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  • Dr .Lavanya Manoharan

ALLERGIC RHINITIS AND TREATMENT PROTOCOL

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What Is Allergic Rhinitis?


Allergic rhinitis the most common type of chronic rhinitis is caused due to the inflammation of the nasal mucosa (linning) after being triggered by allergens. The allergens trigger an inmmunological response which leads to inflammation and in turn the symptoms.


Allergic rhinitis is characterized by four classical symptoms which include the following: (1)





When left untreated allergic rhinitis can cause sleep disturbance, fatigue, low mood, and a decline in cognitive function impairing the quality of life.


Depending on the severity of the symptoms allergic rhinitis can be classified as (2)



What Is The Disease Burden?


Around the world, 10 to 20% of people suffer from allergic rhinitis, and in certain regions reaching up to 40%. In India, around 20-30% of the people suffer from allergic rhinitis, and 15% progress to develop asthma. (1)


What Are The Tests Done To Determine Allergic Rhinitis?


There are mainly two types of tests available.


The first type is a skin prick test in which you will be tested for allergens on your forearm. It is done by injecting small quantities of the allergens over the forearm, and then reading for the responses after a few minutes. This test is usually performed under your doctor’s supervision at his clinic or hospital. Results are available within 20 minutes, and you will likely come to know about the cause of your child’s allergy once the identified allergen is correlated with the relevant history.


Specific immunoglobulin E (IgE) levels, the second type of test, can be measured in the blood for which a blood sampling is needed. Results are usually available in 48 hours and many types of allergens can be detected. (3)



What Is The Treatment Protocol In Adults?


The treatment protocol depends on the age of the person, the severity of the symptoms, and other factors specific to the individual. There is pharmacological therapy and non-pharmacological therapy. Pharmacological therapy includes oral medications, intranasal medications, and non-pharmacological therapy includes allergen avoidance, immunotherapy, and adjunct surgical management.


The management of allergic rhinitis is as follows: (3)


The management involves a through history and examination followed by relevant investigations at the discretion of your treating doctor.



Pharmacotherapy Includes:

  1. Antihistamines (Chlorpheniramine, Bilastine)

  2. Corticosteroids in the form of intranasal spray such (fluticasone furoate, mometasone)

  3. Chromones (Sodium Cromoglycate)

  4. Decongestants (phenylephrine systemically or oxymetazoline topically as nasal drops)

  5. Anticholinergic intranasally (ipratropium)

  6. Antileukotrienes (Montelukast)

The below flow chart explains the pharmacological treatment protocol: (1)



What Is The Treatment Protocol In Children?


1) Mometasone and fluticasone furoate is recommended in children above 2 years of age.

2) Topical concommitant use of decongestants is effective for short term.

3) Oral and intramuscular glucocorticoids to be avoided in children.

4) Immunotherapy is recommended in subjects who have not adequately responded to maximal pharmacotherapy. (1)


Commonly used intranasal corticosteroids in allergic rhinitis and their dosages: (3)



Second generation antihistamines and dosages as per age : (3)



What Is The Treatment Protocol During Pregnancy? (1)


1) Chlorphenamine, loratadine, and cetirizine are safe in pregnancy.

2) Intranasal corticosteroids budesonide is a category B drug.

3) Decongestants and immunotherapy to be avoided.

4) Risk-benefit ratio to be determined when using antihistamines and nasal steroids.



What Is Allergen Immunotherapy?


Allergen immunotherapy involves the regular administration of gradually increasing doses of allergen extracts over a period of years. Immunotherapy can be given to patients as an injection or as tablets, sprays, or drops under the tongue (sublingual).


Allergen immunotherapy changes the way the immune system reacts to allergens, by switching off an allergy. The end result is that you become immune to the allergens so that you can tolerate them with fewer or no symptoms. Those agreeing to allergen immunotherapy need to be committed to a longer time of treatment for it to work. This is always undertaken after a complete evaluation under the supervision of your doctor.


At Bangalore ENT Institute & Research Center, our expert doctors offer comprehensive allergic rhinitis diagnosis and management to help you improve your quality of life! To know more about allergic rhinitis, talk to our doctors at info@beirc.net or on any of our social handles!



References:


1) Indian guidelines on diagnosis and management of allergic rhinitis – a consensus approach by The Association of Otolaryngologists of India.

2) Klimek L, Bachert C, Pfaar O, Becker S, Bieber T, Brehler R, Buhl R, Casper I, Chaker A, Czech W, Fischer J, Fuchs T, Gerstlauer M, Hörmann K, Jakob T, Jung K, Kopp MV, Mahler V, Merk H, Mülleneisen N, Nemat K, Rabe U, Ring J, Saloga J, Schlenter W, Schmidt-Weber C, Seyfarth H, Sperl A, Spindler T, Staubach P, Strieth S, Treudler R, Vogelberg C, Wallrafen A, Wehrmann W, Wrede H, Zuberbier T, Bedbrook A, Canonica GW, Cardona V, Casale TB, Czarlewski W, Fokkens WJ, Hamelmann E, Jutel M, Larenas-Linnemann D, Mullol J, Papadopoulos NG, Toppila-Salmi S, Werfel T, Bousquet J. ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergol Select. 2019 Dec 30;3(1):22-50. doi: 10.5414/ALX02120E. PMID: 32176226; PMCID: PMC7066682.

3) Standard treatment guidelines forallergic rhinitis by Indian academy of paediatrics.

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