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About Allergic Rhinitis PowerPoint Presentation

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On : Mar 14, 2014

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  • Slide 1 - ALLERGIC RHINITIS Definition Types Etiology -Genetic -Atopy -pollution
  • Slide 2 - Asthma and Allergic Rhinitis
  • Slide 3 - Prevalence of Allergic Rhinitisby Age Group 10-20% of world Allergy+Asthma 50-58% Asthma+Non eosinophillic rhinitis -14%
  • Slide 4 - Allergic Rhinitis (AR): Risk Factor for ASTHMA Prevalence of AR: Adults 31.5% Children 40% About 50-80% of asthmatics have AR About 40% of allergic rhinitis cases have Bronchial Asthma Untreated nasal allergy leads to other airway diseases including Asthma (post-nasal drip as trigger, irritant receptors in upper AW, mouth breathing)
  • Slide 5 - Related Anatomic StructuresCompromised by Allergic Rhinitis
  • Slide 6 - ALLERGENS SEASONAL Occupational Pollens Bakery,Dust Fungi Washing powder Grass Latex,Drugs Perennial Food House dust mite Tartazine,Sulphate,Cheese Cat-Fel d l Fish,Nuts,Eggs Cockroaches Citrus fruits
  • Slide 7 - Environmental Allergens and Childhood Asthma Dust mites Furry pets Molds Cockroaches
  • Slide 8 - Allergic RhinitisFirst exposure – Phase of sensitizationOn re-exposure- Mast cell degranulation Exposure of genetically predisposed individuals to allergens (pollen, animal dander, fur) Activation of T-lymphocytes Stimulates IgE production by B-lymphocytes IgE coat mast cells [on re-exposure mast cell degranulation]
  • Slide 9 - Allergin Rhinitis: Inflammatory cells Mast cells Contain Granules (histamine) Other mediators (leukotrienes and PGs) Lymphocytes T cells Increased mobilisation of inflammatory cells Eosinophils, macrophages, neutrophils Eosinophils Major basic protein, Eosinophilic Cationic Protein (epithelial injury, nasal block)
  • Slide 10 - Allergic Rhinitis: Inflammatory mediators Released by inflammatory cells (mast cells, eosinophils, lymphocytes) Leukotrienes hypersecretion of mucus oedema (Increased vascular permeability) Histamine itching, rhinorrhea (Allergic rhinitis) Cytokines Interleukins (IL) IL-4 (IgE production) IL-3 and IL-5 (eosinophil, mast cell recruitment / activation)
  • Slide 11 - ALLERGIC RHINITIS PATHOGENESIS EAR- Early Allergic Reaction – Within 15 - 30 minutes after exposure Mast cell degranulation: histamine LAR- Late Allergic Reaction 6-12 hours after exposure Eosinophils, Basophils. Epithelial damage, increased mucus secretion.
  • Slide 12 - ALLERGIC RHINITISSYMPTOMS SEASONAL Pollen Eye symptoms Skin allergy test + Symptoms include: Runny nose, itching, sneezing, nasal block PERENNIAL --Skin allergy test - Symptoms include: itching, nasal block, Hyposmia, palatl itch, facial pain
  • Slide 13 - ARIA GUIDELINESDIAGNOSIS History Skin prick test Nasal smear RAST ELISA
  • Slide 14 - CLASSIFICATION OF ALLERGIC RHINITIS (AR) Intermittent AR < 4 days per week or < 4 weeks Mild Intermittent AR Moderate-Severe Intermittent AR Normal Sleep No impairment of daily activities Normal work and school No troublesome symptoms Abnormal Sleep Impairment of daily activities Problem at work and school Troublesome symptoms
  • Slide 15 - CLASSIFICATION OF ALLERGIC RHINITIS (AR) Persistent AR > 4 days per week or > 4 weeks Mild Persistent AR Moderate-Severe Persistent AR Normal Sleep No impairment of daily activities Normal work and school No troublesome symptoms Abnormal Sleep Impairment of daily activities Problem at work and school Troublesome symptoms
  • Slide 17 - Allergic Rhinitis: Treatment Avoid contact with allergen Hyposensitization (Allergy tests / vaccines ) Drug therapy Antihistamines / Relievers: Nasal sprays (Superior) / Oral Steroids / Preventers: Nasal (Superior) / Oral / Drops Other preparations (Na Cromoglycate or Chromone, Ipratropium, Decongestants, LTRA or Montelukast)
  • Slide 18 - Drug options for Allergic Rhinitis
  • Slide 19 - Treatment Options: Allergic Rhinitis Antihistamines Oral: Most common form of Treatment. (Drowsiness / Dryness of mouth / Urinary retention / Blurred vision / appetite +).Cetrizine, Rupatidine Nasal Spray : Azelastine. Potent H1 blocker with immediate effect / Also blocks other mediators (LT, PAF) Corticosteroids Nasal Sprays: Most effective treatment of AR / certain types of perennial rhinitis (Beclomethasone / Budesonide / Fluticasone / Mometasone. Block both EAR / LAR : Reduce swelling & secretions in nasal mucosa (anti-inflammatory) Oral Corticosteroids: Short term
  • Slide 20 - TREATMENT OF POLYPOSIS Topical nasal corticosteroids are mainstay of treatment for ethmoidal polyposis
  • Slide 21 - Fluticasone Nasal Spray Fluticasone (50 mcg / spray) 120 doses Dose: 2 sprays / nostril once daily (Adults). Used for Prophylaxis & treatment of AR/perennial rhinitis/Vasomotor rhinitis/ Symptomatic relief of Nasal polyps/ Prevent recurrence of polyps (post-polypectomy) Potent anti-inflammatory action (Block both EAR / LAR : Reduce swelling & secretions in nasal mucosa) Safe: No HPA axis suppression/systemic absorption. Can be used for long periods even in children
  • Slide 22 - Allergic Rhinitis & its Impact on Asthma (ARIA) Guidelines Management of Intermittent AR Avoid Allergens Mild Intermittent AR Moderate-Severe Intermittent AR Nasal H1 blocker / Spray Oral H1 blocker Decongestants LTRA Nasal H1 blocker / Spray Oral H1 blocker Decongestants/LTRA/Chromone FLUTICASONE - 2 sprays/nostril OD LTRA= Leukotriene Receptor Antagonists
  • Slide 23 - Allergic Rhinitis & its Impact on Asthma (ARIA) Guidelines Management of Persistent AR Avoid Allergens Nasal H1 blocker Oral H1 blocker / LTRA Decongestants / Chromone Intranasal CS / NOMETASONE/ /FLUTICASONE Review patients after 2-4 weeks Step up if no improvement Continue: 1 month if improvement
  • Slide 24 - REFERENCES Clinical Recommendations (IJCP, Oct 2003) : Intranasal CS should be the 1st line therapy for AR Fluticasone Vs loratidine (Ann Allergy Asthma Immunol 2004 Mar) Fluticasone Vs CTZ+MSK (Clin Exp Allergy 2004 Feb) Fluticasone in perennial rhinitis (Auris Nasus Laryx 2003 Dec) Fluticasone improves asthma in children with chronic rhinosinusitis (Ann Allergy Asthma Immunol 2003 Jul) Fluticasone in 2-3 year old patients (Pediatrics 2003 Jul) Fluticasone Vs Montelukast (MSK) (Ann Allergy Asthma Immunol 2003 May) Fluticasone in perennial rhinitis (Allergy Asthma Proc 2003 Jan-Feb)
  • Slide 25 - THANK YOU
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