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Symptoms of allergic rhinitis generally begin after the second year of life, and the
disease is prevalent in children and adults ages 18-64 years. After age 65 years, the
number of cases decreases.
Risk factors for developing allergic rhinitis include family history of atopy (allergic
disorders) in one or both parents; filaggrin (skin barrier protein) gene mutation; elevated
serum IgE greater than 100 IU/mL
Allergic rhinitis has been classified as seasonal allergic rhinitis (“hay fever”) usually in
late summer or spring
, perennial allergic rhinitis occurs through out the year .
New classifications , intermittent allergic rhinitis (IAR) occurs less than 4 days or less
than 4 weeks per year and persistent allergic rhinitis (PER)more than 4 days or more
than 4 weeks per year.
Allergic rhinitis cannot be cured. The goals of therapy are to reduce symptoms and
improve the patient’s functional status and sense of well being.
Mold is challenging to eliminate due to ability to grow in wall cracks ,carpet fibers and
difficult to reach areas where spores are the reproductive unit of and other fungi.
Cat derived allergens are small and light, and they stay airborne for several hours. Cat
allergens can be found in the house months after the cat is removed.
Ventilation systems with high efficiency particulate air (HEPA) filters remove pollen,
mold spores, and cat allergens from household air.
Filters need to be changed regularly to maintain effectiveness.
HEPA filters are also found in some vacuum cleaners. Weekly vacuuming of carpets,
drapes, and upholstery with a HEPA filter equipped vacuum cleaner may help
reduce household allergens.
1)Intranasal corticosteroids
2)Oral antihistamincs
3)Oral leukotrien receptor antagonist
4)Intranasal antihistaminics
5)Decongestants
6)Intranasal mast cell stabilizers
7)Intranasal anticholinergics
8)combination therapy
FDA in 2012 has approved beclomethasone(Qnasal) dry nasal aerosol to be the first
non aquous nasal formulation available.
Complete symptom control may not be seen for up to 1 week. Patients should be
instructed to shake the bottle well before each use and discard the
product after a total of 60 or 120 doses, depending on which size was purchased, even
if the bottle does not feel completely empty.
Oral Antihistamines
Antihistamines are indicated for relief of symptoms of allergic rhinitis (e.g., itching,
sneezing, and rhinorrhea) and other types of immediate hypersensitivity reactions
They are classified as sedating (first generation, nonselective i.e. brompheniramine ,
chlorpheniramine , promethazine)
or non sedating (second generation, peripherally selective i.e.acrivastine,ebastine,
loratadine,cetrizine),(third generation i.e. levocetrizine ,desloratidine,fexofenadine)
Intranasal antihistamines
i.e. Azelastine
They ara targeted delivery drugs increasing dosage to nasal tissues
They are not recommended as first line therapy due to high cost ,less effective and
more adverse effects than INCS
Decongestants
Nasal wetting agents nasal irrigation with warm saline (isotonic or hypertonic) may
relieve nasal mucosal irritation and dryness.That process also aids in the removal of
dried or thick mucus from the nose.
It is only for the symptoms not treating therapy.
Immunotherapy
Subcutaneous immunotherapy SCIT, commonly called allergy shots is a unique way of treating
allergies and asthma.
Medications treat the symptoms of allergies while immunotherapy changes the way a person’s
immune system is reacting to the environment.
First allergen skin testing identifies a person’s allergic triggers. A personalized vaccine is then
formulated using all natural protein extracts. This extract is then administered subcutaneously
with small doses by developing immunity or tolerance to the allergen.
Allergy shot treatment involves two phases. The first phase involves
frequent injections of increasing amounts of allergen extract. This
is followed by a maintenance phase, during which the injections are
given about once a month.
Anti-immunoglobulin E antibody
References
2015 American academy of otolaryngology-head and neck surgery foundation(AAO-
HNSF) guidelines for allergic rhinitis.