summary about the disease and its treatment

1. Role of antidepressants in
allergic rhinitis

2. Presentation made by Nada Naeem
Mahmoud alqattan
Faculty of medicine ain shams
university

3. Introduction
- Allergic rhinitis is characterized by IgE-mediated
immediate hypersensitivity and usually progresses to
chronic nasal inflammation with depression is one of
its co morbidity .
- It's a very common condition, estimated to affect
around one in every five people in the UK.
- Persistent allergic rhinitis has a significant effect on
quality of life (QOL), especially on sleep and work
performance .

4. Who are mostly Affected ?
- It quickly became clear that AR influence runs deeper than an itchy
nose. The emotional burden of hay fever can be huge for
adolescents .
- Many studies examined how adolescents are emotionally affected by
AR .They found adolescents with AR had higher rates of anxiety and
depression and a lower resistance to stress. They also exhibited
more hostility, impulsivity, and changed their minds often.
- They are affected differently than children or adults. Part of this is
due to issues surrounding sleep, something that is vital for a host of
essential functions, such as laying down new memories and
enhancing creativity.

5. - Lack of sleep or poor sleep are both huge issues for
adolescents, and it can be made worse by the symptoms
of hay fever and Poor sleep can have a negative impact
on school attendance and achievements.

6. What mechanism is behind this
connection?
- Growing evidence suggests a link between allergic
disorders and depression, but literature assessing the
association between Allergic Rhinitis and depression is
conflicting, and large population-based studies are
lacking
- Recently , A strong Relationship between persistent
allergic rhinitis and specific psychiatric syndromes has
been illustrated in many studies and Many theories
that demonstrate it as either immune-related
illnesses through the presence of cytokines ; sleep
disruption with subsequently negative effects on
psychiatric symptoms or outcomes .

7. - Some experts also explain the allergy-depression
connection in psychological terms, focusing primarily
on the heavy emotional toll of chronic allergy
symptoms .
- There’s no evidence that there is a causality between
allergic rhinitis and depression But if you can’t breathe
through your nose, if you have headaches , if you
can’t sleep well at night, there’s a good chance you’re
going to feel depressed.

8. Classification
Allergic rhinitis classification actually reflects the clinical
course with its burden on QOL into:
- intermittent (total duration <4 weeks)
- Persistent (symptoms continue throughout the whole year)
Also according to severity as :
- mild (patients sleep normally and perform normal activities)
- moderate/severe (affects sleep and daily activities) .

10. 1- Surroundings : Dust , mites , Dusts
2- Seasonal : spring , Temerature variation
3- Food L Milk , Egg , Wheat
Causes

12. Types

13. Risk factors
1-Genetic 2- Environmental 3- Mixed interaction

14. Symptoms and Signs

15. New studies suggest that Patients with persistent
allergic rhinitis and persistent nasal symptoms usually
form poor QOL scores. Such poor QOL probably
results in :
1- difficulty getting to sleep.
2- waking up during the night.
3- fatigue.
4- mood changes irritability.
5- memory deficits, and lack of a good night's sleep.
That result in forming a burden their daily life, which
limits them from doing well in their work and lead
them to psychiatric disorders Like depression .

16. Complications
Complications may be physical or mental.
Physical :
- Sinusitis
- Nasal polyp
- Middle ear infections
- Worsens Asthma

17. Mental :
- poor school
performance
- Sleeping
Disturbances
- Drowsiness
- Depression

18. Diagnosis
1-History taking including psychiatric diorders
and examination.
:2-Allergy testing
skin prick test
blood test

19. Tests for complications as sinusitis and nasal polyp :
1- nasal endoscopy
2- nasal inspiratory flow test
3- CT Scan

20. Differential Diagnosis

21. Treatment
Treatment for allergic rhinitis depends on how severe your symptoms
are and how much they're affecting your everyday activities.
1-Self-help
Avoid exposure to allergens that trigger the condition
mild cases with OTC medications : long-acting, non sedating antihistamines
2-Cleaning your nasal passages
Using a salt water solution known as nasal douching to keep the nose free of
irritants
homemade solution , pharmacy made Or small syringes to help flush the
solution around the inside of your nose.
3-Medication : Antihistamines - corticosteroids
They help to treat symptoms not curing the disease
persistent symptoms and you have a nasal blockage or nasal polyp
4-Immunotherapy
known as hyposensitisation or desensitisation, is another type of treatment
used for some allergies when symptoms are severe

23. Treatment with anti-depressants :
Desipramine
- Desipramine is a tricyclic antidepressant, beside its indication for
the treatment of depression and improve patients mood
- It has antihistaminic properties, affecting histamine
H1 receptors which was possibly achieved by reducing allergen-
specific IgE and Th2 cytokine production maintaining a
balance between Treg and Th17 cells.
- Many studies provided evidence that desipramine may be
utilized to treat allergic Rhinitis , especially for those allergic
patients with depression or depression patients with allergy
and this is another accepted mechanism for The connection
between AR and depression .

24. Prevention
- Avoid your allergens or Try to reduce exposure to it.
- Take medicines as prescribed to manage symptoms.
- Keep a diary.
- Wear a medical alert bracelet (or necklace).
- Know what to do during an allergic reaction.

25. Summary
Many Studies suggest that the use of
antidepressants diminishes the allergic
symptoms in patients with treatment resistant
AR since psychosomatic factor is of great
importance in the patient population of AR.
However, additional studies are required to
determine the role of antidepressants among
the various AR treatment options aiming to
Improve The Quality of Life .

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