Allergic Rhinoconjunctivitis

Question 1

What is allergic rhinoconjunctivitis?

Answer 1

Chronic IgE mediated inflammatory response to mucosal contact with inhaled allergens

Question 2

What are the history features of allergic RC?

Answer 2

• Rhinitis: Nasal obstruction, itch, sneezing and clear rhinorrhoea
• Conjunctivitis: itching and increase in tear fluid

Question 3

How does the time course of symptoms reflect the trigger?

Answer 3

○ Spring/summer/autumn: Pollen or mould
○ Perennial: indoor allergens eg house dust mite, animal dander, cockroaches
- Episodic: often animal dander

Question 4

What are the exam findings in allergic RC?

Answer 4

• Nose
  ○ Swollen and pale turbinates, when severe they can extend to the nasal septum
• Eyes
  - Conjunctival injection oedema which appears red and swollen

Question 5

With what presentations would you consider an alternative cause?

Answer 5

Obstruction being the only symptom - anatomical cause

Sneezing, mucoid rhinorrhoea and/or obstruction predominate - vasomotor or infective rhinitis

Question 6

When do you investigate? How?

Answer 6

Perennial not seasonal course

Skin or serology IgE testing

Question 7

What are the principles of management?

Answer 7

• Intermittent symptoms - anti-histamines
• Prolonged - topical steroids + anti-histamines
• Steroids are best for obstructive symptoms but also reduce rhinorrhoea, sneezing and conjunctival symptoms
• Anti-histamines are not effective for obstructive symptoms
• Start steroids treating before spring for best effect and consider decongestants first