Derm - Allergic Rhinitis

Question 1

Defintion

Answer 1

Condition caused by an IgE-mediated type 1 hypersensitivity reaction. Environmental allergens cause an allergic inflammatory response in nasal mucosa. It is very common

Question 2

Types of allergic rhinitis

Answer 2

Seasonal: e.g. hay fever
Perennial (year round) e.g. house dust mite allergy
Occupational associated with the school or work environment

Question 3

Signs and symptoms

Answer 3

Runny, blooded and itchy nose
Sneezing
Itchy, red and swollen eyes

MC seen in Perennial type:
- Post nasal drip
- Chronic cough
- Nasal congestion

Question 4

Risk factors

Answer 4

• Family history of other allergic conditions (atopy)
• Cigarette smoke exposure
• Not breastfed

Question 5

Triggers

Answer 5

• Tree pollen or grass allergy leads to seasonal symptoms (hay fever)
• House dust mites and pets can lead to persistent symptoms, often worse in dusty rooms at night. Pillows can be full of house dust mites
• Pets can lead to persistent symptoms when the pet or their hair, skin or saliva is present
• Other allergens lead to symptoms after exposure (e.g. mould)

Question 6

Conventional Management

Answer 6

Avoid the trigger
Vacuuming and changing pillows regularly
Allowing good ventilation of the home can help with house dust mite allergy
Staying indoors during high pollen counts can help with hay fever symptoms
Minimise contact with pets that are known to trigger allergens

Question 7

Pharmaceutical management

Answer 7

Oral anti-histamine taken prior to exposure to reduce allergic symptoms:
- Non-sedating antihistamines = cetrizine, loratadine, and fexofenadine
- Sedating antihistamines = chlorphenamine (Piriton) and promethazine

Nasal corticosteroids sprays = fluticasone and mometasone
Nasal antihistamines = rapid onset symptoms in response to trigger

Referral to an immunologist may be necessary if symptoms are still unmanageable

Question 8

Nasal spray technique

Answer 8

Important to get good coating through the nasal passage
Hold spray in left hand when spraying into the right nostril vice versa
Aim to spray slightly outward, away from the nasal septum.
Do NOT sniff at the same time as spraying, as this sends the mist straight to the back of the throat.
The patient should not taste the spray at the back of the throat. If they do, that means it has gone too far