Rhinitis
Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial in Textbook of Allergy for the Clinician, 2021
Allergic Rhinitis (AR) is caused by immunologic sensitization to one or more environmental allergens, which leads to production of allergen-specific IgE antibodies that bind high-affinity IgE receptors on the surface of mast cells and basophils. Upon re-exposure, the allergen cross-links allergen-specific IgE antibodies, resulting in mast cell and basophil degranulation and release of preformed histamine and newly synthesized mediators, namely prostaglandins, leukotrienes and kinins. This early phase response is characterized by itching, sneezing and congestion due to increased vascular permeability, vasodilatation and mucus production. Further release of inflammatory mediators results in a late-phase reaction that occurs 4–6 hours after allergen exposure. Cytokines and chemokines generated during this phase recruit T lymphocytes, basophils and eosinophils, which in turn, release further inflammatory mediators which worsen nasal symptoms and prime the nose so that future allergen exposure leads to more severe symptoms. Mediators involved in allergic rhinitis are listed in Table 8.1.
Subcutaneous Immunotherapy for Allergic Rhinoconjunctivitis, Allergic Asthma, and Prevention of Allergic Diseases
Richard F. Lockey, Dennis K. Ledford in Allergens and Allergen Immunotherapy, 2014
Several aspects of the treatment of allergic rhinitis require careful consideration: 1) About 20% of the subjects with rhinitis experience symptoms from the lower airways—often neither considered nor treated as asthma; 2) patients presenting symptoms only from the upper airways have a significant risk of developing asthma; and 3) patients with less intensive symptoms need less symptomatic treatment, but interventions affecting the natural course of the disease might be more attractive than reducing symptoms only. There are no definite guidelines for the institution of SCIT in allergic rhinitis or asthma. The initiation of SCIT is based on a careful balancing of advantages and disadvantages, taking into consideration the patient’s attitude to both the symptoms and possible treatment options of the disease [9]. Analyzed in this way, SCIT is not a treatment only initiated in severe and persistent disease but, instead, is being considered as a supplement to pharmacotherapy in the early phase of the disease [10,11]. The considerations for initiating immunotherapy in allergic rhinitis and asthma are illustrated in Table 26.1 [3,9,11,28].
Local mucosal allergic disease
Richard F. Lockey, Dennis K. Ledford in Allergens and Allergen Immunotherapy, 2020
Allergic rhinitis (AR) constitutes an important health problem worldwide [1]. This IgE-mediated chronic inflammatory disease negatively impacts patients’ social life, school performance, and work productivity. Moreover, AR is a risk factor for allergic asthma [2]. Allergic rhinitis and asthma should not be considered two differentiated entities but the organ-specific expressions of a single condition. Thus, the term allergic respiratory disease (ARD) has been recently proposed to collectively refer to allergic rhinitis and asthma [3]. In most cases of ARD, the IgE sensitization to environmental allergens induces the onset of AR during childhood or adolescence. The disease naturally evolves toward clinical worsening, the development of new IgE sensitizations, and the association of comorbidities in other mucosal organs like the bronchi or the conjunctiva. Therefore, ARD should be regarded as a chronic, lifelong respiratory disorder naturally progressing possibly to severe phenotypes [3].
A quality-of-life mapping function developed from a grass pollen sublingual immunotherapy trial to a tree pollen sublingual immunotherapy trial
Published in Journal of Medical Economics, 2020
Katherine Dick, Andrew Briggs, Robert Ohsfeldt, Tobias Sydendal Grand, Sarah Buchs
Allergic rhinitis is a common inflammatory disorder of the nasal mucosa affecting more than 20% of the European population. Allergic rhinitis is caused by sensitivity to environmental allergens such as tree or grass pollen1–5. Symptoms of allergic rhinitis include a runny, itchy, or blocked nose and itchy, gritty, or watery eyes. An estimated 10–40% of patients also suffer from concomitant allergic asthma2,3,5,6. In addition to physical symptoms, patients often experience reduced sleep quality, emotional problems such as depression, and social difficulties3,5,6. Patients often require additional general practice services and medication, which can be a financial burden to patients, healthcare providers, and society3,6–8.
Tinospora Cordifolia: A review of its immunomodulatory properties
Published in Journal of Dietary Supplements, 2022
Charles R. Yates, Eugene J. Bruno, Mary E. D. Yates
Allergic rhinitis involves type 2 helper (Th2) cell driven mucosal inflammation caused by IgE-mediated reactions to inhaled allergens (Bousquet et al. 2008). Allergic rhinitis symptoms include sneezing, nasal pruritis, airway obstruction, and clear nasal discharge. It is estimated that up to 40% of people with allergic rhinitis have or will have asthma (Shaaban et al. 2008). Due to T. cordifolia’s anti-inflammatory and anti-allergic properties, Badar et al. conducted a randomized double-blind placebo-controlled trial to assess the efficacy of T. cordifolia extract in individuals with allergic rhinitis (Badar et al. 2005). Patients (n=75) were randomized to receive either placebo or an aqueous extract of T. cordifolia stem (300mg/day) orally for eight weeks. After eight weeks, subjects receiving T. cordifolia extract reported experiencing less sneezing, nasal discharge, nasal obstruction and itching compared to subjects in the placebo arm. In addition, T. cordifolia treated subjects were found to have reduced eosinophil and neutrophil counts, as well as absent goblet cells, in their nasal smears. T. cordifolia was well-tolerated and leukocyte numbers and cytology results correlated with clinical findings implying that T. cordifolia may serve as a natural remedy for sufferers of allergic rhinitis.
Impact of nasal conditions on chronic otitis media: a cross-sectional study in Koreans
Published in Acta Oto-Laryngologica, 2018
Kyung Wook Heo, Min Jae Kim, Jun Ho Lee
Otoscopic or endoscopic examinations that were included in the KNHANES, were performed to detect middle ear pathologies. Nasal pathologies were checked by endoscope under pre-constricted and post-constricted nasal conditions. Patients were assessed for SD, nasal polyps, interior turbinate hypertrophy, and post-nasal drip (PND). Pure tone audiometry was also performed. Allergic rhinitis (AR) was defined by a history of a clinician’s diagnosis via an otorhinolaryngological questionnaire. Otologic physical examinations were performed in subjects older than 1 year. A 0° endoscopic examination of the tympanic membrane or external auditory canal was performed in subjects older than 4 years. Nasal examinations and pure tone audiometry were performed in subjects older than 12 years. Among the data, the prevalences of nasal and middle ear pathologies were considered in the present study. In the survey, endoscopic examinations were performed by third-year residents of the Departments of Otorhinolaryngology – Head and Neck Surgery who were assigned by the Korean Society of Otorhinolaryngology – Head and Neck Surgery, and captured images were reassessed by Otorhinolaryngology specialists.
Related Knowledge Centers
- Allergen
- Allergic Conjunctivitis
- Asthma
- Atopic Dermatitis
- Immunoglobulin E
- Pollen
- Rhinitis
- Immune System
- Sneeze
- Genetics