Allergic Rhinitis Classification

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Allergic Rhintis is a problem of the nasal passages cause by the infection of the nasal mucosa through the IgE and the resultant exposure to trigger of Rhinitis.

Symptoms of allergic rhinitis are : Nasal drip; blocked nose; itching of the nose; sneezing.

These symptoms may recede spontaneously or through medication.

Previously allergic rhinitis was classified as :

Seasonal
Perennial
Occupational
The modern classification of allergic rhinitis is based on :
Symptoms and extent of effect on lifestyle.
Intermittent or persistent
Mild to moderate to severe
Causes

Triggers :

airborne triggers, particularly household triggers have caused a rise in allergic rhinitis, asthma and other allergies in the present era.

Household triggers include mites, pet animals, insects and fluff from plants

A less evident allergic problem, than occupational rhinitis and asthma are symptoms occurring in the nose and the bronchus.

Latex from trees are a cause of concern for patients and health professionals, and they have to be conscious about the problem and take appropriate preventive measures and course of treatment.

Infected matter :

Infected matter can enhance symptoms of allergic rhinitis

We now know in more detail the mechanism by which infected matter can be a trigger of rhinitis and escalate the symptoms.

Household air pollution is an important aspect for discussion.

In the advanced countries, people spend more than 80 per cent of the time inside houses and offices.

Household pollution include household triggers, household infected matter, and cigarette smoke.

In many countries, urban pollutants include vehicle emissions, and atmospheric pollutants include Nitrous Oxide and Sulphur Dioxide.

Diesel vapours increase the possibility of IgE creation and allergic inflammation

Aspirin :

Aspirin and non-steroidal anti-inflammatory drugs (NSAID), can cause allergic rhinitis and asthma

Mechanism of infection :

Allergic rhinitis is caused by inflammation through IgE.

The significant aspect in allergic rhinitis is conglomeration of inflamed cells which include the mechanisms of :

Chemotoxic, selective recruitment and transepithelial migration of cells.

Secretion of chemical substances such as cytokenes and chemokines

Creation and differentiation of cells -eosinophils, T-cell, mast cell and epithelial cells

Extending of cell life

Expelling of chemical substances such as histamine and cystenyl leukotrines (Cyst LT) by cells

Linking of bone marrow with the immune system

The nose is sensitive to allergic rhinitis due to reaction to triggers whereby sneezing, nasal drip and nasal congestion occur. Sensitivity can occur if the nose is exposed to pollen. This can cause transformations in the nasal mucosa.

For perennial rhinitis the triggers set off reactions and their interactions continue. Intermittent rhinitis is a newer and important aspect.

For patients with perennial rhinits, exposure to triggers is much less. Though the patient may not display and symptoms, the inflammation of the nasal mucosa persists.

For an appropriate medical management of allergic rhinitis, the basis will have to be inflammation of the nasal mucosa, not just the appearance of symptoms.

Diagnosis :

Examinations for diagnosing allergic rhinitis :

Detection of free or cell-connected IgE is undertaken.

With improved methods, the levels of the triggers can be determined for correct diagnosis and prevention. These preventive measures are by use of inhalants.

Examination of hypersensitive skin :

This examination observes the comprehensive reaction to IgE, and is an important test for determining rhintis if undertaken appropriately.

The tests must be carried out by trained health professionals to get accurate results.

Determining allergy levels in the blood is as important as for skin.

Management of the disease :

Elimination of triggers. The treatment method is based on research on asthmatic conditions, but there is not enough research on allergic rhinitis.

Eliminating a single trigger is not enough for management of allergic rhinitis or asthma

House dust mite must always be eliminated for appropriate management of the disease

To eliminate the triggers and manage the disease, sufficient evidence of symptoms of the disease is required

Management of the disease is by medication, definitive treatment for curing infection, educating patients about the disease. In specific cases surgery is indicated.

These recommendations are techniques for safe and efficient treatment of the upper and lower nasal tracts affected by allergic rhinitis.

Persons with perennial and severe allergic rhinitis should consult the doctor.

Source : Allergic Rhinitis & its Impact on Asthma. (Instruction Booklet for Health Professionals based on proceedings of WHO Workshop)

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