過敏性鼻炎(英文版)課件

1、Allergic RhinitisAllergic RhinitisCONCEPTAllergic Rhinitis is an IgE-mediated, type 1 hypersensitivity reaction in the mucous membranes of the nasal airway. CONCEPTAllergic Rhinitis is anARIAAllergic rhinitis is defined clinically by nasal hypersensitivity symptoms induced by an immunologically medi

2、ated (most often IgE-dependent) inflammation after the exposure of the nasal mucous membranes to an offending allergen. Symptoms of rhinitis include rhinorrhea, nasal obstruction or blockage, nasal itching, sneezing, and postnasal drip that are reversible spontaneously or under treatment. Allergic c

3、onjunctivitis often accompanies allergic rhinitis. We classified allergic rhinitis as intermittent or persistent according to the duration of symptoms, and as mild or moderate-severe according to the severity ARIAAllergic rhinitis is defin過敏性鼻炎(英文版)課件過敏性鼻炎(英文版)課件BackgroundTotal cost $5.3 billion per

4、 year. (in America)Morbidity 10%-40% ( in China)Classification Perennial allergic rhinitis Seasonal allergic rhinitis (pollinosis)BackgroundTotal cost $5.3 billPathophysiology Allergic reaction is an exaggerated or inappropriate immune reaction and causes damage to the hostType I immediate hypersens

5、itivity reaction mediated by IgE antibodies, which trigger the mast cells and basophils to release pharmacologically active agents. Pathophysiology Allergic react過敏性鼻炎(英文版)課件CLINICALHistory: Obtaining a detailed history is important in the evaluation of allergic rhinitis. Allergy history environment

6、al exposures occupational exposures effects on quality of life Family history Past medical historyCLINICALHistory: Obtaining a dPredisposing factors Genetic factors Increase in exposure to allergen, air pollution and irritants (smoke, gas) Decrease in infections (Worm vs.Wealth-HygieneHypothesis ) F

7、oods StressPredisposing factors Genetic fAllergenHouse dust mitePollen : tree, grass, weedMould spore : Cladosporium, Alternaria, Aspergillus, PenicillumAnimal products : dander, feather, saliva, urine (cat, dog, cow, horse, sheep, etc.)Others : cockroach, flour, foods, etc.AllergenHouse dust miteCL

8、INICALSymptoms and Signs of Allergic Rhinitis Sneezing (paroxysmal) Itching (nose, eyes, ears, palate) Rhinorrhea（watery secretions) Congestion HyposmiaCLINICALSymptoms and Signs of SignsNasal crease (allergic salute).SignsNasal CreaseNasal CreaseSignsAllergic shiners Nasal examination :swollen (bog

9、gy), pale, blue-gray mucosaSignsAllergic shinersAllergic rhinitis: ClassificationSeasonal Outdoor allergens ( pollens, moulds)Perennial Indoor allergens ( dust mites, moulds, insects, animal dander)OccupationalAllergic rhinitis: ClassificatAllergic rhinitis: ClassificationIntermittent The symptoms a

10、re present less than 4 days a week or for less than 4 weeksPersistent The symptoms are present more than 4 days a week or for more than 4 weeksAllergic rhinitis: ClassificatAllergic rhinitis: ClassificationMild None of the following items are presentSleep disturbance Impairment of daily activities,

11、leisure and/or sportsImpairment of school or workTroublesome symptomsModerate-severe One or more of the above items are presentAllergic rhinitis: ClassificatLab Studies Total serum IgEFinding allergen Common allergen: Perennial: house dust ,mite ,fungus, pollen chemical material Seasonal: pollen ( s

12、unflower, corn , glass )Lab Studies Total serum IgELab StudiesFinding allergen a. Skin testing: prick test （點(diǎn)刺試驗(yàn)） intracutaneous test （皮內(nèi)試驗(yàn)） b. Nasal allergen challenge test c. Serum special IgE determinationLab StudiesFinding allergenDiagnosishistoryClinical manifestationAllergy diagnosisDiagnosish

13、istoryAllergic rhinitis : Diagnosis (I)History Symptoms sneezing, nasal itching, rhinorrhea, nasal obstruction, hyposmia Personal atopic diseaseGeneral ENT examination pale, boggy, edematous mucosa allergic stigmata : shiners, allergic salute, nasal crease, adenoidal faceAllergic rhinitis : Diagnosi

14、s Allergic rhinitis : Diagnosis (II)Blood eosinophil countNasal cytology (nasal smear) : eosinophiliaAllergic rhinitis : Diagnosis Allergic rhinitis : Diagnosis (III)Total serum IgESpecific IgE Skin test : Prick test, Intradermal test Serum specific IgE : RAST, MAST, FAST, CAP Allergic rhinitis : Di

15、agnosis Allergic rhinitis : Diagnosis (IV)Nasal provocation test (challenge test)Other assessments nasal airway (rhinomanometry, AR), olfaction, radiology, bacteriology, mucociliary functionAllergic rhinitis : Diagnosis Differential DiagnosisVasomotor rhinitis 血管運(yùn)動性鼻炎Differential DiagnosisVasomotoCo

16、mplicationAllergic sinusitis過敏性鼻竇炎Asthma哮喘Secretory otitis media分泌性中耳炎ComplicationAllergic sinusitiTreatmentMedical Care (1) Avoidance Environmental controls and allergen avoidance (2) Pharmacotherapy (3) Immunotherapy TreatmentMedical Care Treatment(2) Pharmacotherapya. Steroid: topicalnasal steroi

17、d sprays generalb.Antihistamines: H1-receptor antagonist First-generation: toldrin (drowsiness ) 2nd/ 3rd -generation:clarity (dont cross the blood- brain barrier)c.Mast cell stabilizing drug: disodium cromoglycate d. DecongestantsTreatment(2) PharmacotherapyTreatment(3) Immunotherapy Exact mechanis

18、m unknown Decrease allergen-specific IgE levels Increase allergen-specific IgG levels IgG molecules ( blocking antibodies that are important in impeding the allergic reaction. )TreatmentTreatment(3) Immunotherapymethod: increasing doses of injected allergen until the maximum tolerated dose is reache

19、d maintenance dose(maximum tolerated dose ) course: 2 years or more Treatment(3) ImmunotherapyTreatmentSurgical Care: Surgical care is not indicated for allergic rhinitis but may be indicated for comorbid or complicating conditions.TreatmentSurgical Care: SurgicPatient EducationEducate patients on e

20、nvironmental control measures, which involve both the avoidance of known allergens (substances to which the patient has IgE-mediated hypersensitivity) and the avoidance of nonspecific, or irritant, triggers Patient EducationEducate patieAllergic rhinitis : Treatment1. Allergen avoidance: environment

21、al control2. Drug therapy Antihistamines (H1 receptor antagonists) Decongestants (-adrenergic agonists) Mast cell stabilizing drug Corticosteroids 3. Immunotherapy4. Surgery: turbinate or septal surgeryAllergic rhinitis : Treatment1Pollen avoidance measuresAttention to pollen forecastStay inside hou

22、se when pollen count is highKeep window and doors closed when pollen count is highThe use of high efficiency particulate filterConsider using face mask and eyeglasses outside houseGargling, washing eyes and nose-blowing on returning inside the houseAvoid high pollen areasPollen avoidance measuresAtt

23、enHouse dust mite control (I)BedroomRemove feather pillows replace with synthetic ones and wash them frequentlyChange woolen blankets to cotton cellular ones and wash frequentlyRemove carpeting if possibleVacuum the mattress, pillows, around the base of the bed and bedroom floor each weekUse HDM-impermeable mattress and pillow coverHouse dust mite control (I)BedHouse dust mite control (II)Each week change