Allergic Rhinitis is an inflammatory condition of the nasal mucosa characterized by sneezing, watery nasal discharge and obstruction of nasal passages. It may be associated with conjunctional and pharyngeal itching, lacrimation and sinusitis. Seasonal Allergic Rhinitis is commonly caused by exposure to allergens such as pollens, especially from grasses, trees, weeds, and molds. Perennial Allergic Rhinitis is frequently due foods house dust and animal dander.
Nasal mucosal surface probably allows penetration of allergens deeper into the nasal mucosa of a sensitized individual results in IgE – dependent triggering of mast cells. Subsequently the mediators that cause mucosal hyperemia, swelling and fluid transudation are released. Inflammation sets in tissue-cells where allergens make contact with mast cells. Obstruction of openings of sinuses may result in development of secondary sinusitis with or without bacterial infection.
Vasomotor Rhinitis, Upper Respiratory Infections, Irritant exposure, pregnancy with nasal mucosal edema, rhinitis due to use of beta adrenergic agents are some the common diseases confusing with Allergic Rhinitis.
Prevention: Identification and avoidance of offending antigen.
1. Specific –This management consists of identification of specific offending agents and prevention. Our statistics has been shown elsewhere.
2. Symptomatic-This is centered around blocking the effects of allergic reactions with pharmaceutical agents.
Terfenadine 60mg orally twice a day
Astemezole 10 mg orally four times a day
Loratadine 10 mg orally four times a day
There are many more in the market.
The use of either Tarfenadine or Asteminazole is contraindicated in combination with these drugs; and in individuals with concomitant medical illness that impairs hepatic function or predisposes to cardiac arrhythmias.
The clinical picture is almost diagnostic; but investigations are needed to rule out other diseases. Haemogram is done to assess the Eosinophilic cell count. There are serological investigations to assess IgE –specific antibodies as well. So there is no unequivocal opinion about this modalities; therefore we rarely recommend. Spirometry is a technique of estimating various lung volumes. Now a days computerized machines are available in our country. This modality will depend on the performance of the patient apart from the lung capacities. There fore one must understand exact maneuver to avoid exhaustion.Forced Vital Capacity (FVC) It the maximum volume of air that can be forcibly breathed out after maximum inspiration.
Forced Expired Volume in first second (FEV 1) This the volume of air exhaled out in first second while performing FVC.
Peak Expiratory Flow rate(PEFR) : This is the maximum speed of air flow while performing FVC.
In Bronchial Asthma FVC remains normal; but FEV1 is disproportionately reduced. Thus FEV1/FVC ratio decreases. Similarly PEFR also reduces. These changes are reversible spontaneously initially or with bronchodilators.
Allergy Testing: This is a very important investigation to diagnose the allergic cause of Bronchial Asthma. More details have been described in the general introduction of allergy.
A prolonged management plan has to be adopted by the patients. As previously stated this is a multifaceted disease; and multiple factors should identified and corrected. Then only a patient establishes equilibrium with the disease. We suggest following management plan:
Now a days management of Bronchial Asthma involves devices of drug delivery. Frequently an Attack of Asthma is sever and patient may not be able to get medical help immediately. More over these drugs have to be given through parenteral routes. This all can be overcome with the help of inhalation devices for asthma. They are as follows:
Dry powdered Inhalers: In these devices a capsule containing active medication is punctured or opened mechanically and a specified dose can be inhaled. These are simpler devices; easy to use and effort dependant. A patient needs no training to use these devices.
These devices use inert gases to suspend the active medication. The design of these devices is more complicated. The dose required here is less than above devices. Moreover they are less effort dependent. But these devices require training. All of the products have an information leaflet explaining use and relevant information. A patient is expected to read carefully.
Method of inhalation: The patient should in upright position and hold the device as shown in picture with his fingers. Hold the device in mouth with lips tight around it. Then he should exhale out all the air through nose; and start a deep inhalation. You must trigger the device in the early phase of inspiration. Then only the medication will mix with inhaled air and reach to your lungs. This is important otherwise medication will deposit in the pharynx. Then you must continue inhalation uninterrupted to full chest. Hold the breath for some time and then exhale.
These devices are useful in delivering the drugs in aerosol form. i.e. They prepare mixture of drug and vapor so that the drug can be delivered effortlessly to the lungs of even serious patients. Many varieties were introduced in the market. A mechanical one is based on principle of churning the watery solution of a medication and delivering through the tubes. Ultra sonic devices use the principle of high frequency
Use of nebulisers was fashionable in medical practitioners due to many advantages. It is effortless for a patient. Medications can be administered to even an unconscious patient. It also keeps respiratory tract well hydrated. There are some disadvantages also. Medication goes waste in expiratory phase. The results cannot be better in cooperative patients.Definition = may occur together or separately. Urticaria involves superficial
Dermis and presents as circumscribed weals with raised surpinginous borders and blanched centers. Weals may coalesce. Angioedema involves deeper layers of skin and may include subcutaneous tissue. There disorders may be classified as.
Characterized by massive edema formation in the dermis ( and subcutaneous tissue in angio edema ) presumably the edema is due to increased vasopermeability caused by mediator release from mast cells or other cell populations
Diagnosis :- History with special attention to possible offending exposures and /or ingestion . As well as the duration of lesions vasculitic urtecordia typically resists longest than 72h where as conventional Urticaria often has a duration of less than 48h.
Diagnosis:- History with special attention to possible offending exposure and or ingestion as well as
Differential diagnosis :- A topic dexmatitis, cutaneous mastocytosis ( Urticaria pigmentosa ), systemic mastocytosis.Prevention :- Identification and avoidance of offending agents of possible.
This disease has not been, so far, included in the list of allergic diseases by many standard medical books. However the basic pathoganesis is very much on the lines of immunological reactions. Reader is therefore advised to consider the rationality and discretion before drawing final conclusions.
Pathology = Colonic mucosal inflammation rectum almost always involved, with inflammation, rectum almost always involved with inflammation extending continuously ( no skip areas ) proximally sera variable extent, histological features include epithelial damage, inflammation, exypt abscesses, loss of goblet cells.
Clinical manifestations:- Bloody diarrhea, mucus, fever, abdominal pain, tenesmus, weight loss, spectrum of severity ( majority of cases axe mild )
Limited to recto sigmoid in severe cases dehydration, anemia, hypokalemia, hypoalbuminamia.
Complications :- Toxic megialon, colonic perforations cancer risk related to extent and duration of colitis, often preceded by or coincident with dysphasia ( neoplastic changes in individual epithelial cells ) which may detected on suxneillance colonoscopic biopsies.
Diagnosis = sigmoidoscopy colonoscopy, muscosal exytlema, granulality, fxiability exudates, haemorchage, ulcers, inflammatory polyps ( psudopolyps). Bariums enema, loss of haestorations mucosal irregularity ulcerations.
Food allergy is still one of the most difficult of allergy problems.Many patients who believe they have chronic allergy to foods, do not have the food allergy. However they may have another medical problems such as
The most important feature which distinguishes allergic ( Atopic) individuals is that following an allergic stimulation they develop sustained immunoglobulin – E ( IgE) antibody response to a particular allergen. A normal individual does not produce a high titer of IgE antibodies. Those antibodies become anchored to FC receptors on the surface of mast cells and basophiles. These cells liberate mediators only after re exposure of same antigen. Thus all the features of food reactions are due to release of active mediators and cellular participation. The allergic response occurs in genetically predisposed people
Clinical features:- Reactions due to IgE dependent sensitivity are
Definition = A life threatening systematic hypersensitivity reaction to content with an allergen, it may appear with in minutes of exposure to the offending substances manifestations include respiratory distress, pluxites, Urticaria, mucous membrane swelling, gastro intestinal disturbance including naurea and nomiting painand diarchea and vascular collapse. Virtually any allergen may invite an anaphylactic reaction but among the more common agents are oroteins, such as a antisera hormones pollen extract hymenoptera nunom leads drugs especially ( antibiotics ) and mastic agents. Atopy does not seem to redisplayed to anaphylaxis from pencillin or venom exposures.
Time to on set is variable but symptoms usually occurs with in seconds to minutes of exposures to the offending antigen.
Diagnosis = Made by obtaining history of exposure to offending substance with subsequent development of characteristic complex of signs and symptoms.
Treatment:- Mild symptoms such as pluralities and Urticaria can be controlled by administration of 0.2 to 0.5 ml of 1:1000 epinephrine solution SC repeated at 20 minutes intervals as necessary.
Anl. V infusion should be initiated. Hypotension should be treated by 1.v administration of 2.5 ml of 1:50,000 epinephrine solution at 5 to 10 min intervals, volume expanders e.g., as normal saline and wasopressor agents e.g., dopamine, if intractable hypotension occurs.
Epinephrine provides both alpha-and beta adrenergic effects resulting in were construction and bronchia’s smooth muscle relaxation. Beta blockers are relatively contraindicated in persons at risk for anaphylactic reactions .
The following should also be used as necessary.
The word eczema scans to have originated in AD 543 from the Greek word ekzin which means to boil or to ofter vesce . It is a type IV Delayed hypersensitivity reaction incompassing a broad range of conditions that begin as spongiotic dermatitis and may progress to uchenified stage . Clinically it may present as red edematous plague which may have grooslly visible small vesides suk – acute cessions have associated scales or crusting while long standing lesuis become lichenified severe pruritis is a pronivant accompanying synpton with intensity of itching increased by stress , heat and physical certion . Eczema may remain localized as in eae eczema , lychid dermatitis , nipple eczema , hand eczema ( major occupational dermatitis ) and eczema treatment regemain includes both pharmacological and supportive . superpotent and potent topical steroed agent along with occasional systemic cortico stored and anti – histoninics is the mainstay . Maintenance of proper health hygiene and identifications with protection from the allergen in very case must be inuesaged . Treatment regimen must be practical and should allow the patient to function as normally as be can .
The aetiology of Atopic dermatitis ( eczema ) is not known. However there may usually be a personal or family history of Atopic diseases. ( Hay fever, Asthma, Atopic Dermatitis) with a tendency of IgE mediated susceptibility disorders. Dry hyperirritable skin, food, allergens, and increased to bacterial, viral or fungal skin diseases may acts predisposing factors.
In adults the lesion appears as erythema and lichenified an any part but more so on the flexures of the body skin appear dry and thickened it is diagnosed an clinical grounds. Blood characteristically shows high level of IgE.
Treatment:- Avoidance of irritants, cutaneous hydration , topical glucocorticoids, treatment of infected lesions. Systemic glucocorticoids are used only for severe exacerbations unresponsiveness to topical conservative therapy.
Allergic conductivities, the most common form of eye allergy is a hypersensitivity reaction to specific airborne antigens ocular allergic manifestations Justas the disease has manifestations in various systems of the body, the eye may be involved in the following ways.
Symptoms either symptoms include
Symptoms :- The various features of an examination include.
Pathegenesis = studies suggest that cell mediated immune response also contributes in the pathogenesis of allergic conjuctivities. There is an increased infiltration of the activated fibroblasts and langerhan cells expressing HLA- DR antigen.
DIAGNOSIS :- A comprehensive history distinet physical fendings and adjunct diagnostics tests make the diagnosis simple. A differential diagnosis from bacterial conjunctivitis is important.
Tests for differential diagnosis
Other methods in the predictions of allergic reactions are
A ) Prevention
B ) Therapentic
Amongst all joint diseases Rheumatoid Arthritis is very common disorder. This is more common in elderly women and
It is a Type I reactions. Defined as a chronically relapsing skin disease that usually manifests for the first time in childhood . This disease is a complex interplay of several environmental, food, behavioral and immunological factors in genetically predisposed individuals. It is commonly associated with frequent episodes of sore throat , running nose and asthma It is more common is urban than rural areas . Skin lesions are associated with intense itching, worsening in cold and dry weather. Lesions usually begin with red rashes over the cheeks, fore head and scrap; slowly spreading to the trunk and outer aspect of extremit Siapeu area is typecrtky speed in children with increasing age . lesious end is occur in skin folds / fleseurs , face and neck . Atopic Dermatitis improues of goes into remission near pubuty explaining the conditions and natural history of the disease to the patients / parents of children and there proper councelling foms the cornerstone of management . Expert of the skin to irrelant chemical and physical treatment should be avoided . Among the plethora of treatment options, tpical corticostirocds , emotions and oral sedetine anti histrminics remain the means try of treatment . Their judicious use ofter proper selection of the patient is minatory .
Urticaria is cheracterised by raised erythematous skin lesious that are markedly puritic , generally . cuoesening on scratching . The basic pathomechanism includes activation of mast cells by figger factor leading to viberations of mediators , cousing nesodilation and sesoluting is shelling of the tissue . Lesions and secondary to physical figger , pressure vibration stimulus , change in temperature , following exercise , sun-incpsure , food intake and contact with centre . A detailed history forms the ministry of diagnosis , supported by urraous skin tests , the including open patch test , prick test , the scratch test , the scratch test , the scratch chamber test , the tissue test . Advice and informations on should be provided . Cooling lotions like calamine help in returning pruiritis , besides oral antihistomics . Oral cortieosteloids may surmetines be required in shout tepering couese .
It is an acquired sensitivity to various substances that produce inflamantory.
To reduce the sensitivity of body to allergens a prolonged course of serial injections is given to allergy patients. It’s called immunotherapy or hyposensitization. It is also described as allergy shots by patients.
It can be ascending dose of injections or oral sublingual tablets (SLIT) or drops
Allergic rhinitis, or hay fever and asthma is most commonly treated disease with this form of therapy.Please Note