Section 9

 

A 27-year-old presents with rhinorrhea and nasal obstruction.

(CC) Inferior turbinate hypertrophy
Skin prick testing - hous dust mite positive

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Describe what you see on anterior rhinoscopy in image 1.

  • Pale rhinitic mucosa,
  • Hypertrophied inferior turbinate

Describe what you see in image 2.

Skin prick test

What is the diagnosis?

Allergic rhinitis 

Describe an alternative test to the one displayed above.

RAST testing

Describe 4 potential management strategies

  • Allergen avoidance
  • Nasal steroids
  • Antihistamines
  • Surgery – inferior turbinate reduction e,g. submucosal diathermy, turbinectomy
  • Immunotherapy

Supporting Information

Rhinitis

Inflammation of nasal mucosa:

  • Allergic rhinitis– type 1 reaction- perennial/seasonal. Response to proteins or glycoproteins such as pollen, moulds, dust mites.
    • Symptoms – sneezing, rhinorrhoea, nasal irritation. 
    • Signs– Mucosa is moist, pale and swollen.
    • Tests– skin prick, IGE may be useful. 
    • Treatment– antihistamine, topical steroids, topical anticholinergics (ipratropium) and sodium cromoglycate. And allergen avoidance. 
  • Intrinsic rhinitis– idiopathic, diagnosis of exclusion
    • Symptoms – obstruction, rhinorrhoea, nasal irritation polyps, many have sinus pathology.
    • Signs– Mucosa is red  and irritated
    • Tests– skin prick, IGE may be useful. 
    • Treatment
      • Medical as above
      • Surgical- turbinate reduction, polypectomy, vidian neurectomy and FESS.  
  • Non-allergic rhinitis with eosinophilia syndrome (NARES)- 
    • Presentation– as allergic rhinitis
    • Associated with negative skin prick test and >20% eosinophils on skin sampling
    • Pathophysiology– chronic eosinophilic nasal inflammation with development of nasal micropolyposis and polyposis. Mast cells play a role
    • RISK factor for – OSA, nasal polyposis and aspirin hypersensitivity
    • Treatment– nasal steroids, leukotriene antagonists and antihistamines
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