long-standing cases or VMR develop nasal polypi, hypertrophic rhinitis and sinusitis

17. Other forms of non allergic rhinitis Drug induced rhinitis Rhinitis medicamentosa Rhinitis of pregnancy Honeymoon rhinitis Emotional rhinitis Rhinitis due to hypothyroidism Gustatory rhinitis Non airflow rhinitis

18. Treatment Medical Avoidance of physical factors which provoke symptoms, e.g. sudden change in temperature, humidity, blasts of air or dust. Antihistaminics and oral nasal decongestants are helpful in relieving nasal obstruction, sneezing and rhinorrhoea. Topical steroids (e.g. beclomethasone dipropionate, budesonide or fluticasone), used as spray or aerosol, are useful to control symptoms. Systemic steroids can be given for a short time in very severe cases. Psychological factors should be removed. Tranquillizer's may be needed in some patients

19. S u r g e r y 1. Nasal obstruction can be relieved by measures which reduce the size of nasal turbinates (see hypertrophic rhinitis). Other associated causes of nasal obstruction, e.g. polyp, deviated nasal septum, should also be corrected. 2. Excessive rhinorrhoea, not corrected by medical therapy and bothersome to the patient, can be relieved by sectioning the parasympathetic secretomotor fibres to nose (vidian neurectomy

20. Allergic vs non allergic rhinitis

21. CBL 10 THEME : ALLERGIC / NON ALLERGIC RHINITIS 10. 20 years old female presented to ENT OPD with the history of bouts of sneezing specially in the morning with watery nasal discharge , nasal congestion and teary eyes . What specific question you would ask in history to elicit the diagnosis? Give your differential diagnosis. Give management plan of most probable diagnosis. Differentiate between Allergic rhinitis, viral/bacterial and vasomotor 1. 2. 3. 4. r h i n i t i s . 5. 6. Discuss the complications associated with it. Write prescription for Allergic rhinitis