Professional Documents
Culture Documents
on Sinonasal Problems
Dr. A B John, MBBS (S pore), FRCS
(Glasg), FAMS (S pore)
Snr. Consultant ENT Surgeon
Mount Elizabeth Medical Centre & Visiting
Rhinologist, Alexander Hospital, Singapore.
Rhinology
I.
II.
Allergic Rhinitis
What is Allergy ?
C Von Pirquet 1906, fist coined the term
allergy to designate a changed reaction or
altered sensitivity
It indicated a hypersensitivity reaction to
otherwise innocuous foreign materials which
results in harm to the host
It involves a Type 1 Hypersensitivity reaction
Mast cells play a significant initiating role
What is rhinitis ?
Is local inflammation
of the lining of the
nose
Demonstration of
local inflammation is
often not possible,
therefore we
clinicians often look
at symptoms of
itching, sneezing,
discharge & blockage
What is rhinitis ?
SAR -- symptoms brought about by seasonal
allergens, such as pollens and some molds; and
PAR -- symptoms brought about by year-round
environmental allergens, such as dust mites, pet
dander, and certain molds and pollens.
As a consequence of these symptoms, patients
often experience fatigue, irritability, and
mood/cognitive disturbances.
The buzz word - presenteeism: people going to
work/ physically there but not productive.
Symptom of AR Decrease of productivity @
work place
Intermittent
. Less than 4 days per
week and less than 4
weeks
Persistent
. More than 4 days per
week and more than 4
weeks
Mild
Moderate-severe
normal sleep
& no impairment of daily
activities, sport, leisure
& normal work and
school
& no troublesome
symptoms
Impact of AR in Singapore
Prevalence & severity of asthma, rhinitis & eczema in Singapore schoolchildren. Arch Dis Child
1996, 74, Goh DYT; Chew FT; Quek SC; Lee BW Department of Pediatrics, National University
of Singapore .
A prevalence study of chronic rhinitis among residents in Telok Blangah Town, Singapore, Ann
Acad Med Singapore 1994;23, Chia SE, et al
Epidemiology of chronic rhinitis in Singapore: prevalence estimates, demographic variation&
clinical allergic presentation. Ann Acad Med Singapore 1994;23, Ng TP, Tan WC.
Rhinitis do diagnostic criteria affect the prevalence & treatment Allergy 2002- Wang DY
Diagnosis of ALLERGY :
Skin prick test
Reliable, sensitive
and reproducible
Pricking device
Immediate results
(20 min)
Cheap
Painless
Drops of allergen
extracts
for diagnostic use
Allergen Skin Test & Total IgE in Adults with Rhinitis in Singapore. A B John,
Lee H S, Lee YW, Chng HH ; Asian Pacific Journal of Allergy & Immunology (1996).
Prevalence and distribution of indoor allergens in Singapore. Clin Exp Allergy :1997
Aug;27, Zhang L; Chew FT; Soh SY; Yi FC; Law SY; Goh DY; Lee BW .
Keeping a Pet
V.
Counseling on Allergen
Avoidance
http--www.copeson.org.mx-medicos-asma-Prevencion_alergia_WAO_Guidelines_cond-ACII.pdf.url
http--www.copeson.org.mx-medicos-asma-Prevencion_alergia_WAO_Guidelines_cond-ACII.pdf.url
Indoor Air
Pollution
Is it Rhinitis or
Rhinosinusitis ?
Mucosal Thickening,
Opacification of
Frontal, Ethmoidal,
and Maxillary
Sinuses
Obstructed
Middle Meatus
Congested Middle
and Inferior
Turbinates
Allergy
(1999)- Reviewed
world literature
1985 1998
Long term success
in uncomplicated
sinusitis: 90-93%
Long term success
in allergic rhinitis:
78-85%
Comprehensive rhinologic
or sinonasal care should
account for the impact of
allergic rhinitis
Rhinitis do diagnostic criteria affect the prevalence & treatment Allergy 2002- Wang
Rhinitis do diagnostic criteria affect the prevalence & treatment Allergy 2002- Wang
moderate
severe
intermittent
mild
persistent
moderate
severe
persistent
mild
intermittent intra-nasal steroid
local cromone
allergen
allergen
avoidance
avoidance
indicated
indicated
when
whenpossible
possible
pharmacotherapy
pharmacotherapy
safety
safety
effectiveness
effectiveness
easy
easyto
tobe
beadministered
administered
immunotherapy
immunotherapy
costs
effectiveness
effectiveness
specialist
specialistprescription
prescription
may
mayalter
alterthe
thenatural
natural
course
courseof
ofthe
thedisease
disease
patient's
patient's
education
education
always
alwaysindicated
indicated
Th2
IL 10/TGF
IL 4
+
IFN
IL 4
IL 13
Eosinophils
Th1
Treg
B Lymphocytes
Mast cells
---Inflammatory mediators
SIT
Riad FADEL, MD
antiallergic medications.
An optimal safety profile in children and adults.
That its the chosen therapy by children and parents,
Thank-you