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  Allergic rhinitis

Allergic rhinitis is defined as a recurrent often seasonal but may also be a perennial, inflammation of the nasal mucous membrane caused by hypersensitivity to inhaled allergens such as exposure to pollens, grasses, mold spores, dust mites, animal dander, cigarette smoke, and other inhalants. Pertinent medical history is a strong family history of allergic rhinitis or atopy.

Allergic rhinitis
Allergic rhinitis

The medical term rhinitis is derived from the medical term “rhino” which means nose and this refers to an “irritation of the nose”. Rhinitis is also described as an inflammatory reaction that occurs along the nasal mucosa when an airborne irritants or allergens trigger the release of histamine by mast cells present along the nasal mucous membranes. Histamine is the chemical mediator that produces inflammation and fluid accumulation in the fragile linings epithelium of nasal passages, sinuses, and even the eyelids. Due to the histamine release, there is nasal congestion or stuffiness and irritation accompanied by clear, watery nasal discharge or rhinorrhea, itchiness and sneezing. Other may develop ocular symptoms such as ocular irritation with watery eye discharge or tearing (lacrimation).

There are two main categories of allergic rhinitis namely: seasonal, which occurs during pollen seasons and does not usually develop until after 6 years old; and perennial, occurs throughout the year which is commonly seen among younger children.

The following are the most common symptoms of allergic rhinitis: sneezing, nasal congestion, runny nose or rhinorrhea, itchiness of the nose, throat, eyes, and ears, epistaxis (nosebleeding), and clear drainage from the nose. For those younger children with perennial allergic rhinitis, they may also have the following symptoms: recurrent ear infections (chronic otitis media), snoring and mouth breathing, easy fatigability with poor performance in school and an "allergic salute", which is a line or crease that forms across the nasal bridge when a child rubs his/her hand upward across the bridge of the nose while sniffing.

Diagnosis of allergic rhinitis is based mainly on a thorough medical history and physical examination. Upon physical examination, findings such as the following may be evident including dark circles and creases underneath the eyes, pale, boggy nasal turbinates with possible findings of nasal polyps (outgrowths of chronically inflammed nasal mucosa seen on anterior rhinoscopy) inside the nose. Nasal smear may be requested which may show presence of eosinophils (the type of white blood cells that increases in number in cases of allergic reactions and parasitism). Skin testing known as radioallergosorbent testing (RAST) through intradermal route can identify the specific allergens but this is not routinely done to diagnose allergic rhinitis.

Treatment options for allergic rhinitis may include over-the-counter antihistamines or antipruritics to decrease the release of histamine hence; decreasing the symptoms of itching, sneezing, or runny nose. However, a common adverse reaction of antihistamines is drowsiness because it crosses the blood-brain barrier. (e.g. diphenhydramine (Benadryl) or hydroxyzine (Atarax and Iterax). An alternative is using nonsedating prescription antihistamines which have the same therapeutic action with the older antihistamines but without the drowsiness as side effect. (e.g. cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra). An anti-inflammatory nasal sprays may be prescribed to help to decrease the swelling in the nasal mucosa such as the corticosteroid nasal sprays (e.g. flixotide nasal spray). This work best when used before the symptoms begin, but can also be useful in cases of flare-ups. To act as vasoconstrictors (make the diameter of the blood vessels smaller), the decongestants or vasoconstrictors may help thus, decreasing congestion and redness. Anti-leukotrienes, a new type of medication is beneficial in controlling the symptoms of asthma and allergic rhinitis by helping to decrease the narrowing of the airways or improve the bronchospasm. (e.g. monteleukast). So far, the best treatment is still the avoidance of the specific allergens that are causing the problem once determined.

A consultation to an allergist when there’s a failure to respond to avoidance or to the above medications is mandatory for proper management of the condition. Some advocates allergy shots or immunotherapy based on the findings. Immunotherapy is employed as one way of eventually decreasing the reaction of the body to these known allergens when you come in contact with them by subjecting the patient to repeated injections of these specific allergens for about 3 to 5 years. This method is known as desensitization with the known allergens, a process to reduce symptoms of allergic rhinitis.

Some preventive measures applied to avoid symptoms of allergic rhinitis include the following: environmental controls, such as air conditioning, and staying indoors during pollen season; avoidance of domestic pets and avoid staying in areas where there is heavy dust, mites and molds.

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Claritin tablets


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Claritin Reditabs tablet

Claritin Reditabs

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Singulair tablets


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