Allergic Rhinitis
Allergic Rhinitis is the most common allergic disease in the US. A clinical diagnosis and empiric therapy with intranasal steroids like flonase (fluticasone) are the mainstay of this topic. Second line of treatment is oral or intranasal antihistamines where 2nd generation like cetirizine (Zyrtec) are preferred to 1st generation like Benadryl due to safety profile. other medications include cromolyn, montelukast, decongestants and ipratropium bromide. When these fail then skin testing for IgE specific to allergens is recommended, antihistamines should be stopped to do this test otherwise do the RAST (Radioallergosorbent test).
Differential diagnosis of Allergic rhinitis:
- Aspirin Sensitivity: characterized by asthma, nasal polyps and symptoms especially after aspirin ingestion. Other drugs might also trigger these symptoms.
- Cystic Fibrosis: characterized by infertility, chronic bronchitis, nasal polyposis and chronic sinusitis. Sweat chloride test is gold standard in diagnosis.
- Pregnancy Rhinitis: nasal congestion the third trimester of pregnancy.
- Rhinitis Medicamentosa: happens after prolonged use of nasal decongestants and the treatment will be stopping the offending medication and trial of a short course of intranasal steroids.
- Vasomotor Rhinitis: is related to environmental changes but is not a true allergy with negative skin test, treat with intranasal steroids or intranasal antihistamines.
- Wegener Granulomatosis (Granulomatosis with polyarteritis) characterized by chronic sinusitis, saddle nose deformity and nasal ulceration besides the lungs and kidneys manifestations.
A helpful mnemonic for remembering the symptoms of allergic rhinitis is “SNEEZE”:
Sneezing
Nasal congestion
Eye symptoms (itchy, watery eyes)
Edema (swelling of nasal passages)
Zzz (sleep disturbances due to symptoms)
Eosinophilia (increased eosinophils in nasal secretions)
A book available for primary or family medicine doctors to help with ENT case is this Concise Guide.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your doctor or local emergency services.