General Information
• Allergic rhinitis (AR) is an allergic picture that starts with a feeling of itching in the nose and manifests itself with nasal fullness, sneezing, and discharge.
• If allergic rhinitis persists throughout the year, it is called perennial rhinitis, and if it presents in spring, it is called seasonal AR (hay fever).
Etiopathogenesis
• A family history of atopy and serum IgE>100 IU/ml are risk factors.
• Cesarean section delivery also increases the risk in those with familial asthma and atopy.
• Smoking is a risk factor.
• In early childhood; The risk is reduced in cats, dogs and those exposed to endodoxine.
• Early start to wheat, rye, oats, barley, eggs and fish; It reduces the risk of asthma, allergic rhinitis and allergic sensitization.
• Breastfeeding is protective.
• The decrease in the diversity of intestinal microbiota in infancy is a risk factor for allergic diseases that will develop in school age.
Clinical Findings
Nose
- The nasal mucosa is pale bluish-violet in color and edematous.
- Septal deviation, nasal polyp, turbinate hypertrophy
- Allergic salute
- allergic tics
Eyes
- Allergic shiner: Periorbital bruise. 60% is accompanied by asthma.
Findings Regarding Complications That May Be Accompanying
• Mouth breathing, halitosis (bad breath)
• Sinusitis (most common complication)
• 20% middle ear pathologies
• Recurrent rhinosinusitis, adenoiditis, otitis media, tonsillitis
Lab
• Epidermal prick test, dermal tests, serum specific IgE (RAST), nasal smear test.
• 10% or more eosinophils in nasal smear is in favor of allergic rhinitis.
Differential Diagnosis of Allergic Rhinitis
Vasoma to Rhinitis (Noneosinophilic, nonallergic rhinitis)
• There is increased parasympathetic activity in the nasal mucosa.
• Abundant clear rhinorrhea and nasal obstruction, often shifting from one side to the other.
• There is no eosinophilia and atopy in the nasal mucosa
Nonallergic Rhinitis Syndrome
• NARES (Nan-allergic rhinitis with eosinophilia syndrome),
• There is no sign of allergic disease. It could be a nasal polyp. Clear and itchy rhinorrhea is seen.
Nasal Polyps
In the presence of true polyps, cystic fibrosis should be strongly considered.
Samter's syndrome:
Aspirin hypersensitivity is a combination of nasal polyps and nonallergic asthma. The most common cause of aspirin hypersensitivity is cyclooxygenase 1 (COX1) inhibitors. These patients have a severe asthma attack 2 hours after taking this group of drugs. IL-5 and LTC4 synthesis are increased in these patients.
Cyclooxygenase-2 (COX-2) inhibitors can be given under the supervision of a physician in patients who require non-steroidal anti-inflammatory drugs. If necessary, they should be advised to use weak COX-1 inhibitor drugs such as acetaminophen/paracetamol. Meloxicam is a better tolerated nonsteroidal anti-inflammatory drug because it selectively inhibits COX2 in a patient with aspirin-induced asthma. The best treatment is aspirin desensitization.
• Nasal steroids are used in the treatment of polyps, if there is no response, polypectomy is performed.
• Leukotriene antagonists can also be used in aspirin hypersensitivity.
Chronic Infectious Rhinitis
• Mucopurulent rhinorrhea, subfebrile fever.
• It should be investigated in terms of immunodeficiency and ciliary dysfunction.
Primary Atrophic Rhinitis
• It is autosomal dominant. It develops during puberty.
• There is enlargement of the nasal cavity, paradoxical nasal obstruction, and dryness.
Rhinitis Medicamentosa
• Occurs due to nasal decongestants used for more than a week.
• The nasal mucosa is bright red and fragile.
Treatment
1. Protection from allergies
2. Pharmacological treatment:
• Perennial allergic rhinitis:
- Nasal sodium cromoglicate, daily nonsedative antihistamine (loratidine, cetilism, fexofenadine)
• Seasonal allergic rhinitis:
- Antihistamine in mild disease, cromoglycate for eyes and nose
- Disease with many nasal symptoms: Daily nasal steroid, eye antihistamine or cromoglycate
- Major illness with ocular symptoms: Oral antihistamine, nasal steroid, cromoglycate to the eye
- Nasal steroids: It can cause irritation, burning in the nose, nose bleeding, septum perforation.
• In vasomotor rhinitis: Ipratropium bromide (anticholinergic) is given.
3. Allergen immunotherapy
4. Omalizumab
