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Allergic Rhinitis Richard Douglas Prevalence • Most common disease • 20% adult population Diagnosis • What’s the problem? nasal blockage clear rhinorrhoea sneezing itchy eyes Diagnosis • When during the year do you get these symptoms? perennial worse in springtime Pathogenesis • IgE mediated hypersensitivity to common aeroallergens • Release of histamines, leukotrienes More history • Previous medications occasional antihistamine, Otrivine spray • Past medical history mild asthma as child • Drug allergies nil Examination • Headlight, Thuddicum’s speculum • Nasendoscope • Otoscope Investigations • Skin prick tests Atopy • Atopy is an inherited predisposition to produce IgE to environmental allergens Atopics Non-atopics Allergic Rhinitis Differential diagnosis • Allergic rhinitis • Non-allergic rhinitis with eosinophilia • Vasomotor rhinitis Treatment • • • • Drugs Allergen avoidance Immunotherapy Surgery Drugs • Antihistamines Intermittent symptoms Work quickly Expensive • Intranasal steroids Constant symptoms Slow onset of action Inexpensive Nasal Obstruction Allergen avoidance • Grass pollen difficult to avoid • Best trial of dust mite avoidance shows no effect on allergic rhinitis Immunotherapy • Repeated exposure to high doses of allergen causes anergy • Low dose to high dose • Three year course • Risk of anaphylaxis • Highly effective when the allergen is known What is the role of surgery? •Highly effective •Submucosal resection for good long term results