By:Sara Al-Ghanem

1. Done By : Sara Ali Al-Ghanem
208009915

2. • What is rhinitis ?
• Definition & pathophysiology of AR.
• Symptoms & signs of AR .
• AR in Saudi Arabia
• Triggering factors of AR.
• Investigations of AR.
• Differential diagnosis of AR
• the New Guidelines for Classifying
AR.
• Co morbidities of AR
• Management of AR

3. Rhinitis
Rhinitis
Idiopathic Infective Allergic
seasonal perennial
Non- esionphili
esionphilic c

4. In the ARIA guidelines, allergic rhinitis is clinically defined
as :
a symptomatic disorder of the nose induced by an IgE-
mediated inflammation after allergen exposure of the
membranes of the nose.
ARIA = Allergic Rhinitis and its Impact on Asthma

7. symptoms & Signs:
Symptoms include:
Rhinorrhea
Nasal obstruction
Nasal itching
Sneezing.
These symptoms are all potentially reversible with
treatment.
Signs :
1. bluish or pale oedematous nasal mucosa
2. clear discharge
3. Skin crease above nasal tip (allergic salute)
4. nasal polyps grabe like masses
5. Generalized puffiness around the eye
6. Infra-orbital skin darkness (allergic shiners)

8. The WHO (World Health Organisation)
now classifies allergic disease as the
fourth most important chronic disease
in the world.
AR affects 10  20% of population

9. Allergic Rhinitis is a
MAJOR chronic respiratory disease ?

10. Allergic Rhinitis is a
MAJOR chronic respiratory disease ?

11. Allergic Rhinitis in Saudi Arabia

12. 27.82% of Saudi children (1100)
aged 6-14 years from Riyadh city
were found to be allergically
sensitive, with high prevalence
rates for allergic rhinitis, asthma
and atopic dermatitis
The total prevalence of allergic
rhinitis, asthma, eczema, food
and drug allergies in the studied
children were 12.7, 11.4, 5.6, 1.75
and 0.27%, respectively
Source :
Decreased Prevalence of Allergic Rhinitis, Asthma and Eczema in Riyadh City,
Saudi Arabia Harb Harfi, Kamel Al Abbad and Abbas H. Alsaeed
Trends in Medical Research Year: 2010 | Volume: 5 | Issue: 2 | Page No.: 57-62
DOI: 10.3923/tmr.2010.57.62

13. Allergic Rhinitis in Al-Ahsa
No available Researches

17. Investigations:
1) multi-allergen screening tests.
The inhalant allergy screen is
called an ImmunoCAP
Phadiatop
2) Skin test
3) RAST (Radio-Allergo Sorbent
Test): measures allergen-
specific IgE

18. differential Diagnosis of AR
-
2 or more of the following :
1 hr on most days: -Unilateral symptoms
-Watery anterior rhinorrhea - Nasal obstruction wo other
-Sneezing , especially symptoms
paroxysmal
-Nasal obstruction - Posterior rhinorrheal(post
-Nasal pruritis nasal drip )
+- conjunctivities •W thick mucous
•&OR no ant. Rhinorrhea
-Pain
- recurrent epistaxias
- anosmia

19. Symptoms Symptoms
•< 4 days •>4 daysweek
•Or < 4 consecutive weeks •And >4 consecutive weeks

22. 50% of pt.s with asthma
appear to have AR.
20% of pt W AR are asthmatic
AR account for 30% of
acute sinusitis &
80% of chronic sinusitis cases

23. Believe on what you are doing & appreciate it's value in your
life
written by :Sara Al-

24. Recognize AR
• History AR questionnaire
• Physical examination
Investigations
Classify AR & ttt

25. ARIA AR questionnaire

26. questionnaire of The International
Study of Asthma and Allergies in
Childhood ( ISAAC )

27. The management of AR
The management of AR consists of 3 major categories of
treatment:
• (1) environmental control measures
and allergen avoidance.
• (2) pharmacological management
• (3) immunotherapy.

29. “ not in preferred
order “
•Oral H1- antihistamine
•OR intranasal H1-
antihistamine
MILD •& OR decongestant
• OR leukotriene
receptor antagonist
(LTRA) **
** in particular , in patient with asthma

30. MODERATE - “ Not in preferred order “
SEVER •Oral H1-antihistamine
•OR Intranasal H1-
antihistamine
•& OR decongestant
•OR intranasal CS *
•OR LTRA ( or cromone ) **
MILD
If persistent rhinitis review the
pt after 2-4Wks
•If failure  step – up
•If moderate : continue for 1
month
• Total dose of topical CS should be considered if inhaled steroids are used for concomitant
asthma

31. in preferred order “
Intranasal CS
MILD – •H1- antihistamine or
MODERATE •LTRA**
SVERE Review the pt after 2-4
WKs
Step –down &
continue ttt for 1 1- increase intranasal •Review DX
month CS dose •Review
2- itchsneeze  add H1 complianc
antihistamine e
3- rhinorrhea  add •Query
ipratropuim infections
4- blokage  add •OR other
decongestant OR oral causes
CS “short term “

32. OPD case : Monday 13-2-2012
A middle aged , non Saudi patient, presented last Monday in the
health center – ENT OPD with recurrent attacks of nasal
obstruction since 3-4 months & associated with sneezing 2-3
times per day.
The pt reported that there is no similar attacks in the past & He
started suffering from theses symptoms when he became living
and working in the Al-Ahssa
These symptoms were relived by systemic decongestant , but the
pt. stopped taken his medication after short period when he
was improved.
Examination revealed that he had eczematous left nostril “
vestibulitis “ & big tonsils.

33. •
The ALLERGY ADVISOR contains:
•Weather and Pollen forecasts in your
area
•Triggers and Symptoms logs for multiple
locations
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Refills, etc.
•Healthcare Professionals Contact
Storage

34. Points to Remember
• AR is a major chronic respiratory disease
• AR is associated with co morbidities such as
conjunctivitis
• AR should be considered as risk factor for asthma
along with other known risk factors .
• A stepwise therapeutic approach depends on
Severity of AR.
• The treatment of AR combines ( pharmacology ,
immunotherapy & education )
• Pt with persistent AR should evaluate for asthma &
Vice versa.

36. References
• Books:
1. Abou-Elhomad ENT book
• Websites :
1. Management of allergic rhinitis & its impact on asthma pocket guideline
(http://www.whiar.org/docs/ARIA_PG_08_View_WM.pdf)
2. Decreased Prevalence of Allergic Rhinitis, Asthma and Eczema in Riyadh City,
Saudi Arabia Harb Harfi, Kamel Al Abbad and Abbas H. Alsaeed
(http://scialert.net/qredirect.php?doi=tmr.2010.57.62&linkid=pdf )
3. International study of asthma and allergies in childhood (ISAAC)
http://erj.ersjournals.com/content/8/3/483.full.pdf
4. OtoPhinolaryngology Portal
(http://www.drrahmatorlummc.com/rhinitisallergy.htm )
5. http://www.stallergenes.com/en/understanding-allergies/allergic-rhinitis.html
• Apple store medical app s
1. Ear , Nose & throat (ENT) Miniatlas ( app)
2. Allergy advisor