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Allergic rhinitis & Vasomotor 
rhinitis
• IgE mediated immunological response of nasal 
mucosa to air borne allergen 
• Characterized by sneezing, itching, watery 
nasal discharge, nasal obstruction
Aetiopathogenesis 
• IgE mediated hypersensitivity reaction to 
specific allergen 
• Allergens 
- pollen, grass, weeds- seasonal allergic rhinitis 
- House dust mite, animal hair, dander, perfumes, 
feathers, smoke, dust, atmospheric pollutant-perennial 
allergic rhinitis
Allergic rhinitis
• IgE produced by plasma cell- FC fraction bind 
to mast cell, FAB combines with antigenic 
substance- degranulation of mast cells-histamine 
release, slow releasing substance of 
anaphylaxis
Allergic rhinitis
Allergic rhinitis
Allergic rhinitis
Allergic rhinitis
• Atopy 
– Tendency to develop an exaggerated IgE antibody 
response to one or more allergen 
– Allergic disorder include allergic rhinitis, asthma, 
eczema 
– Genetically inherited
Types 
• Seasonal allergic rhinitis (Hay Fever) 
– Inhaled allergen- pollen grain 
– Certain season –spring, autumn 
• Perennial allergic rhinitis 
– Occur throughout year 
– Caused by house dust mite etc
Clinical features 
• B/L nasal obstruction 
• Rhinorrhoea 
• Paroxysms of sneezing 
• Hyposmia 
• Itchiness of nose, eyes, palate 
• Associated other allergy
• Signs 
– Boggy, bluish edematous turbinates 
– Excessive nasal secretions 
• Sequelae 
– Regression 
– Progression to bronchial asthma, ethmoidal polyp 
– Recurrent sinusitis 
– Serous ottitis media
Allergic rhinitis
Allergic rhinitis
Investigations 
• Nasal smear microscopy- eosinophilia 
• Skin prick test- 10-30% asymptomatic- positive 
test 
• RAST (radioallerosorbent test) 
• Serum IgE 
• Nasal provocation test 
• Scratch test
Treatment 
• Avoidance of allergens 
• Medication 
– Antihistaminics- cetrizine, fexophenadine, 
loratadine 
– Topical corticosteroids spray- fluticasone, 
momentasone, budesonide, beclomethasone 
– Mast cell stabilizers- sodium chromoglycate 
– Nasal decongestant- oxymetazoline, 
xylometazoline
• Desensitization 
– Blocking IgG antibody that prevent antigen 
binding to IgE 
– Effective for seasonal allergy 
– Drawbacks 
• Multiple allergy 
• Difficult to identify exact allergen 
• Series of injections 
• Anaphylaxis 
• Recurrence
Vasomotor rhinitis 
• Non infective, non allergic condition 
• Aetiology is obscure 
• Clinical features similar to allergic rhinitis
• Pathophysiolgy 
– Disorder of autonomic nervous system-parasympathetic 
stimulation 
– Stress, emotional disturbances – aggravate the 
symptoms 
– Increase in vascularity- nasal mucosal swelling, 
rhinorrhea, sneezing 
• No definitive allergen identified
• Eosinophilic 
– Moderate nasal 
obstruction 
– Mild rhinorrhea 
– Minimal sneezing 
– Hyposmia present 
– Marked mucosal 
swelling 
– Inf turbinate enlarged 
– Polyp frequent 
– Sinus mucosal 
thickening- frequent 
• Non eosinophilic 
– Mild nasal obstruction 
– Severe rhinorrhea 
– Minimal sneezing 
– Hyposmia-rare 
– Mucosal swelling mild 
– Mild inf turbinate 
enlargement 
– Polyp- never 
– Sinus mucosal thickening 
- rare
• Types 
– Runners 
– Blockers 
• Treatment 
– Topical nasal steroids 
– Antihistaminics 
– Vedian nerve neurectomy
– Enlarged inferior turbinates 
• Linear thermal cautery 
• Submucosal diathermy, cryotherapy 
• Turbinoplasty

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Allergic rhinitis

  • 1. Allergic rhinitis & Vasomotor rhinitis
  • 2. • IgE mediated immunological response of nasal mucosa to air borne allergen • Characterized by sneezing, itching, watery nasal discharge, nasal obstruction
  • 3. Aetiopathogenesis • IgE mediated hypersensitivity reaction to specific allergen • Allergens - pollen, grass, weeds- seasonal allergic rhinitis - House dust mite, animal hair, dander, perfumes, feathers, smoke, dust, atmospheric pollutant-perennial allergic rhinitis
  • 5. • IgE produced by plasma cell- FC fraction bind to mast cell, FAB combines with antigenic substance- degranulation of mast cells-histamine release, slow releasing substance of anaphylaxis
  • 10. • Atopy – Tendency to develop an exaggerated IgE antibody response to one or more allergen – Allergic disorder include allergic rhinitis, asthma, eczema – Genetically inherited
  • 11. Types • Seasonal allergic rhinitis (Hay Fever) – Inhaled allergen- pollen grain – Certain season –spring, autumn • Perennial allergic rhinitis – Occur throughout year – Caused by house dust mite etc
  • 12. Clinical features • B/L nasal obstruction • Rhinorrhoea • Paroxysms of sneezing • Hyposmia • Itchiness of nose, eyes, palate • Associated other allergy
  • 13. • Signs – Boggy, bluish edematous turbinates – Excessive nasal secretions • Sequelae – Regression – Progression to bronchial asthma, ethmoidal polyp – Recurrent sinusitis – Serous ottitis media
  • 16. Investigations • Nasal smear microscopy- eosinophilia • Skin prick test- 10-30% asymptomatic- positive test • RAST (radioallerosorbent test) • Serum IgE • Nasal provocation test • Scratch test
  • 17. Treatment • Avoidance of allergens • Medication – Antihistaminics- cetrizine, fexophenadine, loratadine – Topical corticosteroids spray- fluticasone, momentasone, budesonide, beclomethasone – Mast cell stabilizers- sodium chromoglycate – Nasal decongestant- oxymetazoline, xylometazoline
  • 18. • Desensitization – Blocking IgG antibody that prevent antigen binding to IgE – Effective for seasonal allergy – Drawbacks • Multiple allergy • Difficult to identify exact allergen • Series of injections • Anaphylaxis • Recurrence
  • 19. Vasomotor rhinitis • Non infective, non allergic condition • Aetiology is obscure • Clinical features similar to allergic rhinitis
  • 20. • Pathophysiolgy – Disorder of autonomic nervous system-parasympathetic stimulation – Stress, emotional disturbances – aggravate the symptoms – Increase in vascularity- nasal mucosal swelling, rhinorrhea, sneezing • No definitive allergen identified
  • 21. • Eosinophilic – Moderate nasal obstruction – Mild rhinorrhea – Minimal sneezing – Hyposmia present – Marked mucosal swelling – Inf turbinate enlarged – Polyp frequent – Sinus mucosal thickening- frequent • Non eosinophilic – Mild nasal obstruction – Severe rhinorrhea – Minimal sneezing – Hyposmia-rare – Mucosal swelling mild – Mild inf turbinate enlargement – Polyp- never – Sinus mucosal thickening - rare
  • 22. • Types – Runners – Blockers • Treatment – Topical nasal steroids – Antihistaminics – Vedian nerve neurectomy
  • 23. – Enlarged inferior turbinates • Linear thermal cautery • Submucosal diathermy, cryotherapy • Turbinoplasty