Rhinitis: Allergic And Non Allergic

Question 1

What is rhinitis?

Answer 1

Symptomatic disorder of the nose characterized by itching, nasal discharge, sneezing and nasal airway obstruction

Question 2

What is allergic rhinitis?

Answer 2

Chronic disease of hypersensitivity of the nasal mucosa to foreign substances mediated through IgE
Rarely occurs under 3 and in elderly
May improve in middle age

Question 3

What are some comorbidities associated with allergic rhinitis ?

Answer 3

Conjunctivitis 
Sinusitis- bother people the most
Otitis media- most common cause in kids
Cough
Asthma

Question 4

What are some causes of allergic rhinitis based on the season?

Answer 4

Spring- trees
Summer- grasses
Fall- weeds especially ragweed
Perennial- cockroaches, dust mites, pets, mold

Question 5

What are the symptoms of allergic rhinitis?

Answer 5

Stuffy nose- most common
Sneezing
Runny nose

Question 6

What is the role of Th1 helper cell in allergic rhinitis?

Answer 6

Anti allergy T helper cell
Stimulates phagocyte mediated defense
Produce intracellular antigens
Produce IFN gamma
IFN gamma down regulates allergy response by decreasing production of IgE, IL-4 and IL-13

Question 7

What is the role of Th2 in allergic rhinitis ?

Answer 7

Allergy producing T helper cell
Produces extracellular antigens
Stimulates IgE, eosinophil, mast cells
Downregulates Th1 response
Increases production of IL-4, IL-13 and IL-5

Question 8

What is the role of Th17 in allergic rhinitis?

Answer 8

Pro inflammatory

Secrete IL-17, IL-6, TNF

Question 9

What are some factors favoring Th1 phenotype?

Answer 9

Presence of older siblings
Early exposure to daycare
Rural environment

Question 10

What are some factors favoring Th2 phenotype?

Answer 10

Widespread use of antibiotics
Western lifestyle
Urban environment
Diet

Question 11

What is the pharmacotherapy of allergic rhinitis ?

Answer 11

Oral antihistamines- 1st gen has too many side effects
Nasal corticosteroids- most potent anti inflammatory agents, first line for persistent allergic rhinitis
Immunotherapy is definitive treatment

Question 12

What is perennial non allergic rhinitis ?

Answer 12

IgE not involved
Skin test is negative
Nasal mucosa is primary site of involvement
Diagnosis of exclusion

Question 13

What is allergen immunotherapy ?

Answer 13

Repeated administration of specific allergens to patients with IgE mediated conditions to provide protection against allergic symptoms
Effective for patients with allergic rhinitis, allergic asthma and bee sting allergy
Takes 5-6 months to achieve top dose
Top dose is maintained 3-5 years