Allergic rhinitis

Question 1

What % of the population of the UK have allergic rhinitis?

Answer 1

5.4%

Question 2

What are the risk factors for allergy and atopic disease?

Answer 2

Host factors are heredity (atopy), race, and age

Environmental factors are alterations in exposure to infectious diseases during early childhood, environmental pollution, allergen levels, and dietary changes etc

Occupational – flour, latex, wood dust, hand wash etc.

Question 3

Define allergy

Answer 3

Damaging immune response by the body to a substance, to which it has become hypersensitive.

Question 4

Give some examples of allergic reactions presenting in the skin

Answer 4

Urticaria / angioedema

Question 5

Give an example of a allergic reaction presenting in the the upper respiratory tract

Answer 5

Rhinitis

Question 6

Give an example of a allergic reaction presenting in the the lower respiratory tract

Answer 6

Asthma

Question 7

Give an example of a systemic allergic reaction

Answer 7

anaphylaxis

Question 8

Describe the symptoms of allergic rhinitis

Answer 8

o Immediate: sneezing, itch, nasal blockage, rhinorrhea (runny nose)

o Late: chronic obstruction, hyposmia (inability to smell), hyperreactivity

Question 9

What are the risk factors for allergic rhinitis?

Answer 9

Risk factors include atopy, family history, 1st born etc. Environmental factors are alterations in exposure to infectious diseases during early childhood, environmental pollution, allergen levels, and dietary changes

Question 10

Describe an allergen

Answer 10

• Allergen - antigen that causes allergic reactions.

* Usually proteins

Question 11

What type of reaction is an allergic reaction?

Answer 11

Type 1 / Immediate Hypersensitivity Reaction

Question 12

Describe the sensitisation stage of a type 1 hypersensitivity reaction

Answer 12

o Sensitization
• Plasma cells produce IgE
• Bind to mast cells

Question 13

What happens on re-exposure to an antigen?

Answer 13

Re-exposure
• Mast cells degranulate
• Release Histamine, Leukotrienes, Prostaglandins & chomotactic factors

Question 14

How is allergic rhinitis diagnosed?

Answer 14

• Skin prick test: responses to known allergens- high NPV, up to 15% false positives
• A radioallergosorbent test (RAST) - a blood test using radioimmunoassay test to detect and subsequently quantify specific IgE antibodies, to determine the substances a subject is allergic to.

o Total Serum IgE

o Nasal Allergen Challenge

o Nasal Cytology – detects cellular modifications in nasal epithelium in response to allergens

Question 15

How is allergic rhinitis treated?

Answer 15

Allergen avoidance- Education

Pharmacotherapy
o	Nasal saline
o	Topical Intranasal steroids
o	Systemic Steroids
o	Antihistamines
o	Sodium Cromoglycate – mast cell stabiliser
o	Allergen Immunotherapy - injection of small components of common allergens to try and induce tolerance in patients
o	Anti-IgE

Immunotherapy e.g. injection of small components of common allergens to try and induce tolerance in patients