Allergic Rhinitis

• increased in children exposed to tobacco smoke and is thought to be associated with the feeding of whole milk and solid foods before 4 to 6 months of age.
• Allergic rhinitis may be further classified:

  as seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR).
• SAR

  cyclic, well-defined course
• PAR


  causes year-round symptoms
• Allergic rhinitis requires two conditions:

  A familial predisposition to develop allergy

  Exposure of a sensitized person to the allergen
• In the allergic child

  symptoms are mediated by immunoglobulin E (IgE), which is produced by the child’s B lymphocytes.
• Clinical Manifestations:

  Have a history of watery rhinorrhea

  Nasal obstruction

  Sneezing

  Itchy throat

  Nasal pruritus
• Clinical Manifestation:

  Nasal itching is troublesome, and the affected child attempts to alleviate the symptoms by rubbing the nose – the “allergic salute”
• Clinical Manifestations:

  On physical examination – children may display dark circles beneath their eyes, or “allergic shiners,” secondary to obstruction of normal outflow from regional lymphatics and veins
• Clinical Manifestations:

  If the nasal obstruction is severe, the child becomes an obligate mouth breather and is seen with an open mouth, or “allergic gape”
• Clinical Manifestations:

  -A horizontal nasal crease across the lower third of the nose caused by frequent rubbing induced by the nasal pruritus.

  -Dennie lines, or extra wrinkles below the lower eyelids.
• Symptoms that appear during peak symptoms periods include:

  Tearing and soreness of the eyes

  Gelatinous conjunctival discharge in the morning

  Irritability

  Fatigue

  Depression

  Loss of appetite
• When the nurse suspects allergic rhinitis, it is important to obtain information regarding clinical signs of related disorders, including:

  Middle ear disease

  Ear pain

  Delayed speech or language development

  Chronic cough

  Wheezing

  Exercise intolerance

  Eczema

  Urticaria
• Diagnostic Evaluation:

  Skin test –involves injection, ID of specific allergens and should be performed by a practitioner who has adequate knowledge to interpret the results
• Diagnostic Evaluation

  IgE helps fight the allergen so if you have Elevated Immunoglobulin E in your blood means you have allergic rhinitis
• Therapeutic Management:

  avoidance of offending allergens and the use of medication and immunotherapy (hyposensitization or desensitization).
• Therapeutic Management:

  Nasal corticosteroids - the first-line drugs used for allergic rhinitis if significant nasal symptoms are present
• Therapeutic Management

  Other medications used are antihistamines, adrenergic decongestants, mast cell stabilizers, leukotriene modifiers and ipratropium
• Therapeutic Management:

  Topical nasal corticosteroids are safe and effective therapies and are more effective than oral antihistamines for symptom relief
• Therapeutic Management:

  First-generation agents include:

  beclomethasone (Vancenase and Beconase)

  flunisolide (Nasalide)

  budesonide (Rhinocort or Pulmicort)

  Second-generation agents are:

  fluticasone (Flovent)

  mometasone (Nasonex)

  Dry powder preparations are also available (beclomethasone furoate or ciclesonide)

  Immunotherapy is somehow exposing the patient slowly in the allergen so that the body will be used to it.