Allergic Rhinitis Ebook
In atopic eczema, matters are equally complicated. Environmental factors may well be responsible for the recent rise in its prevalence as the gene pool within the population is not likely to have changed greatly, but a genetic component is obvious too, even though affected children can be born to clinically normal parents. Within each family, atopic disorders tend to run true to type, so that, in some, most affected members will have eczema, in others, respiratory allergy predominates. The inheritance of atopic eczema probably involves genes that predispose to the state of atopy, and others that determine whether it is asthma, eczema, or hay fever that develops. One plausible gene for the inheritance of atopy encodes for the p subunit of the high affinity IgE receptor, and lies on chromosome 11q13. However several groups have failed to confirm earlier reports of this linkage, and a gene linked to atopic eczema has recently been found on chromosome 3q21.
Classically this condition is the end-result of intense, chronic pruritus that results from repetitive rubbing or scratching. The skin responds by thickening and the increase in skin markings is referred to as lichenification. This occurs mostly in individuals with a history of allergies, eczema, hay fever or asthma. They have sensitive and easily irritated skin.
OME is a common cause of mild hearing loss in children, most often between the ages of two and seven years. The middle ear contains fluid that varies from a thin transudate to a very thick consistency (glue ear). Eustachian tube obstruction is usually caused by primary congenital tube dysfunction. Other possible contributing factors are allergic rhinitis, adenoidal hyperplasia, supine feeding position, or a submucous cleft. Middle-ear effusion was found to persist for at least one month in up to 40 of children who had suffered from AOM, and for at least three months in 10 of afflicted children (27).
Asthma, hypereosinophilia ( 1.5 X 109l-1), necrotising vasculitis, extravascular granulomas, and allergic rhinitis.The vasculitis involves two or more extrapulmonary organs.The combination of late onset asthma with severe, recurrent sinusitis that requires surgery, particularly if there are abnormal paranasal sinus X-rays, may give a clue to the presence of the disease (D'Cruz et al 1999).
Numerous 1-indole acetic acid derivatives compounds have been reported as CRTH2 antagonists. These include the tetrahydrocarbazole derivative 17, Rama-troban (BAY U3405), which is currently marketed in Japan for allergic rhinitis 51 . Ramatroban was developed as a thromboxane A2 receptor (TP) antagonist later it was also shown to be a CRTH2 antagonist. Ramatroban has been reported to reduce antigen-induced early and late-phase allergic responses in mice, rats and guinea pigs. In humans, Ramatroban has been reported to attenuate PGD2-induced bronchial hyper-responsiveness 52,53 . It has been postulated that the efficacy observed with Ramatroban in humans cannot be fully explained by its action on TP and that Ramatroban's efficacy in humans is due in part to its CRTH2 antagonist activity 23 . The affinities of Ramatroban and its close analogs, 18 and 19, for the CRTH2 receptor were determined using a 3H -PGD2 binding assay (K values for Ramatroban, 18 and 19 were 4.3, 0.5 and 0.6 nM,...
A syndrome of asthma, allergic rhinitis, pulmonary and systemic small-vessel vasculitis and extravascular granulomas. Reid et al (1999) reported organ systems involvement as follows lungs (48 ), heart (44 ), kidney (48 ), nervous system (78 ),skin (48 ),bowel (30 ), joints (57 ), and muscle (57 ).The presence of severe gastrointestinal disease or myocardial involvement is associated with a poor prognosis (Guillevin et al 1999). It has sometimes been associated with the new leukotriene antagonists used for asthma. However, it is thought that the disease is unmasked when these drugs replace corticosteroids for treatment, rather than being the cause of it (Churg & Churg 1998, Stirling & Chung 1999).
Patients with a viral URTI may benefit from symptomatic therapy, aimed at improving their quality of life during the acute illness. The use of normal saline as a spray or lavage can provide symptomatic improvement by liquefying secretions to encourage drainage. The short-term (three days) use of topical alpha-adrenergic decongestants can also provide symptomatic relief, but their use should be restricted to older children and adults due to the potential for undesirable systemic effects in infants and young children. Topical glucocorticosteroids may also be useful in reducing nasal mucosal edema, mostly in those cases where a patient who has seasonal allergic rhinitis develops the complication of an acute URTI. The antipyretic and analgesic effects of nonsteroidal anti-inflammatory agents can relieve or ameliorate the associated symptoms of fever, headache, generalized malaise, and facial tenderness. Until the clinical diagnosis of acute bacterial sinusitis is established, management...
Antihistamines are used in patients with underlying allergic rhinitis. They can relieve symptoms of itching, rhinorrhea, and sneezing in allergic patients, but in nonallergic patients they can cause thickening of secretions, which may prevent needed drainage of the sinus ostia.
Epiphora in a child with a history of tearing since birth has been caused mostly by an obstructive membrane within the naso-lacrimal duct (Valve of Hasner). Intermittent acquired epiphora in an adult usually results from partial stenosis of the membranous duct and or dacryolithiasis, and may also be seen in patients with allergic rhinitis. The relationship of symptoms to the previous medical therapy (topical idoxuridine, phospholine iodide, systemic 5-fluoro-uracil), orbital trauma, and environmental factors, however, as to the head position, stress, etc., are also factors. Previous sinus surgery should indicate the possibility of duct injury as well. The presence of recurrent sinus disease can cause rhinitis or intranasal polyps.
M. reported that Jeff's prenatal and birth history were unremarkable. She had a normal, full-term pregnancy, and gave birth to Jeff through a normal delivery. Jeff weighed 7 pounds, 3 ounces at birth and was 20 inches long. According to his mother, Jeff's medical history includes having tubes placed in his ears at age 3, due to repeated ear infections. He also had chicken pox at age 5, and is currently affected mildly by hay fever. No other major illnesses or injuries were reported. His parents indicated that he has a physical exam annually for his participation in school athletics.