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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