Allergic Rhinitis [4]

Allergic Rhinitis [4]

Allergic rhinitis often presents with REPETITIVE SNEEZING, RHINORRHEA, NASAL CONGESTION, AND ITCHING of the mucous membranes. In severe cases, ear fullness and popping, malaise, and fatigue may be present.

Determine whether symptoms are related temporally to specific trigger factors. This might include exposure to pollens outdoors, mold spores while doing yard work, specific animals, or dust while cleaning the house. Irritant triggers such as smoke, pollution, and strong smells can aggravate symptoms in a patient with allergic rhinitis.

Physical examination is important, but it lacks specificity. Classical clinical signs such as ALLERGIC SHINERS, DENNIE-MORGAN INFRAORBITAL CREASES, and the “ALLERGIC SALUTE” are frequent in children, but they are rarely seen in adults. Examination of the nasal mucosa can reveal PALE, SWOLLEN NASAL TURBINATES, but some patients may have an erythematous mucosa. After shrinking of swollen mucosa with topical decongestants, polyps can often be readily appreciated.

EVALUATION OF AN ALLERGIC PATIENT

History

  • Recent illness
  • Family history
  • Occupational history

Physical exam

Skin testing

  • Percutaneous (prick and puncture)
  • Intradermal

Laboratory exam

  • Eosinphil count (peripheral blood and nasal lavage)
  • Radioallergosorbent test

Effective treatment of allergic rhinitis involves a combination of environmental control and pharmacotherapy. When symptoms persist despite these measures, allergen immunotherapy should be considered. Oral antihistamines are effective in reducing symptoms of itching, sneezing, and rhinorrhea and are the first-line therapy for allergic rhinitis. However, they have little effect on nasal congestion.Therefore, there are a number of antihistamines, both first and second generation, available combined with a decongestant.

Intranasal antihistamines are effective and in contrast with oral preparations may reduce nasal congestion. They are appropriate for use as first-line
treatment of allergic rhinitis. Those with prolonged allergic symptoms should add intranasal corticosteroids. They are the most effective medication class in controlling symptoms of allergic rhinitis.

R Thomas, Staecker H. Otolaryngology: Basic science and clinical review. Thieme Medical Publishers. New York. 2006: 39-40

Sheikh J.  Allergic Rhinitis. [Online] 2011 [Cited January 30, 2012]. Available from: http://emedicine.medscape.com/article/134825-clinical

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