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Allergy and Immunology

Allergic Rhinitis

Nasal symptoms: Rhinorrhea, congestion, sneeze, itch

Eye symptoms: Watery, red, itchy

Itching of palate and ear canals

Rare under age 4

Aeroallergens

Pollens: Grasses, trees, weeds (not flowers)

Spores: Molds

Animal Danders: Cat, dog, allergic rhinitis or any other furry animal

Dust mites

Clinical Evaluation allergic rhinitis of Allergic Rhinitis

History Allergy Immunology

Symptoms include sneezing, allergic rhinitis rhinorrhea, nasal congestion, and itchy eyes.

Symptoms may be seasonal

Symptoms may be triggered by allergic rhinitis specific substances

Family history usually is significant for atopy (ie, allergic rhinitis, asthma, atopic dermatitis)

T cell controlled atopy

Allergic Rhinitis: Physical Exam

· The exam is usually normal.

· Periorbital venous congestion may appear as "shiners."

· A transverse nasal crease may result from repeated rubbing of the nose.

· Pale, boggy turbinates

· These findings are not specific for allergic rhinitis.

· Polyps should be excluded

· A trial of nasal decongestant trial should be completed

Allergic Rhinitis: Skin Testing

· Appropriate allergens

· Controls: positive and negative (antihistamines suppress skin test reactivity)

· Interpretation: A positive skin test does not necessarily equal allergy

RAST

· Disadvantages: Less sensitive than skin testing, expensive, time-consuming

· Advantages: Not affected by medication or dermatitis.

allergic rhinitis: allergy, immunology Environmental Control

· Cats, dogs, other furry pets should be removed from the home or kept outside, or at least out of bedroom.

· House dust mites: Vacuum regularly (not by patient), mattress and pillow encasings, hot wash bedding.

Treatment of Allergic Rhinitis

· Antihistamines are effective for rhinorrhea, sneeze, itchy nose and for itchy, watery eyes.

· Decongestants are effective for congestion.

· Combination agents are available.

· Medications can be used on an as need or regular basis.

Side Effects of Medications

· Antihistamines: Sedation, impaired performance, cardiac arrhythmias

· Decongestants: Insomnia, hypertension

Immunotherapy for Allergic Rhinitis

· Immunotherapy is a form of immunization. It is not a cure.

· Progressive dose schedule

· Time commitment

· Side effects: local, systemic

· Physician present

· Not a substitute for environmental control

· Avoid "quack immunotherapy"

Non-Allergic Rhinitis

· Chronic nasal symptoms not caused by allergies.

· Usually characterized by congestion and post nasal drip.

· Usually not associated with sneezing, nasal pruritus, or eye symptoms.

· Rhinorrhea (vasomotor rhinitis) may be present.

· Allergic rhinitis and non-allergic rhinitis often coexist.

Treatment of