Definition

It is an IgE mediated inflammation following exposure to allergen resulting in the running and blocking of nose, itching and sneezing.

Etiology/Risk Factors

•           Genetics and family history

•           Environment:    developed    urbanization,    lifestyle    changes, increased exposure to allergen, dietary modification.

Clinical Features

•           Paroxysmal sneezing, rhinorrhoea and itching of nose.

•           Perennial allergic inflammation -nasal obstruction, poor sense of smell.

•           Allergic crease or allergic salute on nasal dorsum at junction of cartilaginous and bony part of nose.

•           Allergic nasal mucosa bilaterally swollen, pale or bluish in colour, oedematous and covered with watery secretions.

Lab Diagnosis

•           TLC, DLC

•           Blood test for allergy (total IgE, specific IgE)

Management

A.  Non - Pharmacological

•           Allergen avoidance.

•           Environmental control.

•           Encase mattress and pillows in plastic covers or special allergen proof fabric.

•           Remove objects that accumulate dust or place in a cabinet.

•           Remove carpets, replace with washable rugs, install hardwood floor.

B.  Pharmacological

1.   Antihistamines

•   Cetirizine (Oral)

Adults                                   5-10mg once daily

Children (4-6yrs)                2.5mg once daily to max of 5mg a day (6 yrs and older)        5-10mg once daily

•   Fexofenadine (Oral)

Adults                                  180mg PO once daily

Children                               30mg PO twice daily (not recommended in<2yrs of age)

•   Loratidine (Oral)

Adult                                      10 mg P0 once daily

Children            5mg P0 once daily

2.   Topical Steroids

Fluticasone, mometasone, beclomethasonedipropionate, budesonide, flunisolide acetate reduce inflammation and hyperreactivity, nasal symptoms, eye symptoms and improve sense of smell.

3.   Sodium cromoglycate               2% solution for nasal drops or spray or as an aerosol powder.

4.   Decongestants                             Xylometazoline nasal drops

5.   Systemic corticosteroids                                            for     very     severe     symptoms during hayfeverfor short duration.

Can be combined with topical steroids.

6.   Anti leukotrienes                                   Montelukast Adult     10mg once a day

Children                                5mg once a day

7.   Nasal douching                             improves quality of life.

8.    Immunotherapy - updosing phase involves weekly injections for 8-16 weeks followed by maintenance injections at 4-8 weeks intervals for 3 to 5 years.