Simran Maredia

ISM- Period 7

Scadding, Glenis K. “Optical Management of Allergic Rhinitis.” Archives of Disease in Childhood. 2

June 2015. BMJ Publishing Group. 5 April 2018.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4514979/.

● Allergic rhinitis (AR), the most common chronic disease in childhood is often ignored,
misdiagnosed and/or mistreated. Undertreated AR impairs quality of life, exacerbates asthma and
is a major factor in asthma development. It can involve the nose itself, as well as the organs
connected with the nose manifesting a variety of symptoms.
● Rhinitis, which can be allergic, infectious or neither of these, is defined as at least two nasal
symptoms, including rhinorrhoea, blockage, sneezing and itching. It is a common problem in
childhood and adolescence which impacts negatively on physical, social and psychological well-
being.
● Allergic rhinitis (AR) is an under-recognised inflammatory condition of the nasal mucosa, caused
by immunoglobulin E (IgE)-mediated early-phase and late-phase hypersensitivity responses,
usually to inhalant allergens, similar to those in allergic asthma.
● Typical allergens include house dust mite, grass and tree pollens, dander from animals such as
cat, dog, horse and, occasionally, moulds.
● Children with AR can present with symptoms related to nasal connections, such as lungs, throat,
ears, or to quality-of-life impairment, often related to poor quality sleep and consequent fatigue,
poor concentration and school performance.
● AR is often part of a systemic inflammatory process associated with other inflammatory
conditions, including allergic conjunctivitis (AC), rhinosinusitis and asthma. Asthma shows an
increased prevalence in children with both allergic and non-allergic rhinitis and a higher
prevalence of asthma is found among those suffering from persistent and more severe rhinitis.
● Minimal persistent allergic inflammation of the nasal mucosa synergises with infective
inflammation; thus, subjects with AR have more problems with viral colds, and the combination
in children of allergic sensitisation, relevant allergen exposure and viral cold gives a high risk for
hospital admission for asthma in children. Poor asthma control is found in children with moderate
to severe rhinitis, which should be identified and treated.
● AR precedes asthma development in preadolescence, adolescence or adult life and carries a
threefold risk of it persisting into middle age. Bronchial hyper-responsiveness, raised exhaled
nitric oxide and reduced lung function have been observed in children with AR.
● Environmental factors (tobacco smoke, pollution, infections, diet) acting on a genetic background
(family history) contribute to the development of AR which may follow earlier atopic dermatitis
but also occurs as the initial manifestation of allergy.
● AR is diagnosed by detailed history, including questions about possible asthma, and nasal
examination, together with inspection of throat, ears and chest where possible, backed up by
specific allergy tests, either skin prick or blood tests, for specific IgE to allergens suggested by
the history.

This source was very beneficial in allowing me to understand the causes of allergic rhinitis and the factors
that play into the rise of allergic rhinitis, which has been commonly affecting children and adolescents.
 Simran Maredia
ISM- Period 7

Kim, Harold, et al. “Allergic Rhinitis.” Allergy, Asthma & Clinical Immunology. 10 November

2011. BioMed Central. 5 April 2018. aacijournal.biomedcentral.com/articles/10.1186/1710-1492-

7-S1-S3.

● Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis. It is
usually a long-standing condition that often goes undetected in the primary-care setting. The
classic symptoms of the disorder are nasal congestion, nasal itch, rhinorrhea and sneezing. A
thorough history, physical examination and allergen skin testing are important for establishing the
diagnosis of allergic rhinitis.
● Rhinitis is broadly defined as inflammation of the nasal mucosa. It is a common disorder that
affects up to 40% of the population. Allergic rhinitis is the most common type of chronic rhinitis,
affecting 10 to 20% of the population, and evidence suggests that the prevalence of the disorder is
increasing. Severe allergic rhinitis has been associated with significant impairments in quality of
life, sleep and work performance.
● In the past, allergic rhinitis was considered to be a disorder localized to the nose and nasal
passages, but current evidence indicates that it may represent a component of systemic airway
disease involving the entire respiratory tract.
● There are a number of physiological, functional and immunological relationships between the
upper (nose, nasal cavity, paranasal sinuses, pharynx and larynx) and lower (trachea, bronchial
tubes, bronchioles and lungs) respiratory tracts.
● Allergen immunotherapy is an effective immune-modulating treatment that should be
recommended if pharmacologic therapy for allergic rhinitis is not effective or is not tolerated.
● Evidence has shown that allergen provocation of the upper airways not only leads to a local
inflammatory response, but also to inflammatory processes in the lower airways, and this is
supported by the fact that rhinitis and asthma frequently coexist.
● Therefore, allergic rhinitis and asthma appear to represent a combined airway inflammatory
disease, and this needs to be considered to ensure the optimal assessment and management of
patients with allergic rhinitis.
● In allergic rhinitis, numerous inflammatory cells, including mast cells, CD4-positive T cells, B
cells, macrophages, and eosinophils, infiltrate the nasal lining upon exposure to an inciting
allergen (most commonly airborne dust mite fecal particles, cockroach residues, animal dander,
moulds, and pollens).
● The T cells infiltrate the nasal mucosa and release cytokines, which promote immunoglobulin E
(IgE) production by plasma cells. IgE production, in turn, triggers the release of mediators, such
as histamine and leukotrienes, that are responsible for arteriolar dilation, increased vascular
permeability, itching, rhinorrhea (runny nose), mucous secretion, and smooth muscle contraction
and later triggers a further cellular inflammatory response over the next 4 to 8 hours (late-phase
inflammatory response) which results in recurrent symptoms (usually nasal congestion).

This article was helpful because it provides an overview of the pathophysiology, diagnosis, and
appropriate management of allergic rhinitis, thus developing my understanding of this disorder.
 Simran Maredia
ISM- Period 7

Church, Diana S. “Allergic Rhinitis: Impact, Diagnosis, Treatment and Management.” The

Pharmaceutical Journal. Glenis K. Scadding. 9 Aug. 2016. 5 April 2018.

www.pharmaceutical-journal.com/research/review-article/allergic-rhinitis-impact-diagnosis-

treatment-and-management/20201509.article.

● Allergic rhinitis is a common allergic disease with increasing prevalence; recent estimates suggest
it affects over 30% of individuals, particularly, but not exclusively, teenagers and young adults.
● While considered by many as a trivial disease, allergic rhinitis, in addition to the nasal and ocular
symptoms, is crucially linked to impairments in information processing and changes in attention-
related cognitive processes.
● However, it has been estimated that up to 90% of allergic rhinitis patients are untreated,
insufficiently treated or inappropriately treated. This has the potential to impair patients’ ability to
perform optimally in their daily professional and personal life.
● Allergic rhinitis generally develops during childhood and it is the most common chronic allergic
disorder seen in children. Studies have shown that these children can experience significant
impairment through multiple physical and psychological aspects.
● Their symptoms, particularly a runny nose, mean that children are often embarrassed in school,
have decreased social interaction and are at double the risk of accidental injury.
● Nasal congestion, in particular, is associated with sleep disturbance and resultant daytime fatigue.
Two studies have concluded that untreated allergic rhinitis has a marked detrimental effect on
children’s learning and examination performance. When untreated, allergic rhinitis can
potentially impair patients’ ability to sleep and perform optimally in their daily professional or
personal life. Children’s education is also particularly affected.
● Allergic rhinitis occurs in atopic individuals who produce IgE to allergens, such as pollen, house
dust mites, animal dander and moulds.
● Patients with allergic rhinitis may also experience ocular symptoms, primarily reddened, itchy
and watery eyes. Classically these symptoms were believed to be caused by the allergen landing
on the conjunctival lining of the eye, with subsequent activation of the conjunctival mast cells.
● It is now believed that these symptoms are partly the result of a naso-ocular reflex in which
allergic inflammation in the nose stimulates the trigeminal nerve with subsequent release of
neuropeptides in the tears.
● Subsequent allergic inflammation gives rise to nasal blockage. This responds to nasal steroids.
First generation H1 -antihistamines should be avoided because they exacerbate the psychogenic
effects of allergic rhinitis.

This article was useful and it provided an understanding of the impact and effects of undiagnosed allergic
rhinitis and how to diagnose and treat it effectively.
 Simran Maredia
ISM-Period 7

Brozek, Jan L., et al. “Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines.” The Journal of

Allergy and Clinical Immunology. 16 Oct. 2017. 5 April 2018.

www.jacionline.org/article/S0091-6749(17)30919-3/pdf.

● Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school
and work performance and is a frequent reason for office visits in general practice.
● Allergic rhinitis (AR) is among the most common diseases globally and usually persists
throughout life. The prevalence of self-reported AR has been estimated to be approximately 2%
to 25% in children and 1% to greater than 40% in adults. The prevalence of confirmed AR in
adults in Europe ranged from 17% to 28.5%. Recent studies show that the prevalence of AR has
increased in particular in countries with initial low prevalence.
● Classical symptoms of AR are nasal itching, sneezing, rhinorrhea, and nasal congestion. Ocular
symptoms are also frequent; allergic rhinoconjunctivitis is associated with itching and redness of
the eyes and tearing. Other symptoms include itching of the palate, post-nasal drip, and cough.
● AR is also frequently associated with asthma, which is found in 15% to 38% of patients with AR,
and nasal symptoms are present in 6% to 85% patients with asthma. In addition, AR is a risk
factor for asthma and uncontrolled moderate-to-severe AR affects asthma control.
● Compared with other medical conditions, AR might not appear to be serious because it is not
associated with severe morbidity and mortality. However, the burden and costs are substantial.
● AR reduces the quality of life of many patients, impairing sleep quality and cognitive function
and causing irritability and fatigue. AR is associated with decreased school and work
performance, especially during the peak pollen season.
● AR is a frequent reason for general practice office visits. Annual direct medical costs of AR are
substantial, but indirect costs associated with lost work productivity are greater than those
incurred by asthma. Appropriate treatment of AR improves symptoms, quality of life, and work
and school performance.
● There is no cure for allergies. You can manage allergies with prevention and treatment. More
Americans than ever say they manage allergies. It is among the country’s most common, but
overlooked, diseases.
● Once diagnosed, allergic rhinitis treatment options are: avoidance, eliminating or decreasing your
exposure to the irritants or allergens that trigger your symptoms, medication, and immunotherapy
(allergy shots).
● Immunotherapy (allergy shots) helps reduce allergic rhinitis symptoms in about 85% of people
with allergic rhinitis.

This article was advantageous and informative on the topic of allergic rhinitis in regards to the causes,
symptoms, and treatment options and explained the effects of this disorder impacting majority of the
population.