Allergic Rhinitis: condition overview

Question 1

What is allergic Rhinitis

Answer 1

• systemic IgE antibody mediated, inflammatory response disease
• characterized by inflammation insida nose following allergen inhalation

Question 2

common allergens

Answer 2

• grass/tree pollen, mould, must mites/insects, animal dander

*body responds with a systemic IgT-Mediated Inflammatroy Disease Secondary to Allergen exposure

Question 3

how common is AR

who is it most common in

Answer 3

affects 10-40% common in chidlren and adults but prevalence is highest in school aged chilren and more common is history of asthma and atopic dermatitis

• assocaited with genetic predisposition; if 1 parant is affected, children have 30% change of devleoping it -> if both parents affected children have 50% chance

Question 4

what are the phases of the antigen-antibody mediated reaction

Answer 4

sensitization

immediate response

late phase reaction

Question 5

describe sensitizaiton

Answer 5

*first contact with allergen- allergen enters the nose and sensitizes nnucosal mast cells

• occurs via T-cell release of cytokines -> promote IgE production
• IgE binds to mast cells and absophils

Question 6

describe the immediate response phase of allergy

Answer 6

• occurs within minutes of re exposure to allergen
• lasts 30-90min
• allergen is bound to IgE and sensitized mast cells -> release of preformed mediators like histamine and newly generated oens leukotrienes, prostaglandin D2 and kinins
• mediators attract, recruit and activate other inflammatory mediations (esoinophils, neutrophils and T lymphocytes)
• this then initiates late phase response

Question 7

describe the late reaction to an allergen

Answer 7

• associated w/ chronic inflammation
• characterized by migreation of inflammatory cells, eosinophils, monocytes, macrophages and basophils
• symptoms begin 4-8h after allergen exposure
• peak 12-24 hours
• results in recurrent symptoms (often nasal congestion) that often persist

Question 8

what are the signs and symptoms of allergic rhinitis

Answer 8

• signs of nasal obstruction (congestion, sneezing, nasal itching and rhinorrhea)
• post nasal drainage, irritability and fatigue
• some get allergic conjunctivitis, bilateral ocular itching, redness, tearing and/or burning
• can also get facial pressure, itchy trhaot/palate, and ear fullness/popping

Question 9

symptoms during senzitiziton phase

Answer 9

patients are asymptomatic

Question 10

late phase usually has wht symptom

Answer 10

nasal congestion

Question 11

physial sigsn of allergic rhinitis

face

Answer 11

• • “allergic facies” higher arched palate, open mouth due to chronic mouth breathing, dental malocclusion
• frequent grimacing and twitching of face and especiall nose

*young children typically dont blow nose, so may freq rub nose, snort, sniff, cough etc

Question 12

physical signs of allergic rhinitis

eyes

Answer 12

• dennie morgan lines: accentuated lines or folds below to lwoer eyelids. can get mroe noticable with age
• allergic conjunctivites: ocular itching, burning tearing and conjunctival injection
• allergic shiners: infraorbital edema and darkening due to subcutaneous venodilation

*more severe the disease the more pronounced the discolouration udner the eyes

Question 13

physical signs fo allergic rhinitis

Nose

Answer 13

• allergic salute
• transverse nasal crease caused by repeating rubbing and wiping with of nose

0 nasal mucosal swelling, bleeding

• bluish or pale thin secretions
• nasal polyps or toher structural abnormalities (eg., septal deviation, nasal ulcerations) may be assessed via internal endoscopy

Question 14

physical sings of allergic Rhinitis

Posterior Oropharynx

Answer 14

aka area of throat that is at back of mouth

• Postnasal drip- if nasal pasaged are obstructed, rhinorrhea may be visible driping down posterior pharynx
• lymphoid hyperplasia: hyperplastic lymphoid tissues lines posterior pharynx which resembles cobblestones
• tonsilar hypertrophy: persistenly enlarged tonsils

Question 15

allergic rhinitis physical signs

sinuses

Answer 15

maxillary tooerh sensitivity

palpitation of sniuses for sensitivity

Question 16

allergic rihinits phyxical signs

chest and skin

Answer 16

wheezing (sign of concurrent asthma

atopic disease

Question 17

what cognitive and psychiatric issues are assocaited with AR

children

Answer 17

attention deficit hyperactivity disorder (ADHD)

lower exam scores during peak pollen seasons

poor concentration

impaired athletic performance

low self-esteem

Question 18

what cognitive and psychiatric issues are assocaited with AR

adults

Answer 18

Anxiety

Depression

Reduced academic performance

Reduced work productivity (lower than that of patients with asthma)

Impaired sexual performance

Lower quality of life scores

Question 19

how is allergic rhinitis classified

Answer 19

intermittent or persistent

and

mild or moderate/severe

Question 20

inetmittent vs persistent AR

Answer 20

intermittent: <4days/week or <4 consecutive weeks

Persistent: >4 days/week or > 4 consecutive weeks

Question 21

mild vs molderate/severe AR

Answer 21

• Mild
  
  • normal sleep
  • symp not bothersome
  • no impairemnt of daily activities
  • normal work/school
• Moderate/severe
  
  • Abnormal sleeo OR
  • bothersome symptoms OR
  • impairment of daily activities OR
  • Problems at work/school

Question 22

how are patients symptoms quantified

Answer 22

• use a visual analogue scale VAS
• point wehre on line you feel about a partiuclar characteristic

“Over the past 24 hours, how troublesome are your allergy symptoms on a scale from 0 to 10, with 0 is not troublesome at all and 10 is very troublesome”

• if less than 2 patient is said to ahve well controlled AR

2-5 partily controlled

5 indicated uncontrolled

Question 23

Risk factors of AR

Answer 23

Male gender

Birth during pollen season

Firstborn status

Being overweight

Maternal exposure to cigarette smoke in the baby’s first year of life

Exposure to indoor allergens, such as dust mite allergen

Serum IgE > 100 IU/mL before age 6

Presence of allergen-specific IgE

Question 24

Scholar for gathering info on AR

Answer 24

• Symptoms
  
  • main & associated symptoms: nasal pruritus, congestion, rhinorrhea, sneezing, eye involvement
• Characteristics
  
  • characteristics of allergic symptoms: frequency, severity: VAS score, QoL impact
• History
  
  • have they had AR before
• Onset
  
  • timing/patern/seasonality
  • not uncommon for patietns to attribute peristent nasla symp as “constant col”
• Location
  
  • symptoms affecting eyes, nose or palate
• aggravating factors
  
  • what triggers it
• Remitting
  
  • therapies they trie,d regimines

Question 25

HAMS for AR

Answer 25

• Health Conditions
  
  • family history of AR
  • comorbid medical conditions (asthma, atropic dermatitis, noring, mouth breathing, sinus involvemnt, otitis media, conjunctivities
• Allergies
  
  • medication or environemntal
  • environmental history hsould focus on potentially relevant alleren s(pollens, furred animals, textile flooring/upholstery, tobacco smoke)
• Mecuations (current/recent)
  
  • Rx, OTC, NHP, reccreational
  • meds like aspirin, NSAIDs, ACE inhibitsor, hormone therapy, sildenafil and use of cocaine can lead to rhinitis or nasal congestion
• SOcial history
  
  • any pets, floroing, upholstery, tobacco, noxious irritants, humidity