Nasal allergy
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Transcript of Nasal allergy
• E:\PRESENTATIONS\Animations\CILLIARY MOVEMENTS\Cilliary Movement2.flv
Nasal Allergy
• IgE mediated immunological response
• Usually in response to Air born allergens
• Characteristics
–Nasal obstruction
–Nasal discharge
– Sneezing
– Itching
Types of Nasal Allergy
• Seasonal
–Particular
–Allergy to specific pollen
–Comes and goes with the season
• Perennial
–Persists throughout the year
Aetiology• Inhalants
– Pollens
• Grass
• Trees
– Mould spores
– House dust
– Debries
• Inects
• House Mite
• Food
– Rerely
Genetic Predisposition
• Heredity -- important role
• One parent involvement
–20%
• Both parents
–47%
Pathogens• Inhaled Allergen
• Specific Antibodies
• Antibody Fixed
– Basophils - Fc End
– Mast Cells - Fc End
• Antigen - Antibody
• Degranulation of Mast Cells
• Release of Mediators
– Presynthesized
– Fresh Synthesis
Effects of Chemical Mediators• Vasodilatation
• Mucosal oedema
• Eosinophil infiltration
• Secretion of nasal glands
• Smooth muscles contraction
• Priming effects
–Already sensitized - responds to small doses
• Primed to other non specific allergens
Late or Delayed Phase
• 2-8 hours
• Infiltration of inflammatory cells
• Charactristics
–Swelling
–Congestion
–Thick secretions
EosinophilsNeutrophilsBasophilsMonocytesCD + T Cells
Symptoms - Seasonal Nasal Allergy• Paroxysmal sneezing (10-20)
• Nasal Obstruction
• Watery Nasal discharge
• Itching
– Nose
– Eyes palate
– Pharynx
• Bronchospasm
• Duration and severity
– Varies with the season
Symptoms - Perennial Nasal Allergy• Symptoms - usually not very severe
• Frequent colds
• Persistent stuffy nose
• Loss of sense of smell– Mucosal oedema
• Postnasal dripping
• Chronic cough
• Hearing impairment– Eustachian tube blockage
– Middle ear Effusion
Nasal Signs
• Nasal rubbing
• Allergic salute
• Transverse nasal crease
• Nasal mucosa–Pale
–Oedematous
–Bluish
• Turbinates – Swollen
• Thin watery mucoid nasal discharge
Otologic signs
• Retracted tympanic membranes
• Serous Otitis Media
–Glue ear
• Eustachian tube Blockage
Pharyngeal Signs
• Granular pharyngitis
–Hyperplasia of lymphoid tissue
• Features of Nasal Obstruction
–Like adenoid hypertrophy
Investigations• TLC
– Eosinophilia
• Nasal Smear
–Number of eosinophils
–NARES - May be no Allergy
• Non Allergic Rhinitis with Eosinophilia Syndrome
• Skin tests
–To identify Specific Allergen
Investigations
• RAST
–Radiallergosorbant test
–To measure specific antibody concentration
• Nasal provocation test
–Allergen put in the nose
Complications
• Recurrent Sinusitis - ostiaobstruction
• Nasal polypi
• Serous otitis media
• Orthodontic problems
• Bronchial asthma
Treatment• Avoidance of allergens – if only one allergen
–Most successful•Removal of pet
•Removal of carpet
•Change of work place
•Change of job
•Avoidance of food
• Drugs
• Immunotherapy
Antihistamines • Control
–Rhinorrhoea
– Sneezing
–Pruritis
• Side effects
–Drowsiness
• Individualised
–Dose
–Type
Sympathomimetics
• Constrict blood vessels
• Reduce nasal congestion
• Reduce mucosal oedema
• CNS Stimulation
• In combination of anti histamines
• Pseudoephedrine
• Phenylpropanolamine
Corticosteroids
• Systemic
–Prolonged Use - Side Effects
• Topical
–Inhibit Recruitment of Inflammatory Cells
–Suppress Late Phase Reaction
–Fewer Side Effects
Sodium Chromoglycate
• Stabilizes Mast Cells
• Prevents Degranulation–Despite Formation of IgE-antibody Complex
• 2% Solution Drops / Spray