Definition of Allergic Rhinitis
Allergic Rhinitis is an inflammation of the nasal passages, usually associated with watery nasal discharge and itching of the nose and eyes.
Description of Allergic Rhinitis
Allergic Rhinitis affects about 20-30 percent of the population. The symptoms occur in the nose and eyes and usually occur after exposure to dust, danders, or certain seasonal pollens in people that are allergic to these substances.
There is strong genetic predisposition to allergic rhinitis. One parent with a history of allergic rhinitis has about a 30 percent chance of producing offspring with the disorder; the risk increases to 50 percent if both parents have a history of allergies.
Patients can be severely restricted in their daily activities, resulting in excessive time away from school or work. Millions of dollars are spent each year on physician services and medication for treatment of this chronic illness.
Causes and Risk Factors of Allergic Rhinitis
Dust mites, cockroaches, molds and animal dander, are examples of year-around allergens.
Tree, grass and ragweed pollens are primarily seasonal outdoor allergens. Seasonal pollens depend on wind for cross-pollination. Plants that depend on insect pollination, such as goldenrod and dandelions, do not usually cause allergic rhinitis.
Mold spores grow in warm, damp environments. The highest mold spore counts occur in early spring, late summer and early fall, but mold spores can be measured indoors year-around.
Animal allergens are also important indoor allergens. The major cat allergen is secreted through the sebaceous glands of the animal’s skin. These small, light proteins are capable of staying suspended in the air for up to six hours and can be measured for several months after a cat is removed from an indoor environment.
Symptoms of Allergic Rhinitis
Characteristic symptoms include repetitive sneezing; rhinorrhea (runny nose); post-nasal drip; nasal congestion; pruritic (itchy) eyes, ears, nose or throat; and generalized fatigue. Symptoms can also include wheezing, eye tearing, sore throat, and impaired smell. A chronic cough may be secondary to postnasal drip, but should not be mistaken for asthma. Sinus headaches and ear ache, and itching are also common
Diagnosis of Allergic Rhinitis
After a medical history, your physician will perform a physical exam. Often, the nasal mucosa (lining of the nose) is pale or violaceous because of the engorged veins. Nasal polyps may be seen. Classic signs of allergic rhinitis may include swelling of the eyelids, injected sclerae (the whites of the eyes may be red), allergic shiners (darkened areas under the lower eyelids thought to result from venous pooling of blood), and extra skin folds in the lower eyelids.
Skin testing may confirm the diagnosis of allergic rhinitis. Initial skin testing is performed by the prick method. Intradermal testing is performed if results of prick testing are negative.
Treatment of Allergic Rhinitis
The goal of treatment is to reduce the allergy symptoms. Avoidance of the allergen or minimization of contact with it is the best treatment, but some relief may be found with the following medications.
Antihistamines and Decongestants
Oral decongestants alone may be helpful, including pseudoephedrine. Antihistamines are available as tablets, capsules and liquids, and may or may not be combined with decongestants. Common antihistamines include chlorpheniramine, and clemastine. Non-sedating (less likely to cause drowsiness) long-acting antihistamines include loratidine, Rupatidine and fexofenadine.
Nasal sprays
For rhinorrhea, a nasal spray of cromolyn sodium or a steroid nasal spray, such as flunisolide beclomethasone dipropionate), triamcinolone acetonide and fluticasone may work so well that additional antihistamines or decongestants are unnecessary. It is important to remember that improvement may not occur for one to two weeks after starting therapy with steroid nasal sprays. Short courses of oral corticosteroids may usually be indicated when severe nasal symptoms prevent the adequate delivery of topical agents.
Immunotherapy (Allergy shots)
- Immunotherapy involves giving gradually increasing doses of the substance (or allergen) to which the person is allergic.
Self Care
Avoidance measures
Seasonal allergens (such as tree, grass and ragweed pollens) are difficult to avoid outdoors, but can be controlled by closing windows and running air conditioners.
Excessive exposure to allergens, such as outdoor molds, can be prevented by avoiding lawn mowing and other activities likely to stir these up.
Maintaining an allergen-free environment also includes covering pillows and mattresses with plastic covers, substituting synthetic materials (such as foam mattresses or acrylics) for animal products (such as wool or horsehair) and removing dust-collecting household fixtures (like carpets, drapes and bedspreads).
Air purifiers and dust filters may help.
Indications for Inferior Turbinate Reduction or Blocked Nose surgery
Blocked nose symptoms are multi-factorial. The “Nasal Cycle” always means that one side of the nose will be open, the other relatively blocked, from time to time and side to side during the day and night. Allergy, humidity, air temperature, stress etc can all be related to the symptom of blocked nose. Although Inferior Turbinate reduction with the laser is one option in the treatment of nose blockage, the London Laser Clinic surgeons are experienced in other, more common procedures that may be required. In particular, septoplasty (straightening the cartilage inside the nose), polypectomy (removal of nose polyps) and endoscopic sinus surgery (drainage of the sinuses to remove infection and reduce swelling) may all be required. Those patients with nose blockage due to swelling of the lining of the nose over structures called the Inferior Turbinates are the group that might benefit from laser surgery. Those suitable for surgery will usually have tried a variety of drug treatments, including antihistamine tablets, and nose sprays (steroid and anti histamine).
The pre-treatment diagnosis also often involves X-rays of the sinuses, and full endoscopic examination of the nose. What happens?: The procedure works by altering the function of nose breathing receptors, and reducing the size of the turbinates, thus increasing the size of the breathing channel and reducing the ability to sense blockage.
Anaesthetic
This operation can be performed under local or general anaesthetic. Local anaesthetic is achieved painlessly by the gentle insertion into the nose of a small amount of local anaesthetic moistened cotton wool for 10 minutes.
CO2 Laser is Used
Post-op Instructions
Recovery is quick, such that whether under local or general anaesthetic, a day-stay procedure can be performed. Packing of the nose is not usually required. Application of antibiotic ointment twice daily is necessary, for 1 week. There is little postoperative pain. A follow up appointment is made between 1-2 weeks postoperatively. More than one procedure may be necessary, depending on the severity of the disease.
Following the operation, your nose will feel slightly numb inside and antibiotic cream will have been applied to the inside walls of the nose. The numbness will wear off after an hour. If your operation was performed under general anaesthetic, at this stage you will feel no pain, talk normally, and will be ready to go home 4 hours after surgery. Breathing through the nose is often immediately improved. Before you leave, your surgeon will vist you and give you a prescription for painkillers and antibiotics, nasal drops, antihistamine etc.
You will be given a tube of antibiotic cream to apply to the inside of the nose, at home, using a cotton bud. This should be performed twice a day, usually on rising, and again in the early evening.
The inside of the nose may crust slightly for the first week, the cream also helps to prevent this. If at all worried by this you should contact your surgeon for advice, any crusting is generally innocuous and resolves over a few days.
Full recovery takes about 10 days, at which time the other side of your nose can be treated if necessary. Inferior Turbinectomy is not usually a painful procedure in the postoperative phase and incidence of bleeding, a possible complication of surgery, is less than 1%. If any bleeding does occur, apply pressure to the front of the nose by squeezing the front of the nose between the thumb and forefinger. An ice pack applied to the nasal bridge and back of neck may help, and do not lean forward, simply sit with the head held in an upright position.
After about 10 minutes, if there is no improvement, go to your nearest Accident and Emergency department or call the surgeon.
You will be required to make an appointment for a follow up examination at around 1- 2 weeks postoperatively.
{ 0 comments… add one now }