- Allergic rhinitis is a common disease. Treatment is justified in most cases because of the potential for complications.
- Because an immediate immune response to allergens results in release of inflammatory mediators that cause allergic rhinitis symptoms, patients must understand the rationale for the proper timing and administration of prophylactic regimens.
- Proven therapies include avoidance of allergens and pharmacologic management with antihistamines, topical and systemic decongestants, topical steroids, cromolyn sodium, leukotriene receptor antagonists, and immunotherapy.
- Immunotherapy can be highly successful, offering long-term benefits, but expense, potential risks, and a major time commitment makes proper patient selection critical.
After reviewing this chapter the reader should be able to:
- 1. Describe how commonly allergic rhinitis is seen in the adult and pediatric populations.
- 2. Assess a patientâs medical and family history to identify predisposing factors to the development of allergic rhinitis.
- 3. Describe nasal physiology and how the results of sympathetic and parasympathetic stimulation.
- 4. List the inflammatory mediators and their effects during an immune response.
- 5. Contrast early- and late-phase reactions in allergic rhinitis.
- 6. Describe how a diagnosis of allergic rhinitis can be differentiated from other forms of rhinitis.
- 7. Construct a plan to counsel a patient about what drugs to avoid before diagnostic skin testing.
- 8. Discuss the complications that may result from untreated allergic rhinitis.
- 9. Recommend methods to avoid exposure to allergens.
- 10. Debate the potential value of newer, peripherally selective antihistamines over older nonselective agents.
- 11. Discuss the key points to make when counseling a patient on the potential side effects of antihistamines.
- 12. Describe situations where intranasal and/or ophthalmic antihistamines may be useful.
- 13. Prepare a strategy for a patient to overcome the reliance on nasal decongestant spray.
- 14. Discuss the key points to make when counseling a patient on the use of an intranasal steroid.
- 15. Recognize which allergic rhinitis patients are candidates for immunotherapy.
- 16. Discuss the potential value of alternative treatment options for allergic rhinitis, such as omalizumab and probiotics.
Allergic rhinitis involves inflammation of the nasal mucous membrane. In a sensitized individual, allergic rhinitis occurs when inhaled allergenic materials contact mucous membranes and elicit a specific response mediated by immunoglobulin E (IgE). This acute response involves the release of inflammatory mediators and is characterized by sneezing, nasal itching, and watery rhinorrhea, often associated with nasal congestion. Itching of the throat, eyes, and ears frequently accompanies allergic rhinitis.
Allergic rhinitis may be regarded as seasonal allergic rhinitis, commonly known as hay fever, or perennial allergic rhinitis (increasingly called intermittent and persistent). Seasonal rhinitis occurs in response to specific allergens usually present at predictable times of the year, during plants' blooming seasons (typically the spring or fall). Seasonal allergens include pollen from trees, grasses, and weeds. Perennial allergic rhinitis is a year-round disease caused by nonseasonal allergens, such as house-dust mites, animal dander, and molds, or multiple allergic sensitivities. It typically results in subtler, chronic symptoms. Many ...