Nasal Allergy (Nasal Rhinitis)

Introduction

Nasal allergy otherwise known as Nasal Rhinitis is an allergic response causing itchy, watery eyes, sneezing and other similar symptoms.
It is a hypersensitivity of the nasal mucosa to various foreign substances, of the atopic type.
It manifests as recurrent episodes of sneezing, rhinorrhoea and nasal obstruction whenever a patient comes in contact with the offending allergen.
Symptoms are attributed to the effect of histamine and other chemical substances released from ruptured mast cells in the nasal mucosa.
Common allergens are pollens of various plants, flowers and trees; house-dust; hairs; some foods; fungi and cosmetics.
Nasal allergy is a common condition and affects all age groups.
It may be familial, often associated with allergic asthma or dermatitis

Symptoms of clinical features of Nasal allergy (Nasal rhinitis)

  1. Repeated episodes of sneezing
  2. Watery nasal discharge
  3. Nasal obstruction with itching and
    conjunctival irritation whenever patient is in contact with allergen
  4. Nasal mucosa may be congested or
    sometimes normal at the time of clinical examination
  5. Presentation may be seasonal as with pollen allergy, or perennial with allergy to house dust, etc
  6. Nasal polyps may develop

Differential diagnoses

  • Chronic rhinitis from other causes
  • Vasomotor rhinitis
  • Chronic sinusitis

Complications of Nasal allergy (Nasal rhinitis)

  • Chronic sinusitis
  • Pharyngitis

Investigations

  • Skin tests for allergens: intradermal or prickĀ  tests
  • Smear of nasal secretions for eosinophilia
  • Serological tests: radio-immunoassay for IgE antibodies
  • Sinus X-ray

Treatment for Nasal Allergy (Nasal Rhinitis)

Treatment objectives

  • Control or suppress the allergic symptoms
  • Prevent allergic reactions

Non-drug treatment

  • Elimination of allergens
  • Hyposensitisation by vaccination

Drug treatment

A. Antihistamines

Chlorphenamine

  • Adult: 4 mg orally every 4-6 hours; maximum 24 mg daily
  • Child:
    • not recommended under 1 year
    • 6 – 12 years: 2 mg orally every 4-6 hours; maximum
      12 mg daily;
    • 2-5 years: 1 mg every 4-6 hours; maximum 6 mg daily

Or:

Promethazine

  • Adult: 25 mg orally at night, increased to 25 mg twice daily if necessary or, 10 – 20 mg
    every 8-12 hours
  • Child:
    • not recommended under 2 years
    • 5 – 10 years: 10-25mg orally daily in 1-2 divided doses;
    • 2-5years: 5-15mg daily in 1-2 divided doses

Non-sedative antihistamines
Loratadine

  • Adult and child over 12 years 10mg once daily;
  • Child:
    • 2-12 years, body weight under
      30kg, 5mg/5ml once daily;
    • body weight over 30 kg, 10 mg once daily

B. Topical steroid

Beclomethasone nasal spray

  • Adult and child over 6 years: 100 micrograms (i.e. 2 sprays) into each nostril twice daily Or 50 micrograms into each nostril every 8 hours
  • Reduce dose to 50 micrograms into each nostril twice daily when symptoms are controlled

C. Decongestant

Psuedoephedrine

  • Adult: 60 mg orally 4-6 hourly (up to 4 times daily)
  • Child:
    • 6-12 years: 30 mg (5 mL of syrup) orally every 8 hours;
    • 2-5 years: 2.5 mL

Notable adverse drug reactions, caution

  • Drowsiness with antihistamine drugs
  • Avoid prolonged use of medications

Prevention

  • Avoid known allergenic substances,
    inhalants, foods, etc