This is a tutorial related to (blank) rhinitis (blank) Manjul Dixit M.D.

1. A Quick Tour Of
ALLERGIC RHINITIS
Manjul Dixit, M.D.

2. Allergic Rhinits: Definition
Allergic rhinitis is clinically defined as a symptomatic
disorder of the nose induced by an IgE-mediated
inflammation after allergen exposure of the membranes
lining the nose

3. Interesting Facts
• 10% to 20% of population have intermittent rhinitis
• 30% to 50% of patients have persistent rhinitis
• Up to 15% of patients are children 6 to 7 years of age
• Up to 40% of patients are adolescents 13 to 14 years of age
• 18% to 21% of patients are young adults 15 to 24 years of age
• less than 8% of patients are adults over 65 years of age
• Allergic rhinitis is one of the major 10 conditions that lead to
medical consultation in U.S. managed-case populations

4. Clinical Manifestations
 Repetitive sneezing  Eye symptoms
 Watery rhinorrhea  Ear symptoms
 Nasal pruritus  Postnasal drainage
 Nasal congestion

5. Quality Of Life
• Fatigue
• Sleep Disorders
• Learning Problems
• Chronic Rhinosinusitis
• Dental Abnormalities
• Speech Disorders
• Emotional problems
• Impaired activity and social functioning
• Poor perception of general health
• > 800,000 missed days of work, school, and
decreased productivity days
• $5.4 to $7.7 billion dollars lost

6. Types of Rhinitis

7. Conditions that mimic rhinitis

8. The Allergic Reaction

9. ARIA Classification
Intermittent Persistent
• < 4 days per week • ≥ 4 days per week
• or < 4 weeks • and ≥ 4 weeks
Mild Moderate-severe
normal sleep one or more items
& no impairment of daily  abnormal sleep
activities, sport, leisure  impairment of daily
& normal work and school activities, sport, leisure
& no troublesome symptoms  abnormal work and school
 troublesome symptoms
ARIA Report 2001

10. Diagnosis of AR
 History
 Physical / Nasal Examination
 Laboratory Testing
- Skin Prick Test
- Peak Nasal Inspiratory Flow Rate
- Rhinomanometry

11. PHYSICAL EXAMINATION
 Allergic shiner
 Dennie Morgan line
 Allergic crease
 Allergic salute
 Nasal mucosa may appear normal or pale
bluish, swollen with watery secretions but only if patient
is symptomatic
 Exclude structural problems (polyps, deflected nasal
septum)
Others:
nasal voice, constant mouth breathing, frequent
snoring, coughing, repetitive sneezing, chronic open
gape of the mouth, weakness, malaise, irritability

12. Why?
-Trees: Spring and Fall
Oak, Maple, Cedar, Olive and Elm
- Grasses: Early Summer and Fall
Kentucky Blue Grass, Orchard, Redtop, Timothy, and Bermuda
-Weed: Late Summer and Fall
Pigweed, Sage, Mugwort, lamb’s quarters
-Outdoor Molds: Summer and Early Fall
Alternaria and Cladosporium
Dry and Windy days
-Indoor Molds:
Aspergillus and Penicillium
-Pets
-Cockroaches

13. Management of AR
 Allergen Avoidance
 Pharmacotherapy
 Immunotherapy
- Subcutaneous
- Sublingual

14. Pharmacotherapy

15. Actions of Various Nasal Preparations in
the Treatment of Rhinitis
Nasal Sneezing Itching Rhinorrhea Congestion
Preparation
Antihistamines +++++ ++++ +++ 0
Anticholinergics 0 0 +++++ 0
Corticosteroids +++++ +++++ +++ +++
Decongestants 0 0 + +++++
Antileukotrienes +++ ++ 0 ++++

16. The “Ideal” Drug For Allergic Rhinitis
Should Have The Following Features:
 Inhibit both early and late phases
 Be an H1 blocker
 Counter effects of other mediators
 Fast-acting, to control the early phase
 Dosing-od or bd for compliance
 No side effects
 Manage all symptoms
 Intranasal administration

17. The “Ideal” Drugs Are……
“Corticosteroids are undoubtedly the
pharmacotherapeutic agents with the broadest
application for the treatment of many types of
rhinitis”

18. Intranasal corticosteroid therapy
 Potent topical activity
 Administration of low doses directly at site of action
 Considerable efficacy at low doses
 High topical: systemic activity ratios
 Rapid first-pass hepatic metabolism of any systemically
absorbed drug, to compounds with negligible activity
 Markedly greater inhibition of EAR than with oral
steroids

19. THANK YOU!!!!
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