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Allergic RhinitisAka: Hayfever, Allergic Shiner, Dennie's Lines, Allergic Salute
- Epidemiology
- Onset under age 30
- Peak Incidence in childhood and adolescence
- Most common chronic disease in United States
- Affects 35 million Americans
- Accounts for two million missed school days
- Accounts for three million missed work days
- Significantly affects quality of life
- Pathophysiology
- Type I Antibody-Antigen reaction to allergens
- May take 4 years in a given region to be sensitized
- Sequence of events
- T Lymphocytes and B Lymphocytes release IgE Antibody
- Mast Cells in skin and mucosa with second exposure
- Mast Cells degranulate
- Release of histamine and chemotactic factors
- Release of Prostaglandins and Leukotrienes
- Response of Intravascular Basophils
- Late phase reactants release histamine over 12 hour
- Associated Conditions
- Family History
- History
- Atopy
- History of nasal trauma
- Medication use
- NSAIDs
- Antihypertensive Medications
- Oral Contraceptives
- Suspected environmental allergens
- Symptoms: Specific
- Sneezing
- Rhinorrhea
- Nasal congestion
- Pruritus of the nose, eyes, and throat
- Eye Tearing and Conjunctival discharge
- Symptoms: Chronic Nasal Obstruction
- Symptoms: Generalized due to chronicity of Rhinitis
- Irritability
- Fatigue
- Depression
- Malaise
- Weakness
- Signs
- Vitals
- Rule out Hypertension associated with Antihistamines
- Nose
- Use Nasal speculum with high power illumination
- Examine before and after topical nasal Decongestant
- Mucosa
- Pale blue
- Boggy
- Clear discharge
- Ocular
- Palpebral Conjunctiva pale and swollen
- Bulbar Conjunctiva injected with clear discharge
- Face
- Allergic Shiners
- Bluish purple rings around both eyes
- Results from chronic mid-face venous congestion
- Dennie's Lines
- Skin folds under eyes
- Allergic salute
- Transverse nasal crease from chronic nose rubbing
- Allergic Shiners
- Mouth
- High arched narrow palate OR
- Malocclusion from chronic mouth breathing
- "Cobblestoning" of adenoids and tonsils
- Ear (Rule out associated Eustachian Tube Dysfunction)
- Dull, immobile Tympanic Membrane
- Conductive Hearing Loss
- Sinus (Rule out Sinusitis)
- Purulent discharge
- Tender
- Impaired transillumination
- Vitals
- Labs:
- Skin Testing
- Gold standard
- RadioAllergoSorbent Test (RAST Test)
- Use if unable to skin test contraindicated as above
- Nasal Smears
- Eosinophils supportive of a diagnosis
- Complete Blood Count
- Normal White Blood Cell count
- Increased Eosinophils
- IgE elevated
- Skin Testing
- Differential Diagnosis
- Nasal Causes of Rhinitis
- Nonallergic Rhinitis (Eosinophilia Syndrome)
- Nasal Polyps
- Vasomotor Rhinitis
- Infectious Rhinitis
- Rhinitis Medicamentosa
- Gustatory Rhinitis
- Spicy foods lead to tearing and sweating
- Miscellaneous Causes of Rhinitis
- Pregnancy
- Alcohol Abuse
- Cocaine abuse
- Hypothyroidism
- Results in nasal obstruction
- Medications associated with Rhinitis
- Aspirin
- Clonidine
- Guanabenz
- Guanethidine
- Hydralazine
- Labetalol
- Methyldopa
- Prazosin
- Oral Contraceptives
- Propranolol
- Reserpine
- Terazosin
- Nasal Causes of Rhinitis
- Management
- Decrease Environmental Allergens
- Intranasal Steroids
- Effectively controls Itching, sneezing and discharge
- Moderately controls blockage symptoms
- Small effect of impaired smell
- Antihistamine
- Effectively controls itching and sneezing symptoms
- Moderately controls discharge
- Saline Nasal Drops
- Ipratropium Bromide
- Effectively controls Nasal discharge
- Ocular Allergy Preparations
- Intranasal Cromolyn
- Small effect on symptoms
- Systemic steroids (severe cases)
- Hyposensitization
- Petrolatum
- Applied 4 times daily to inside of nares
- Reduces nasal allergic symptoms
- Schwetz (2004) Arch Otolaryngol Head Neck Surg :
- Resources
- Patient oriented allergy information
- Information from your Family Doctor: General
- Information from your Family Doctor: Symptom Control
- Information from your Family Doctor: Allergy Shots
Allergic rhinitis NOS (C0002103) | |
|---|---|
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 477, 477.9 |
| English | Allergic rhinitis, Allergic rhinitis due to allergen, Allergic rhinosinusitis, ALRH, AR - Allergic rhinitis, Atopic rhinitis, Rhinitis - allergic, RHINITIS ALLERGIC |
| Spanish | rinitis alergica, rinitis atopica |
| Parent Concepts | Allergic rhinitis NOS (C0002103), [X]Other diseases of the upper respiratory tract (C0155839), Rhinitis (C0035455), Allergic disorder of respiratory system (C1504369), Atopic IgE-mediated allergic disorder (C1706410) |
| Sources | COSTAR, CST, DXP, ICD9CM, NCI, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
