Common Allergic Diseases

Allergic Rhinitis (सायनस) :

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.

Diagnosis :

  • Accurate history of symptoms may correlate with time of pollination of plants in a given locale.
  • Special attention must be paid to other potentially sensitizing antigens such as pets.
  • Physical examination; nasal mucosa may be boggy or erythematous; nasal polyps may be present; sinuses may demonstrate decreased transillumilation; conjunctiva may be inflamed and edematous manifestations of other allergic conditions (eg Asthma, Eczema) may be present.
  • Skin tests to inhalant and/or food antigens.
  • Nasal smear may reveal large number of Eosinophil, presence of neutrophils may suggest infection.
  • Total and specific serum IgE (As assessed by immunoassay) may be elevated.


Nasal Polyps


A patient of allergic rhinits


X-rays of Nasal polyps


X-rays of Nasal polyps

Differential diagnosis :

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.

Treatment :

It can be divided in two parts

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.

a) Antihistamines: Chlorpheniramine maleate 12 mg orally twice a day

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.

Note: Life threatening cardiac arrhythmias have occurred due to inhibition of the metabolism of Terfenadine or Astemizole by concomitantly administrated microlide antibiotics (such as Erythromycin and Chlarithromycin) or broad spectrum antifungal agents such as Ketoconazole or Itraconazole.

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.

  • Oral symphathomimetics eg pseudophedrine 30-60 mg orally four times a day; may aggravate blood pressure and produce increase in heart rate. The combination antihistaminic and decongestant preparations may balance side effects and provide expected patient’s relief in symptoms.
  • Tropical vasoconstrictors these should be used sparingly due to rebound congestion and chronic rhinitis associated with prolong use.
  • Topical nasal steroids eg beclomethasone 2 sprays in each nostril twice or thrice a day.
  • Topical nasal Cromolyn Sodium 1-2 sprays in each nostril four times a day.
  • Hyposensitization therapy: If more conservative therapy is unsuccessful then this complex and prolonged therapy will be opted for. You can find more detailed information in the general information section.