Allergic Rhinitis (Immunology)

Question 1

What is hypersensitivity?

Answer 1

Excessive undesirable reaction produced by immune system in a presensitized patient divided into 4 types based on time and mechanism

Question 2

Describe steps of type 1 HS

Answer 2

1. Allergen phagocytosis
2. AP
3. Th0 to Th2
4. Th2 IL 4 10 13
5. Naive B cell to plasma cell
6. IgE production
7. IgE Fc to mast and basophil and Fab to antigen
8. Degranulation of leukotrienes, PG and histamine

Question 3

What does histamine do?

Answer 3

-VD
-Inc Permeability
-inc mucus
-bronchospasm

Question 4

What do PG do?

Answer 4

Smooth muscle contraction
Increase in mucus

Question 5

What does leukotriene?

Answer 5

Bronchospasm

Question 6

What reactions are Abs mediated?

Answer 6

1, 2 and 3

Question 7

What is type 1 HS?

Answer 7

IgE mediated

Question 8

What is type 2 HS?

Answer 8

Antibody dependent cellular cytotoxicity

Question 9

What is type 3 HS?

Answer 9

Immune complex deposition

Question 10

Which is immediate which is delayed

Answer 10

1 and 4

Question 11

What is type 4 HS?

Answer 11

T cell mediated

Question 12

List the examples of type 1 Hs?

Answer 12

Systemic: anaphylactic shock
Local: AR or Hay fever
BA
Food allergy
Atopic dermatitis

Question 13

Which drug causes all types of HS?

Answer 13

Pencillin

Question 14

Describe severity of allergic rhinitis

Answer 14

Usually mild and seasonal unless accompanied by severe asthma, anaphylaxis or secondary infection necessitating hospitalization

Question 15

Most common type of rhinitis ?

Answer 15

Allergic

Question 16

What are the Clinicak features of Allergic rhinitis?

Answer 16

Ear
Earache
Malaise
Headache
Fatigue
Drowsiness

Nose
Sneezing
Posterior Nasal Drip
Congestion
Anosmia
Polyps

Throat
Itching (nose, ears and palate)
Mucus overproduction

Eyes
Eye redness and swelling

Question 17

Types of allergic rhinitis ?

Answer 17

Seasonal: pollen and molds
Prennial: all year round home and outdoor
Sporadic/ intermittent due to pets or food
Occupational: vet, farmer or wood worker

Question 18

What are the factors of allergic rhinitis ?

Answer 18

Host factors
1. Genetic (atopy and airway hyper reactivity)
2. Hormonal (puberty and pregnancy)
3. Male child and adult female
4. Obesity (2ndry to inc leptins)

Environmental
1. Allergens
2. Infections
3. Diet

Question 19

Allergic rhinitis investigations

Answer 19

Immunological
Increase in esinophils
Increase in serum IgE (total and specific) by FEIA
Skin test

Question 20

DD of allergic Rhinitis?

Answer 20

1. Infections
2. Gustatory
3. Hormonal (pregnancy, contraptives and hypothyroidism)
4. NARES
5. Rhinitis of Wagner and Sarcoidosis
6. Vasomotor Rhinitis
7. Drug induced: tropical alpha agonists and vasodilators

Question 21

Management of Allergic Rhinitis?

Answer 21

-Environmental management
-Pharmalogical
• oral or intranasal antihistaminics
• intranasal steroid spray
-immunotherapy (in combination with others)

Question 22

Why is skin test the best in diagnosis of allergic rhinitis ?

Answer 22

As it is not specific nor sensitive

Question 23

What is a pure indication of oral anti histaminics

Answer 23

Sneezing
Itching

Question 24

Why are 2nd generation better than 1st generations (antihistaminics)?

Answer 24

Less sedating

Question 25

Indication of intranasal antihistaminics?

Answer 25

Episodic
Seasonal
Periannial

Question 26

What is the indication of intranasal antihistaminics?

Answer 26

If affecting QOL

Question 27

When is immunotherapy indicated in allergic rhinitis

Answer 27

Poor response
Severe
Complication
Comorbid