Nasal Allergy pdf - D. Mushtaq

Fifth Stage

E.N.T

Dr.Mushtaq – Lecture 18

Nasal Allergy

Allergy : an abnormal reaction of the tissues to certain substances ‘allergens’
‘antigens’ capable of making the body produce antibodies.

In allergic subjects, a special form of antibody (IgE,) is produced. These antibodies
easily fix on tissue cells, including those of the nasal and bronchial mucosa or the
skin.

Aetiology

Mechanism of allergy (3phases):

1. IgE

(formed by lymphocytes in response to

allergen exposure).

2. IgE is bound

to mast and basophil cells

initiates

the secretion of substances such as histamine that
lead to the clinical manifestations.

3. Capillaries become permeable

and

oedema

occurs.

Eosinophils infiltrate

the tissues.

Serous

alveolar glands are stimulated

either directly or via

an autonomic reflex to produce excess

watery

secretion.

Predisposing factors

hereditary

.. ‘

Atopy’=inherited tendency

Precipitating factors

1. Exogenous

a.Inhalants:

dusts,pollens,animal,feathers,fungal spores and
the house-dust mite

b.Ingestants;

(foods): especially in children

such as eggs, strawberries, nuts or fish .Milk or
wheat are less obvious.

c. contacts

to skin or nasal mucosa

;. Face

powders, and hair from electric razors, nasal
drops or sprays .

d. Drugs

; nasal symptoms may be part of a more generalized allergic response.

e. Infection

: bacterial ,fungi and parasites allergy has been suspected but never

proved.

2. Endogenous

; tissue proteins from injured tissues, transudates and exudates

) ..

Clinical types

1.Seasonal ('hay-fever': pollinosis).
2.Non-seasonal (perennial).

Age incidence

less common after 50 years of age.

Signs and Symptoms

• Sneezing

• Earache

• Itchy nose, ears, eyes and palate

•Tearing of eyes

• Red eyes

• Rhinorrhea

• Swollen eyes

Physical Examination

• Nasal crease

Horizontal crease across the lower half of the bridge of the
nose

• Rhinorrhoea

Thin Watery secretions

• Deviated or perforated nasal septum

• Post nasal drip

• Fatigue

• Congestion

• Drowsiness

• Anosmia

• Malaise

• Headache

Extra Nasal Manifestation

• Retracted and abnormal flexibility of TM

• Injection and swelling of palpebral conjunctivae with excess
tearing.

• Cobblestoning on oropharynx

Classical Signs of AR

• Over bite

• High arched palate

• Allergic shiners

• Allergic salute

• Transverse crease over tip of nose and lower eye lid

• Conjunctival congestion

• Periorbital oedema

Diagnosis

  1.Careful history.
2.Clinical examination..
3. Eosinophils. May be found in great numbers in the nasal secretions ,the nasal
mucosa or polypi. The eosinophil count of the blood is raised, especially in the
morning, and always in the presence of an extrinsic allergen.
4. Skin tests. These are confirmatory. Sensitivity is less than 50% of cases clinically
suggestive of a non-seasonal allergy. Nearly all patients with seasonal symptoms will
give positive responses.
5. intranasal test. A drop of test solution may promote rhinorrhea and sometimes
lacrimation - so-called 'nasal provocation' test.
6. Elimination test. may be helpful, especially in suspected food allergies.

Management (Avoidance, Medical, Surgical)

Avoidance

• Minimize contact with offending allergens

• Reduce dust mite exposure by encasing bed pillows and matress in allergen
proof covering

• Use of allergen proof bedding…

Acute Phase medications:

• Antihistamines effectively block histamine effects (runny nose and watery
eyes)

• Side effects : sedation, dry mouth, nausea, dizziness, blurred vision,

nervousness

• Non sedating antihistamines (cetrizine, Ioratidinelr

• Fewer side effects .

• Fexofenadine may be effective _

• Carries a lower risk of cardiac

arrythmias

• Decongestants

• Anticholinergenic agents

• inhibit mucous secretions, act as

drying agent

• Topical eye preparations

• Reduce inflammation and relieve

itching and burning, -

Prevention Therapy:

• Intranasal corticosteroids

• Reduce inflammation of mucosa

• Prevent mediator release

• Can be used safely daily

• May be given systemically for a short course during disabling attack.

• Intranasal cromolyn sodium

• Mast cell stabilizer

• Prevent release of chemical mediators

• Oral Mast cell stabilizer

• Ophthalmic solution cromolyn

• Leukotriene receptor antagonists

• Montelukast (singulair) and Zatirlukast (accolate)

• Systemic agents used for asthma

• Reduce inflammation, edema and mucous secretions of allergic rhinitis

Immunotherapy

• lf allergic rhinitis is refractory to pharmacotherapy or severe

• Helps in reducing the specific serum IgE level

• decreases the basophil sensitivity .

• increases IgG blocking antibody level, thus preventing allergen from
reaching mast cells and subsequent mast cell degranulation.

Surgical Therapy

•Limited

• Submucosal turbinectomy - reduces size of boggy turbinates

• Septoplasty - correction of deviation of septum

• Sinus surgery – clearance of sinuses if sinusitis is present.

Complications

• Allergic asthma

• Chronic otitis media

• Hearing loss

• Chronic nasal obstruction.

• Sinusitis

• Orthodontic malocclusion in children.

Thank you,,,