Allergic Rhinitis
Lizi Qiu
E.N.T department
The second affiliated hospital
Guangzhou Medical College
Background
? Rhinitis is defined as inflammation of
the nasal membranes and is
characterized by a symptom complex
that consists of any combination of the
following,sneezing,nasal congestion,
nasal itching,and rhinorrhea,Allergic
rhinitis is the most common cause of
rhinitis,
Background
? Total cost $5.3 billion per year,(in
America)
? Morbidity 10%-40% ( in China)
? Classification
Perennial allergic rhinitis
Seasonal allergic rhinitis (pollinosis)
Pathophysiology
? Allergic reaction is an exaggerated or
inappropriate immune reaction and
causes damage to the host
? Type I immediate hypersensitivity
reaction
mediated by IgE antibodies,
which trigger the mast cells and
basophils to release pharmacologically
active agents,
CLINICAL
? History,Obtaining a detailed history is
important in the evaluation of allergic rhinitis.
Allergy history
environmental exposures
occupational exposures
effects on quality of life
Family history
? Past medical history
CLINICAL
? Signs and Symptoms of Allergic Rhinitis
Sneezing
Itching (nose,eyes,ears,palate)
Rhinorrhea（ watery secretions)
Congestion
Hyposmia （嗅觉下降）
CLINICAL
? "Allergic shiners"
? "Nasal crease"
(allergic salute).
? Nasal
examination,swol
len (boggy),pale,
blue-gray mucosa
Lab Studies
? Total serum IgE
? Finding allergen
Common allergen,page 58
Perennial,house dust,mite,fungus,pollen
chemical material
Seasonal,pollen ( sunflower,corn,glass )
Lab Studies
Finding allergen
a,Skin testing,prick test
（点刺试验）
intracutaneous test
（皮内试验）
b,Nasal allergen challenge test
c,Serum special IgE determination
Diagnosis
?history
?Clinical manifestation
?Allergy diagnosis
Differential Diagnosis
? Nonallergic rhinitis with eosinophilia
嗜酸粒细胞增多性非变应性鼻炎
? Vasomotor rhinitis
血管运动性鼻炎
Complication
? Allergic sinusitis
过敏性鼻窦炎
? Asthma
哮喘
? Secretory otitis media
分泌性中耳炎
Treatment
? Medical Care
(1) Avoidance
Environmental controls and
allergen avoidance
(2) Pharmacotherapy
(3) Immunotherapy
Treatment
? (2) Pharmacotherapy
a,Steroid,topical— nasal steroid sprays
general
b.Antihistamines,H1-receptor antagonist
First-generation,toldrin (drowsiness )
Second-generation:clarity (don’t cross the
blood- brain barrier)
c.Mast cell stabilizing drug:disodium cromoglycate
d,Decongestants
Treatment
? (3) Immunotherapy
Exact mechanism unknown
Decrease allergen-specific IgE levels
Increase allergen-specific IgG levels
IgG molecules ( blocking antibodies
that are important in impeding the
allergic reaction,)
Treatment
? (3) Immunotherapy
method,increasing doses of injected allergen
until the maximum tolerated dose is
reached
maintenance dose(maximum tolerated dose )
course,2 years or more
Treatment
? Surgical Care,Surgical care is not
indicated for allergic rhinitis but may be
indicated for comorbid or complicating
conditions.
Patient Education
? Educate patients on environmental
control measures,which involve both
the avoidance of known allergens
(substances to which the patient has
IgE-mediated hypersensitivity) and the
avoidance of nonspecific,or irritant,
triggers
References
? Blaiss MS,Quality of life in allergic rhinitis,Ann Allergy Asthma
Immunol 1999 Nov; 83(5),449-54[Medline],
? Corren J,Allergic rhinitis,treating the adult,J Allergy Clin
Immunol 2000 Jun; 105(6 Pt 2),S610-5[Medline],
?, Hussain I,Kline JN,DNA,the immune system,and atopic
disease,J Investig Dermatol Symp Proc 2004 Jan; 9(1),23-
8[Medline],
? Platts-Mills TA,Vaughan JW,Carter MC,Woodfolk JA,The role
of intervention in established allergy,avoidance of indoor
allergens in the treatment of chronic allergic disease,J Allergy
Clin Immunol 2000 Nov; 106(5),787-804[Medline],
? Skoner DP,Complications of allergic rhinitis,J Allergy Clin
Immunol 2000 Jun; 105(6 Pt 2),S605-9[Medline],
Question
? What are the major symptoms of allergic
rhinitis?
? The main complications of allergic rhinitis are:
? The indication of the immunotherapy?(p60)
Lizi Qiu
E.N.T department
The second affiliated hospital
Guangzhou Medical College
Background
? Rhinitis is defined as inflammation of
the nasal membranes and is
characterized by a symptom complex
that consists of any combination of the
following,sneezing,nasal congestion,
nasal itching,and rhinorrhea,Allergic
rhinitis is the most common cause of
rhinitis,
Background
? Total cost $5.3 billion per year,(in
America)
? Morbidity 10%-40% ( in China)
? Classification
Perennial allergic rhinitis
Seasonal allergic rhinitis (pollinosis)
Pathophysiology
? Allergic reaction is an exaggerated or
inappropriate immune reaction and
causes damage to the host
? Type I immediate hypersensitivity
reaction
mediated by IgE antibodies,
which trigger the mast cells and
basophils to release pharmacologically
active agents,
CLINICAL
? History,Obtaining a detailed history is
important in the evaluation of allergic rhinitis.
Allergy history
environmental exposures
occupational exposures
effects on quality of life
Family history
? Past medical history
CLINICAL
? Signs and Symptoms of Allergic Rhinitis
Sneezing
Itching (nose,eyes,ears,palate)
Rhinorrhea（ watery secretions)
Congestion
Hyposmia （嗅觉下降）
CLINICAL
? "Allergic shiners"
? "Nasal crease"
(allergic salute).
? Nasal
examination,swol
len (boggy),pale,
blue-gray mucosa
Lab Studies
? Total serum IgE
? Finding allergen
Common allergen,page 58
Perennial,house dust,mite,fungus,pollen
chemical material
Seasonal,pollen ( sunflower,corn,glass )
Lab Studies
Finding allergen
a,Skin testing,prick test
（点刺试验）
intracutaneous test
（皮内试验）
b,Nasal allergen challenge test
c,Serum special IgE determination
Diagnosis
?history
?Clinical manifestation
?Allergy diagnosis
Differential Diagnosis
? Nonallergic rhinitis with eosinophilia
嗜酸粒细胞增多性非变应性鼻炎
? Vasomotor rhinitis
血管运动性鼻炎
Complication
? Allergic sinusitis
过敏性鼻窦炎
? Asthma
哮喘
? Secretory otitis media
分泌性中耳炎
Treatment
? Medical Care
(1) Avoidance
Environmental controls and
allergen avoidance
(2) Pharmacotherapy
(3) Immunotherapy
Treatment
? (2) Pharmacotherapy
a,Steroid,topical— nasal steroid sprays
general
b.Antihistamines,H1-receptor antagonist
First-generation,toldrin (drowsiness )
Second-generation:clarity (don’t cross the
blood- brain barrier)
c.Mast cell stabilizing drug:disodium cromoglycate
d,Decongestants
Treatment
? (3) Immunotherapy
Exact mechanism unknown
Decrease allergen-specific IgE levels
Increase allergen-specific IgG levels
IgG molecules ( blocking antibodies
that are important in impeding the
allergic reaction,)
Treatment
? (3) Immunotherapy
method,increasing doses of injected allergen
until the maximum tolerated dose is
reached
maintenance dose(maximum tolerated dose )
course,2 years or more
Treatment
? Surgical Care,Surgical care is not
indicated for allergic rhinitis but may be
indicated for comorbid or complicating
conditions.
Patient Education
? Educate patients on environmental
control measures,which involve both
the avoidance of known allergens
(substances to which the patient has
IgE-mediated hypersensitivity) and the
avoidance of nonspecific,or irritant,
triggers
References
? Blaiss MS,Quality of life in allergic rhinitis,Ann Allergy Asthma
Immunol 1999 Nov; 83(5),449-54[Medline],
? Corren J,Allergic rhinitis,treating the adult,J Allergy Clin
Immunol 2000 Jun; 105(6 Pt 2),S610-5[Medline],
?, Hussain I,Kline JN,DNA,the immune system,and atopic
disease,J Investig Dermatol Symp Proc 2004 Jan; 9(1),23-
8[Medline],
? Platts-Mills TA,Vaughan JW,Carter MC,Woodfolk JA,The role
of intervention in established allergy,avoidance of indoor
allergens in the treatment of chronic allergic disease,J Allergy
Clin Immunol 2000 Nov; 106(5),787-804[Medline],
? Skoner DP,Complications of allergic rhinitis,J Allergy Clin
Immunol 2000 Jun; 105(6 Pt 2),S605-9[Medline],
Question
? What are the major symptoms of allergic
rhinitis?
? The main complications of allergic rhinitis are:
? The indication of the immunotherapy?(p60)
