NASAL ALLERGY (Allergic rhinitis)

INTRODUCTION

Allergy is an abnormal response of the tissues to certain material, often a protein, which is called allergen. This reaction results in the formation of specific antibody. In allergic subjects, in addition to these normal antibodies, special form of antibodies (Reagin) are produced which gets fixed to tissue cells of the nasal and the bronchial mucosa. First introduction of antigen produce characteristic features of allergy by reacting with these tissue antibodies releasing histamine like substances and leads to dysfunction of cellular enzyme activity and subsequent tissue damage. Hypersensitivity of the host depends on antigen dose, frequency of exposure, genetic make-up, and hormone activity of the body.

AETIOLOGY:

Predisposing factors:

(a) Heredity: Family history is often present.

(b) Psychological: Emotion and anxiety often seen.

(c) Endocrinal: more common during puberty, pregnancy, and menopausal period.

(d) Temperature variation and seasonal changes.

Precipitating factors:

1. Inhalants: Inhalation of pollens, smokes and dusts, house dusts, powders, tobacco smoke, animal excreta, etc.

2. Ingestants (foods): Eggs, crabs, prawns, brinjals, pineapples, milk products, nuts, etc.

3. Infection: Bacterial allergy.

4. Drugs: Aspirin, iodide, antibiotic, etc. often cause allergic reaction.

5. Synthetic materials, etc.

Pathology: (a) Oedema of the submucosal tissue by allergic fluid; (b) Infiltration by eosinophils and plasma cells; (c) Vascular dilatation cause more engorgement of inferior turbinate (d) Increased activity of the sero-mucinous glands; and (e) In some cases polyp formation occurs.

Clinical features:

May be seasonal, such as" hay fever"; or non-seasonal.

(1) Characteristic features are bouts of sneezing followed by rhinorrhoea-clear watery discharge which is profuse in amount,

(2) This is usually followed by nasal obstruction which is often alternating in character. Nasal irritation is common. Anosmia occurs when there is nasal obstruction.

(3) Heaviness of head and headache may occur, if associated sinusitis is present.

(4) There may be associated irritation and congestion of eyes, respiratory distress, and broncho-spasm,

(5) On anterior rhinoscopy, nasal mucosa is oedematous, pale-grey and boggy in appearance on both sides. This is more marked on inferior turbinate. In some cases allergic polyps are seen.

Radiology of paranasal sinuses (O.M. View): Mucosal thickening of lining mucosa and sometimes polypoid hypertrophy, is seen more commonly in maxillary antrum.

Diagnosis:

1. Careful history: Present, past, family, and of allergens.

2. Clinical features: Anterior and posterior rhinoscopy.

3. Nasal smear may show eosinophil in great number in inhalant allergy and mast cells in food allergy.

4. Blood count may show eosinophilia.

5. Allergic test:

(a) Skin test: intradermal test with allergens.

(b) Provocative food test or nasal challenge test.

(c) Radio-allergosorbency test measures concentration of IgE antibodies.

(d) Cell-degranulation test.

Treatment:

1. Prophylactic-

(a) precipitating factors (allergen) should be removed or avoided.

(b) Hyposensitisation by vaccines is more effective in seasonal allergy.

 

 

TREATMENT AT DR. SOHAN LAL CLINIC

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