Allergic Rhinitis in Children

Presentation on theme: "Allergic Rhinitis in Children"— Presentation transcript:

1 Allergic Rhinitis in Children
Doç Dr H.Tekin Nacaroğlu Çocuk İmmünolojisi ve Allerji Hastalıkları

2 Objectives Allergic Rhinitis , Atopic Dermatitis and Anaphylaxis
Symptoms Concomitant disease Diagnosis Treatment Prevent measures

3 Allergic Rhinitis Allergic rhinitis is clinically defined as a symptomatic disorder of the nose, induced after allergen exposure, by an IgE mediated inflammation of the nasal membranes.

4 Asthma Allergic Rhinitis
40% of patients with AR have asthma The majority of patients with asthma have AR AR is a major risk factor for poor asthma control All patients with AR should be assessed for asthma

5 Prevalence The prevalence of AR has been reported to increase between 3% and 40% worldwide, depending on region and age, with an increase in prevalence In our country, prevalence is % in children Not mortal but effects the social life of the patient, school and work performances, and the economic burden is high. Küresel bir halk sağlığı sorunu olarak karşımıza çıkar

6 Allergic Rhinitis risk factors
Atopy Male Birth at polen season First child Usage of antibiotics in early age Maternal smoking Indoors allergens contact Aeroallerjen sensitization in child Food allergy

7 Allergens Dust mite Fel d1

8 Immunopathology of allergic rhinitis:
Burun akıntısı Burunda kaşıntı Hapşırık Konjesyon

9 IgE mediated Rhinorhoea Nasal blockage Postnasal drip Itchiness
Major symptoms of allergic rhinitis: ARIA Rhinorhoea Nasal blockage Postnasal drip Itchiness Sneezing Associated health effects IgE mediated

10 Allergic Rhinitis –Physical examination

11 Physical examination Nazal mukoza soluk mavimsi veya konkalar ödemlidir

12 Physical examination Cobblestone view Serous Otitis Media

13 AR Classification Intermittent Persistent
. < 4 days per week . or < 4 weeks Persistent . > 4 days per week . and > 4 weeks Moderate-severe one or more items . abnormal sleep . impairment of daily activities, sport, leisure . abnormal work and school . troublesome symptoms Mild normal sleep & no impairment of daily activities, sport, leisure & normal work and school & no troublesome symptoms

14 Other Causes of Rhinitis in Children
Infection Viral, bacterial, Rhinosinusitis Foreign body in the nose Rhinitis associated with physical or chemical factors Drug, food induced rhinitis NARES, aspirin sensitivity Vasomotor rhinitis

15 Diagnosis of Allergic Rhinitis
History & symptoms of recurrent or persistent rhinitis and/or associated health effects Signs of atopy and recurrent or persistent rhinitis Demonstration of IgE allergy Exclusion of other causes of rhinitis

16 Demonstration of IgE allergy

17 Immunoassay vs Skin Test for Diagnosis of Allergy
Not influenced by medication Not influenced by skin disease Does not require expertise Quality control possible Expensive Skin test Higher sensitivity Immediate results Requires expertise Cheaper

18 ARIA workshop: Therapeutic options
Allergen avoidance indicated when possible Pharmacotherapy Safety, effectiveness easy to be administered Immunotherapy Specialist Rx, may alter the natural course of the disease costs Patient's education always indicated

19 Environmental Control
1. Allergens House dust mites Pets Cockroaches Molds Pollen 2. Pollutants and Irritants

20 House dust mite allergen avoidance
Provide adequate ventilation to decrease humidity Wash bedding regularly at 60°C Encase pillow, mattress and quilt in allergen impermeable covers Use vacuum cleaner with HEPA filter Dispose of feather bedding Remove carpets Remove curtains, pets and stuffed toys from bedroom

21 Allergen Avoidance Pets
Remove pets from bedrooms and, even better, from the entire home Vacuum carpets, mattresses and upholstery regularly Wash pets regularly (±) Molds Ensure dry indoor conditions Use ammonia to remove mold from bathrooms and other wet spaces Cockroaches Eradicate cockroaches with appropriate gel-type, non-volatile, insecticides Eliminate dampness, cracks in floors, ceilings, cover food; wash surfaces, fabrics to remove allergen Pollen Remain indoors with windows closed at peak pollen times Wear sunglasses Use air-conditioning, where possible Install car pollen filter

22 Allergic Rhinitis: Medical Treatment

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24 Medications of allergic rhinitis
sneezing rhinorrhea nasal nasal eye obstruction itch symptoms H1-antihistamines oral to intranasal intraocular Corticosteroids Chromones intranasal intraocular Decongestants intranasal oral Anti-cholinergics Anti-leukotrienes ? ++

25 Medications of allergic rhinitis