Rhinitis%20-%20allergic Signs and Symptoms

Signs and Symptoms

Definition

Rhinitis

Inflammation of the nasal lining membranes

Allergic Rhinitis

A symptomatic disorder of the nose secondary to IgE-mediated inflammation of the nasal membranes induced after exposure to allergens
Also known as hay fever or allergic rhinosinusitis

Signs and Symptoms

Major Symptoms

Nasal itching
Watery rhinorrhea
Nasal obstruction/congestion
Sneezing
Postnasal drainage

Other Symptoms

Headache
Conjunctival symptoms, eye pruritus
Impaired smell
Morning cough
Sleep problems/excessive daytime sleepiness/sleep-disordered breathing or obstructive sleep apnea

Symptoms can reverse spontaneously with or without treatment

Pathophysiology

There may be various diatheses for allergic rhinitis sensitization but the most important mechanisms are:
- Genetic factors
- Production of IgE antibody
Most allergic rhinitis are caused by inhalation antigens such as:
- Dermatophagoides (antigen in house dust) - most common
- Pollens (eg trees, grasses and weeds) - most common
- Fungi
- Pets
Two phase reactions:
- Early phase reaction happens when histamine and leukotrienes are released from mast cells and irritate the sensory nerve endings and blood vessels of the nasal mucosa
  - This irritation causes sneezing, rhinorrhea (watery), nasal mucosal swelling or blockage
- Late phase reaction happens when inflammatory cells like activated eosinophils infiltrate the nasal mucosa that is exposed to these antigens
  - Seen 6-10 hours after the exposure to antigens
  - Causes mucosal swelling

Epidemiology

Affects approximately 25% of children and 40% of adults worldwide
- Estimated prevalence in Europe and United States is 30%
Approximately 80% of symptoms of allergic rhinitis develop before 20 years of age

Dual and triple therapy in COPD and asthma care

Prof. Wisia Wedzicha, 19 Apr 2023

Long-acting beta-agonist (LABA), long-acting muscarinic antagonist (LAMA) and inhaled corticosteroid (ICS) are standard agents used in management of chronic obstructive pulmonary disease (COPD) and asthma. At the Autumn Respiratory Seminar 2022, Professor Wisia Wedzicha of the Imperial College London, UK, discussed current evidence and recommendations regarding the use of dual bronchodilator therapy with a LABA/LAMA combination in patients with COPD as well as when triple therapy with a LABA/LAMA/ICS combination is appropriate in those with poorly controlled symptomatic COPD or asthma.

Tackling multidrug-resistant gram-negative bacterial infections in critically ill patients: Challenging the standard approach

Dr. Asok Kurup, Dr. Kenneth Chan, 07 Dec 2020

The rising incidence of infections caused by multidrug-resistant (MDR) gram-negative bacteria has become a serious health threat and a major challenge for intensivists. Against a backdrop of high patient mortality and risk factors for infection in intensive care units (ICU), early adequate therapy is of paramount importance. At a recent Pfizer-sponsored symposium, Dr Asok Kurup, Infectious Disease Physician, Singapore presented the implications of MDR gram-negative infections in critically ill patients in Asia, while Dr Kenneth Chan, Respiratory Physician and Intensivist, Singapore highlighted the role of ceftazidime-avibactam (Zavicefta) and shared published real-world data on ceftazidime-avibactam.

Multidisciplinary approach to eosinophilic disorders: Why and how?

Dr. Terence Tam, Dr. Ho SO, Prof. Michael Wechsler, 19 Dec 2023

Eosinophilic disorders, such as eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES), often necessitate the use of corticosteroids due to diverse signs and symptoms. However, long-term corticosteroid use is associated with various complications. Patients with poor response to corticosteroids may experience disease recurrence. At an industry-sponsored symposium jointly organized by the Hong Kong Society of Rheumatology and the Hong Kong Thoracic Society, experts shared insights on multidisciplinary team management of eosinophilic disorders and discussed clinical evidence supporting the use of add-on medications, such as mepolizumab, in EGPA and HES.