Allergic Rhinitis Ebook

Hay Fever and Allergies

This eBook addressed the real causes of seasonal allergies like hay fever and other irritating health problems, and provides more informed solutions based on recent research into how to stop allergies at the system level. It doesn't take much now to be able to get rid of allergies, without having to see a doctor, pay huge medical and pharmaceutical bills, or fill your body with chemicals that do more harm than good to your system. However, if you are a doctor or run a clinic of any kind, you can learn things that you can apply to your own clinic to provide maximum benefit to you and your patients. Keep yourself informed with real research! When you find the underlying causes of allergic rhinitis (the medical term for hay fever) you will be far more informed on how to fight this in your own body. Take the natural way to heal yourself!

Hay Fever and Allergies Summary

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Author: Case Adams
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Epidemiology and Risk Factors

The strongest risk factors for developing asthma are exposure to household smokers and a family history of asthma or atopy (asthma, atopic dermatitis, or allergic rhinitis). Family history of nasal polyps or aspirin hypersensitivity can also suggest risk for IgE-mediated atopic disease. Data are mixed on the impact of early childhood infections and bottle feeding versus breastfeeding on the development of asthma, although both are clearly associated with wheezing episodes in the first 3 years of life. Data showing a paradoxical protective effect of early childhood exposure to pets, farm animals, and bacterial antigens are still controversial (Adler et al., 2005 Platts-Mills et al., 2005 Remes et al., 2005 Waser et al., 2005).

Understanding Food Allergies

The most common food culprits linked to allergic reactions are wheat, shellfish, nuts, soybeans, corn, the protein in cow's milk, and eggs. Furthermore, the organs most commonly affected are the skin (symptoms include skin rashes, hives, itching, and swelling), the respiratory tract (symptoms include difficulty breathing and hay fever ), and the gastrointestinal tract (symptoms include nausea, bloating, diarrhea, and vomiting). Some allergic reactions are so severe they can even provoke anaphylactic shock, a life-threatening, whole-body response that requires immediate medical attention.

Allergic Conjunctivitis

Allergic conjunctivitis is frequently found in pediatric patients and adults. It is usually seasonal, most often the spring and fall. Although often associated with allergic rhinitis, allergic conjunctivitis may occur without systemic symptoms. There is an increase in itching, redness, and swelling, which is variable from day to day. Seasonal allergic conjunctivitis is related to tree and grass pollens, each of which has a distinct season and severity. The condition may be asymmetric. Chronic allergic conjunctivitis is most often related to various indoor allergens, including dust mites, animal dander, molds, and cockroaches. Cats are especially irritating to the eye for the allergic patient.

Obstructive Sleep Apnea

The introduction in the 1980s of continuous positive airway pressure (CPAP) administered via a nasal mask revolutionized the management of OSA. '251 Nasal CPAP functions as an air splint to maintain positive intraluminal pressure in the upper airway. Although nasal CPAP can be used by children as well as by adults and is effective in 80 to 90 percent of patients, the proportion who use CPAP on a regular basis is substantially less. If nasal obstruction prevents the use of nasal CPAP, treatment with decongestants, steroid inhalers, septoplasty, or other forms of nasal surgery may be required. Other factors that may prevent the use of CPAP or reduce its benefit include a poorly fitting or uncomfortable mask, sinus infections, claustrophobia, chronic mouth breathing, incomplete efficacy, and lack of motivation. The more expensive bilevel positive airway pressure (BPAP) devices provide different pressures during inspiration and expiration, and are sometimes better tolerated, particularly...

The pathogenesis of atopic dermatitis

Langerhans Skin Cells Images

The skin is much more than just a protective coat and encounters a high number of antigens at the interface between the body and the surrounding environment.1,2 Atopic dermatitis (AD) is a chronic inflammatory skin disease, clinically and histologically very similar to contact dermatitis. AD can occur at any age and has a high prevalence in children. In past years, the rising interest in this disease has been forced by its increasing prevalence in Western societies and its contribution to the worsening of health care costs.3 AD offers a wide clinical spectrum ranging from minor forms presented by a few dry eczematous patches to major forms with erythematous rash.4 Cardinal features of AD are erythematous eczematous skin lesions, flexural lichenifications or papules which go along with an intense pruritus and cutaneous hyperreactivity.5,6 Various names, such as atopic eczema, neurodermitis constitutionalis, endogenous eczema, eczema flexurarum, Besnier's prurigo, asthma eczema, or hay...

Temperament and Personality

Several studies have also suggested that there is an association between childhood medical conditions and the subsequent development of anxiety. Kagan et al. (1984) reported an association between allergic symptoms, particularly hay fever, and inhibited temperament in young children. In a retrospective review of pre- and perinatal and early childhood risk factors for different forms of psychiatric disorders in adolescence and early adulthood, Allen et al. (1998) found that anxiety disorders in adolescents were associated specifically with illness during the first year of life, particularly

The clinical manifestations of atopic dermatitis

Dennie Morgan Fold

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease related to other atopic symptoms like allergic rhinitis, allergic conjunctivitis, and asthma. AD usually starts before the age of 2 years and is the first of the atopic symptoms that shows clinical signs. Patients with AD have an increased risk of developing other atopic symptoms later in life. Both endogenous and exogenous factors interact in the development of clinical signs of the disease. Hereditary factors are important, but exogenous causes like the cold climate, stress and pollen are usually necessary to develop clinical symptoms. The term atopic dermatitis was introduced by Wise and Sulzberger in 1933 as a skin disease characterized by dry skin, pruritus, and chronic relapsing erythematous lesions.1 The name 'atopy' comes from the Greek meaning 'wrongly placed'. Coca et al had introduced the term atopy to describe a hereditary disorder different from anaphylaxis which was clinically characterized by hay...

Genetic dissection of eczema

Treatment Genetic Diseases Strategies

Eczema is a chronic inflammatory skin disease that is characterized by intense pruritus. In the industrialized countries the prevalence of eczema is approximately 15 with a steady increase over the last decades.1,2 Along with asthma and allergic rhinitis, eczema is commonly associated with the state of atopy which is characterized by the formation of allergy antibodies (IgE) to environmental allergens. Eczema is commonly the first clinical manifestation of allergic disease. Onset of disease is observed during the first year of life in 57 and during the first 5 years in 87 of patients.3 For the majority of affected children eczema heralds a lifetime of allergic disease. The development of atopic disease often follows an age-dependent pattern that is known as the 'atopic march'.4 A susceptible child commonly passes a characteristic sequence of transient or persistent disease stages that begins with eczema and food allergy in the young infant and continues with the development of...

Patient Encounter Part 2 The Medical History Physical Exam and Diagnostic Tests

PMH Allergic rhinitis for 6 years (allergic to dust mites per skin testing no other allergies positive on the skin testing panel). Bronchitis 3 times in the last 6 years (all treated with azithromycin and Robitussin DM) last episode 6 months ago. Hospitalized with viral lower respiratory tract infections twice at ages 1 and 2. FH Mother had asthma as a child, but outgrew it and has had no problems with it since she was 12 or 13 years old both her mother and father have allergic rhinitis.

Levocarnitinein Libido

Labyrinthitis, nausea and vomiting with, 358t Lacrimation, in opioid withdrawal, 619 Lactase deficiency, 376 Lactase tablets, 380 Lactated Ringer's solution, 482, 482t in dehydration, 1268t in hypovolemic shock, 256a, 257 in intra-abdominal infections, 1285 Lactation, 821-838 AAP table, 829 allergic rhinitis in, 1059 antimicrobials in, 1165 bacterial vaginosis in, 825, 833-834 breast infections in, 837-838 depression in, 665 drug, 829, 829t in allergic rhinitis, 1051t, 1056, 1060t Leuprolide in allergic rhinitis, 1053, 1054t supplementation during hemodialysis, 472 Levodopa in allergic rhinitis, 1049-1050 in cirrhosis, 394 in constipation, 373 in erectile dysfunction, 885 in GERD, 317, 319, 320t in hyperlipidemia, 234, 236t, 240, 958 in hypertension, 58-59, 59t, 957-958 in ischemic heart disease, 117-118 in musculoskeletal disorders, 1027-1028 in osteoarthritis, 1000 in Parkinson's disease, 557 in urinary incontinence, 914 Lifting, in enuresis, 9231 Lifting techniques, 1028 Ligament,...

Acupuncture Yoga and Homeopathic Remedies

Known for his groundbreaking research showing homeopathic treatment of allergic rhinitis more effective than placebo (Taylor et al., 2000), David Reilly of Glasgow, Scotland, commented on the increasing scientific validation for homeopathy over the past decade. Noting that studies reviewed show positive evidence for overall effect and citing the growing prospective, observational research that indicates beneficial outcomes, Reilly (2005) points out that homeopathy can offer therapeutic options when conventional care has failed or reached a plateau, no conventional treatments exist, conventional treatments are contraindicated, side effects of conventional treatments are not tolerated, and patients are reluctant to accept conventional care. An important distinction clouds other areas of medical research The two dimensions of care need to be considered the direct effects of the remedy and the therapeutic impact of the method of approach on the patient. Believing that the homeopathic...

Exercise Induced Bronchospasm

Exercise-induced asthma or, more accurately, exercise-induced bronchospasm (EIB) is a transient narrowing of the airways following vigorous exercise. Ninety percent of known asthmatics and 40 of patients with allergic rhinitis have bronchoconstriction caused or worsened by exercise (Feinstein et al., 1996). In some patients, the only manifestation of airway hyperresponsiveness is EIB, with up to 50 of athletes having EIB in some high-risk sports (Langdeau and Boulet, 2001). the addition of a leukotriene modifier (e.g., montelukast, 10 mg) taken at least 1 hour before exercise can provide additional relief (Coreno et al., 2000). Another treatment alternative is an inhaled mast cell stabilizer (e.g., cromolyn) before exercise. Inhaled corticosteroids are not as useful for acute prophylaxis because of their delayed onset of action, but can be very useful in patients with chronic persistent asthma and EIB. Any underlying chronic asthma or allergic rhinitis should also be optimally...

Placebo Effect Of Aromatherapy

Placebo effects have been shown to relieve postoperative pain, induce sleep or mental awareness, bring about drastic remission in both symptoms and objective signs of chronic diseases, initiate the rejection of warts, and other abnormal growths, and so on (Weil, 1983). Placebo affects headaches, seasickness, and coughs, as well as have beneficial effects on pathological conditions such as rheumatoid and degenerative arthritis, blood cell count, respiratory rates, vasomotor function, peptic ulcers, hay fever, and hypertension (Cousins, 1979). There can also be undesirable side effects, such as nausea, headaches, skin rashes, allergic reactions, and even addiction, that is, a nocebo effect. This is almost akin to voodoo death threats or when patients are mistakenly told that their illness is hopeless both are said to cause death soon after.

Put a Close to the Runny Nose

Herbal medicine is frequently used with acupuncture to alleviate sinus pressure and stop your waterfall nose. I've instructed patients to use biomagnets as a self-care home treatment in between visits. All of these techniques have worked well for relieving and sometimes completely ending chronic allergy complaints. A word of advice, though start treatment of allergic rhinitis a few months before the allergy season hits. This will give your body a chance to change in order to lessen or eliminate the seasonal symptoms.

Diagnostic Tools in Pulmonary Medicine History and Physical Examination

In addition to general history-taking, a detailed history of respiratory exposures and risk factors is essential. Smoking is perhaps the most important pulmonary risk factor. A detailed smoking history includes age of first smoking, quantity smoked, number of years as a smoker, other tobacco use, previous attempts to quit, and an assessment of the level of nicotine addiction. Family history can reveal relatives with immunoglobulin E (IgE)-mediated allergy or atopy (allergic rhinitis, asthma, eczema, nasal polyps, or aspirin hypersensi-tivity) or even more serious genetic risk factors, such as cystic fibrosis or a1-antitrypsin deficiency. Perinatal history of premature birth, neonatal respiratory failure, and ventilator care can lead to bronchopulmonary dysplasia and chronic lung disease in children who survive neonatal intensive care.

Concepts of Addiction The US Experience

Pure cocaine proved extraordinarily popular. Within a year of its introduction in the United States in 1884, Parke, Davis & Co. offered cocaine and coca in 14 forms. Cocaine was expensive, but soon became an ingredient in the new drink Coca-Cola and was found to be a specific remedy for hay fever and sinusitis. Within a few years, reports appeared in medical journals and the popular press telling of ruined careers and bizarre behavior among some users, but eminent experts such as William A. Hammond, a professor of neurology in New York medical schools and a former surgeon-general of the U.S. army, reassured the profession and the public that cocaine was harmless and the habit no more severe than that of drinking coffee.

Large Number Of Different Skin Diseases

Typically, this condition is characterised by itching, dry skin and inflammatory lesions especially involving skin creases. Patients suffering from atopic dermatitis may also develop IgE-mediated allergic diseases such as bronchial asthma or allergic rhinitis. An overall cumulative prevalence of between 5 and 20 has been suggested by the age of 11. Around 60-70 of children are clear of significant disease by their mid-teens. Even if genetic factors seem to play a major role, environmental factors such as allergens and irritants are important and there is reasonable evidence to suggest that the prevalence has increased

Hypersensitivity Reactions

Immediate hypersensitivity reactions occur within 8 h of secondary allergen exposure and are not cell-mediated, but humoral in nature, resulting in generation of antibody-secreting plasma cells and memory cells. The hypersensitivity reactions may be classified into type I (IgE-dependent), type II (antibody-mediated cytotoxicity), type III (immune complex-mediated hypersensitivity) and type IV (delayed type hypersensitivity) and are shown in Table 24.1. Type I reactions are mediated by IgE antibodies which bind to receptors on mast cells or basophils, leading to degranulation and release of mediators. The principal effects are smooth muscle contraction and vasodilatation, and these may result in serious life-threatening systemic anaphylaxis, asthma, hay fever and eczema. Table 24.2 shows common antigens associated with type I reactions.

Pulmonary Defence Mechanisms

Inhaled air contains particles of dust and airborne bacteria and viruses. The respiratory system contains several defence mechanisms to protect the lower airways and alveoli. The primary defence is the nose with its lining of mucus-producing ciliated epithelium. The turbinates ensure turbulence, thus avoiding streaming of the inhaled air. The nasal mucosa becomes engorged and secretes extra mucus in response to inhaled irritants, as every hay fever sufferer knows. The tracheobronchial tree is also lined with ciliated epithelium and equipped with mucus glands. The cilia sweep the mucus coat with the entrapped particles towards the pharynx where it is swallowed with the saliva. Coughing also contributes.

Epidemiology and etiology

Rhinosinusitis is one of the most common medical conditions in the United States, affecting about 1 billion people annually.1 It is caused mainly by respiratory viruses but also can be caused by allergies or environmental irritants. Viral rhinosinusitis is complicated by secondary bacterial infection in 0.5 to 2 of adults and 5 to 13 of children.23, 4 Upper respiratory infections of less than 7 days' duration are usually viral, whereas more prolonged disease or severe symptoms are often caused by bacteria. Risk factors for ABRS include prior viral respiratory infection, allergic rhinitis, anatomic defects, and certain medical conditions23, 5 (Table 72-3).

Allergic conjunctivitis Etiology

Ocular allergy is a broad term that includes several diseases with the hallmark symptom of itching, often accompanied by tearing, conjunctival swelling, and nasal congestion.14 Seasonal ocular allergy is the most common type of allergic conjunctivitis. This is an IgE-mediated hypersensitivity to pollen or other airborne allergens.11 Often, the patient's history is positive for atopic conditions such as allergic rhinitis, asthma, or eczema.14 Perennial allergic conjunctivitis has similar but less severe symptoms and may not be tied to a specific time of year. Finally, conjunctivitis medicamentosa is a contact allergy to a topical medication, often an antibiotic.11

Patient Encounter Part

There may be similarities and differences in illnesses such as infections, asthma, allergic rhinitis, attention deficient hyperactivity disorder, diabetes, and seizure disorders between children and adults. These have been discussed throughout the textbook. The incidence of previously common childhood illness such as measles, mumps, and rubella has significantly decreased as a result of en masse vaccination of infants and children. The Advisory Committee on Immunization Practices (ACIP) within the CDC release and update child and adolescent immunization schedules every year. Patients' immunization records should be reviewed routinely for needed immunizations based on these schedules. , Most of the common illnesses in children leading to missed school and or need for clinician consultation are ambulatory in nature however, some complications may require hospitalization.

Treatment Nonspecific Measures

Removing known allergens is of prime importance because it can eliminate symptoms. When exposure is unavoidable, environmental control should reduce symptoms and prevent exacerbations. The patient or the family must assume responsibility for environmental control, so an understanding of allergens is helpful. Commonly inhaled allergens include pollens, which can produce symptoms of seasonal allergic rhinitis, conjunctivitis, and asthma. Allergenic pollens come from trees, grasses, and weeds. Pollens from flowering plants are insect-borne and are not important allergens. Pollen prevalence is usually determined by gravity slides, which sample pollen fallout without regard to wind direction, speed, and turbulence, so that daily reports of pollen prevalence often do not reflect the true concentration in the air or individual exposure.

Specific Immunotherapy

When skin tests identify sensitivity to an unavoidable inhalant allergen, immunotherapy may be indicated for treating allergic rhinitis. Its efficacy has been shown to be 80 for controlling pollen symptoms and 60 for controlling mold and house dust symptoms. Immunotherapy is therefore more effective in seasonal allergic rhinitis than perennial allergic rhinitis. When considering immunotherapy, the ease of control of other therapies should be weighed against the frequency and severity of symptoms as well as the possibility of complete resolution of allergy with immunotherapy.

Other Pulmonary Diseases of the Pulmonary Vasculature

Diffuse alveolar hemorrhage may result from autoimmune collagen vascular disease or vasculitis, Goodpasture's syndrome, and other vasculitides. Goodpasture's syndrome results from the formation of anti-glomerular basement membrane antibodies, which can also attack the lung capillary membranes. Primary pulmonary vasculitides affect mostly small vessels, but systemic conditions can affect vessels of all sizes. Churg-Strauss syndrome is a small-vessel vasculitis that often manifests first as asthma. Most patients also have maxillary sinusitis, allergic rhinitis, or nasal polyposis. Gastrointestinal, neurologic, and cardiac involvement often follows. The condition responds well to systemic steroids, but patients can require long-term low-dose prednisone as maintenance therapy (Guillevin et al., 2004).

Clinical History

In patients complaining of anosmia or hyposmia, it is useful to ask whether smell function is diminished or completely lost, localized to the right or left nostril, or both, and whether the dysfunction is for all odorants or only a few. Patients with loss due to nasal sinus disease are more likely to experience a gradual loss of function than those who have loss due to a prior upper respiratory infection or to head trauma. 1 Some patients report temporary recovery of function in circumstances in which nasal patency is increased, such as on warm days or during exercise, showering, or treatment with corticosteroids this implies a problem with intranasal airway blockage (as in allergic rhinitis) rather than a sensorineural problem.

Clinical Problems

Complaints related to the nose and sinuses are among the most common seen in a family medicine practice. Acute rhinitis (the common cold), allergic rhinitis, and sinusitis compose the vast majority of these complaints and, taken together, result in an enormous socioeconomic impact in terms of missed workdays and schooldays and pharmaceutical costs. Nasal complaints are usually related to nasal congestion, rhinorrhea, bleeding, facial pressure or pain, headache, cough, otalgia, facial or periorbital swelling, altered (diminished, absent, or distorted) sense of smell, or postnasal drainage.

Control of Symptoms

Antihistamines are effective for symptomatic control of allergic rhinitis, whether it is seasonal or perennial (Bousquet et al., 2008 Wallace et al., 2008 SOR A). For optimal results, antihistamines should be used before exposure to the known allergen. Complete control might not be achieved when patients use antihistamines only sporadically. During the implicated season, around-the-clock administration provides maximal symptomatic relief. Because compliance is always an issue, the new second-generation antihista-mines offer a convenient dosing regimen (Table 20-2). These groups of drugs, with specific binding properties, allow little to no penetration into the central nervous system (CNS), thus greatly reducing their side effects, primarily sedation. The second-generation antihistamines also have antiinflammatory effects. Fexofenadine (Allegra), an analog of terfenadine, is safe and effective. Through its effects on T cells, fexofenadine can decrease airway inflammation. Loratadine...

Allergies Aahh Choo

I remember having mixed emotions about the coming of spring, because I suffered from hay fever. The winter was over, the sun was out but so were tree pollens and grasses. If you've ever had seasonal allergies (allergic rhinitis), you know the feeling itchy, watery eyes, waterfalls from your running nose, irritability, fatigue, sneezing, and more sneezing. At first you might think it's a cold, but allergies do not come with a fever, and the nasal discharge is runny and clear, instead of the yellow-to-green thicker stuff that's typical of a cold.

Paranasal sinuses

Acute inflammatory sinusitis is seen in patients with acute seasonal allergic rhinitis, commonly known as hay fever. As such, this condition is seldom diagnosed and the treatment relies on treating the inflammatory rhinitis Chronic inflammatory sinusitis occurs in people with allergic nasal conditions (asthma, allergic rhinitis, aspirin sensitivity). It is usually associated with an allergic or inflammatory rhinitis, which is characterised by boggy swelling of the nasal mucosa. Patients present with nasal obstruction, a feeling of congestion, pressure between the eyes and over the nasal bridge and postnasal discharge of mucus. Treatment includes long-term low-dose topical nasal corticosteroids. Antihistamines may be of value in acute flare-ups.

Prognosis

In most infants and young children, dietary management of food allergies and topical treatment with corticosteroids will successfully control the manifestations of AD. The severity of food allergy-related AD usually decreases towards the end of the second year. Elimination diets can be progressively relaxed as the infant develops tolerance to the offending food item. About 85 of infants with CMA and about 50 of egg allergies will develop tolerance by 3 years of age.55,58 In contrast, only about 20 of children with allergy to peanut or tree nuts will become tolerant.153 Although allergen avoidance appears to hasten the subsequent development of antigen tolerance it remains unclear to what extent dietary manipulations alter the course of food allergies.143,154 Persistence of AD may be associated with sensitization to inhalant and environmental allergens, particularly to house dust mite. Infants with AD may therefore be at increased risk of other atopic manifestations in relation to...

Airways Diseases

Airway obstruction is a common and important feature of some respiratory diseases. It can be acute, 'semi-chronic' (e.g. due to cancer) or chronic. The chronic obstructive airway diseases can be divided into whether the obstruction is reversible or not. In the former case the patient usually has asthma, in the latter case chronic obstructive pulmonary disease, abbreviated COPD. These disease concepts lack precise definitions, and the division is only meant as a first approximation. Both diseases are inflammatory diseases mainly of the lower respiratory tract in asthma there is an inflammatory process mainly in the central airways, whereas the inflammation of COPD is predominantly peripheral with progressive destruction of lung tissue. Inflammation in the upper respiratory tract, i.e. rhinitis, is characterised by both acute and chronic conditions, the most distinctive being seasonal hayfever. Rhinitis can be allergic or non-allergic, where the latter is characterised by presence of...

Adjunctive Therapy

Tain patients. ' Analgesics can be used to treat fever and pain from sinus pressure. Oral decongestants relieve congested nasal passages but should be avoided in children younger than 4 years of age and patients with ischemic heart disease or uncontrolled hypertension. Intranasal decongestants can be used for severe congestion in most patients 6 years of age or older, but use should be limited to 3 days or less to avoid rebound nasal congestion. Guaifenesin is often used as a mucolytic with no evidence to support its use in rhinosinusitis. Antihistamines should be avoided because they thicken mucus and impair its clearance, but they may be useful in patients with predisposing allergic rhinitis or chronic sinusitis. Similarly, intranasal corticosteroids usually

Norwegian Scabies

Pictures Norwegian Scabies

Atopic dermatitis, a form of eczema, is a common disease associated with other atopic diseases such as asthma and allergic rhinitis. It is characterized by itchy, dry, inflamed skin. The symptoms of atopic dermatitis often begin at a young age. Infants and young children may have eczematous patches on the face, scalp, and extensor surfaces of the extremities. These patches may erode and ooze. Scaling erythematous plaques often develop. As the child grows older, the atopic dermatitis begins to involve the flexural areas such as the neck, antecubital

Rhinitis

Allergic Rhinitis Seasonal allergic rhinitis affects 10 to 30 of adults and up to 40 of children in the United States. Although half the patients with allergic rhinitis have symptoms for only 4 months per year, 20 experience symptoms more than 9 months per year. Direct medical costs of treating this condition plus indirect costs of lost productivity and absences from work or school are estimated at up to 2.4 billion per year in the United States. Unfortunately, seasonal allergic Understanding the immunologic mechanisms of seasonal allergic rhinitis directs the physician to the appropriate therapy. Allergens such as pollens are deposited on the nasal mucosa and processed by macrophages. The allergens are then brought to T lymphocytes and B cells, the latter producing immunoglobulin E (IgE), which in turn attaches to receptors on mast cells and basophils, causing the release of histamine and other inflammatory substances. The action of these substances on the nasal mucosal cells and...

Sinusitis

Sinusitis represents one of the most common disorders requiring antibiotic treatment in adults. The challenge to the clinician in evaluating the patient with possible sinusitis is to differentiate viral URI, allergic rhinitis, and even a migraine headache, which do not require antibiotics, from bacterial sinusitis, which does respond to antibiotic treatment. There still seems to be a public perception that antibiotics hasten recovery from the common cold. Some physicians prescribe antibiotics in these situations, not wanting to disappoint the patient and seeing no significant risk. In fact, evidence suggests that there is a greater likelihood of harming rather than benefiting the patient with inappropriate use of antibiotics (Scott and Orzano, 2001). The emergence of bacteria highly resistant to broad-spectrum antibiotics has forced the medical community to modify its behavior regarding the treatment of URIs. Antibiotics should not be prescribed unless a bacterial infection is certain...

Manifestations

In seasonal allergic rhinitis, exposure is followed by complaints of paroxysmal sneezing, a watery nasal discharge with congestion, and nasal pruritus. Conjunctival and pharyngeal itching often occurs. Less specific symptoms are postnasal drainage or fullness or aching in the frontal areas. In perennial allergic rhinitis, nasal congestion, itching, obstruction, and frequent sniffing may be associated with a loss of sense of taste or smell, with decreased hearing and a popping sensation in the ears. A lower sneezing threshold often occurs with altered autonomic reflexes in perennial allergic rhinitis. Paroxysms of sneezing and rhinorrhea can result from changes in ambient temperature, head movement, odors from perfume, tobacco smoke, irritants, alcohol, and exposure to small quantities of antigen. Exercise reverses nasal congestion temporarily, from minutes to hours. The turbinates are usually swollen and edematous and may be mistaken for nasal polyps, which are pearl-gray gelatinous...