Allergic rhinitis is manifested by seasonal or year-round occurring sneezing, rhinorrhea, nasal congestion and sometimes conjunctivitis caused by pollen or other allergens. The diagnosis is made by history and occasionally by skin tests. The treatment of choice are nasal corticosteroids (with or without an oral or nasal antihistamine) and an oral antihistamine and a decongestant drug with effect.
An allergic rhinitis may occur through seasonal or year (a form of perennial rhinitis). The seasonal rhinitis is allergic in general. In 25% of cases, perennial rhinitis is not allergic founded.
Allergic rhinitis is manifested by seasonal or year-round occurring sneezing, rhinorrhea, nasal congestion and sometimes conjunctivitis caused by pollen or other allergens. The diagnosis is made by history and occasionally by skin tests. The treatment of choice are nasal corticosteroids (with or without an oral or nasal antihistamine) and an oral antihistamine and a decongestant drug with effect. An allergic rhinitis may occur through seasonal or year (a form of perennial rhinitis). The seasonal rhinitis is allergic in general. In 25% of cases, perennial rhinitis is not allergic founded. Seasonal allergic rhinitis (hay fever) is usually caused by plant allergens, which vary according to season. Common plant allergens, spring: tree pollen (eg oak, elm, maple, alder, birch, juniper, olive.) Summer. Grass pollen (. Eg Bermuda grass, timothy, vernal sweet, fruit trees, Johnson) and weed pollen (eg . Russian thistle, English plantain) autumn. Other weed pollen (eg ragweed) The causes are also regional differences. Occasionally, seasonal allergic rhinitis by airborne fungal spores (mold) is caused. The perennial rhinitis caused by an all-season exposure to allergens in the home (z. B. feces of dust mites, cockroaches, animal dander, molds) and by a strong reactivity to pollen in the various seasons. Often allergic rhinitis and asthma are common; but whether rhinitis and asthma episodes of the same allergic process are (hypothesis of disposable airway) or acts rhinitis as a discrete asthma triggers is unclear. The non-allergic forms of perennial rhinitis are infectious, vasomotor, drug-induced (eg., Aspirin or NSAID) and atrophic rhinitis. Symptoms and signs Patients complain of itching in the nose, eyes or throat; Other symptoms include sneezing, rhinorrhea, and obstruction of the nose and sinuses. By a sinus obstruction can cause headaches in the forehead region; Sinusitis is a common complication. It may coughing and sneezing occur, especially if asthma is present. The clearest symptom of perennial rhinitis, chronic nasal obstruction that can in children lead to chronic otitis media; By its nature, the symptoms vary during the year, itching is less prominent than those of seasonal rhinitis. There may be chronic sinusitis and nasal polyps develop. The clinical signs are edematous swollen, bluish-red discolored nasal turbinates, and in some cases of seasonal allergic rhinitis occurs conjunctival and eyelid edema. Diagnosis Clinical survey Occasionally, skin tests, allergen-specific serum IgE tests, or both, the diagnosis of allergic rhinitis can almost always be made solely by the history. Diagnostic examination procedures are not routinely required, unless that is established with empirical treatment no improvement of symptoms; then skin tests can be conducted to a reaction to pollen (seasonal), or feces of dust mites, cockroaches, animal dander, mold, and other antigens (perennial) to show; hereby a guide for additional treatments will be given. Occasionally skin test results are ambiguous or the tests can not be performed (eg. As because patients are taking medicines that affect the results). In this case, an allergen-specific serum IgE test is performed. The presence of eosinophils in the nasal secretions with a negative skin test indicates a Acetylsalicylsäureempfindlichkeit or non-allergic rhinitis with eosinophilia (NARES, nonallergic rhinitis with eosinophilia) out. Non-allergic rhinitis throughout the year is also diagnosed a history generally. The lack of a clinical response to treatment of presumed allergic rhinitis and negative results of the skin tests and / or allergen-specific serum IgE tests also indicate a non-allergic cause; the disorders to consider include nasal tumors, enlarged tonsils, hypertrophied turbinates, granulomatosis with polyangiitis (Wegener’s granulomatosis), and sarcoidosis. Therapy antihistamines decongestants Nasal Corticosteroids For seasonal or severe refractory rhinitis, sometimes desensitization The treatment of seasonal and perennial rhinitis usually no different. In the case of perennial rhinitis attempts should be made to remove allergens or vertmeiden (z. B. elimination of dust mites and cockroaches). Desensitisation in seasonal or severe persistent rhinitis can help immunotherapy for desensitization. The most effective drugs of choice are nasal corticosteroids with or without oral or nasal antihistamines (see Table: Inhaled nasal corticosteroids) Oral antihistamines and decongestants Less effective alternatives to facilitate rhinorrhea provide nasally administered mast cell stabilizers (e.g., cromolyn sodium.), Di- to four times daily, the nasally administered H1-blocker azelastine, one to two puffs twice a day, and 0.03% ipratropium, 2 sprays every 4-6 h, represents. nasal verbarechte drugs are often preferred to oral medications, because less of the drug is absorbed systemically. Inhaled corticosteroids Nasal drug dose per spray First dose (sprays per nostril) beclomethasone 42 ug 6-12: 1 spray twice daily> 12: 1 spray 2 to 4 times daily 32 ug budesonide ?6 years: 1 spray 1- times daily flunisolide 29 micrograms 6-14 years: 1 spray 3 times Täg Lich or 2 sprays 2 times daily Adults: 2 sprays 2 times daily fluticasone 50 ug 4-12 years: 1 spray 1 times a day> 12 years: 2 sprays 1 times daily mometasone 50 micrograms 2-12 years: 1 spray 1 twice daily ? 12 years: 2 sprays 1 times daily triamcinolone 55 micrograms> 6-12 years: 1 spray 1 times a day> 12 years: 2 sprays 1 times a day Inhalation nasal mast cell stabilizers drug dose per spray First dose (sprays per nostril) azelastine 137 ug 5-11: 1 spray 2 times daily> 12: 1-2 sprays 2 times daily cromolyn sodium 5.2 mg ? 6 years: 1 spray 3 times to 4 times daily olopatadine 665 micrograms 6-11 years: 1 spray> 12 years 2 times a day: 2 sprays 2 times daily intranasal saline, often forgotten, helps thick nasal secretions to solve and moisturize the nasal mucosa; various saline kits and irrigators (z. B. squeeze bottles, Ball syringe) are available over the counter or can be prepared by the patients themselves. Specific immunotherapy can be more effective than the perennial allergic rhinitis in seasonal allergic rhinitis; it is recommended if symptoms are severe allergen can not be avoided Drug treatment is insufficient The first Desensibilisierungsversuche should start soon after the end of the pollen season, to be ready for next season; adverse effects increase when starting the desensitization during the pollen season, because at this time the allergic immunity of the patient is already maximally stimulated. Sublingual immunotherapy using 5-grass pollen sublingual tablets (an extract of grass pollen 5) can be used to treat a grass pollen-induced allergic rhinitis. Dosage For adults: A 300-IR (Index of Reactivity) tablet of day for patients aged 10 to 17 years: at the same time a 100-IR tablet on day 1, two 100 IR tablets on day 2, then the adult dose from day 3 to the first dose is given in a medical institution and patients should be observed for 30 minutes after the administration, as anaphylaxis may occur. If the first dose is tolerated, patients can take additional doses at home. Treatment is started four months before the start of each grass pollen season and maintained throughout the season. Patients with allergic rhinitis should wear a prefilled epinephrine syringe to inject yourself with them. Montelukast, a leukotriene blocker relieves symptoms associated with allergic rhinitis, but its role is uncertain in relation to other treatments. Omalizumab, an anti-IgE antibody is currently being studied as a treatment of allergic rhinitis. The use will be limited, however, as cheaper and more effective alternatives are available. The treatment of non-allergic rhinitis with eosinophilia syndrome (NARES) is carried out with nasal administered corticosteroids. A Acetylsalicylsäureempfindlichkeit is by avoiding aspirin and non-selective NSAIDs (may cross-react with aspirin) treated and desensitization and after use leukotriene blockers. Prevention For year-round allergies should be eliminated trigger or avoided. Measures: pillows made of synthetic fibers and impermeable sheets use Frequent washing of sheets, pillowcases and blankets in hot water removing upholstered furniture, stuffed animals and carpets exterminating cockroaches to prevent exposure dehumidifiers in basements and other poorly ventilated, damp rooms treatment of flats water vapor using high efficient air particles and filters (high efficiency particulate air, HEPA) avoidance of triggering food limiting the animal husbandry to certain rooms or outside the home Regular household or home cleaning additional non-allergenic trigger (z. B. cigarette smoke, sharp odors, acrid smoke , air pollution, low temperatures, high humidity) as possible should also be avoided or ko be ntrolliert. Summary Seasonal rhinitis is usually an allergic reaction to pollen. Patients with allergic rhinitis can have the following symptoms: coughing, wheezing, frontal headache, sinusitis, or, especially in children with perennial rhinitis, otitis media. The diagnosis of allergic rhinitis is usually a history; Skin tests and sometimes an allergen-specific serum IgE test is required only if patients do not respond to empirical treatment. First nasally administered corticosteroids are tried as they have the most effective treatments are and few systemic effects.