Immunological and Pharmacological Management of Allergic Diseases

Abstract

Allergic rhinitis is an immediate-type, IgE-mediated reaction involving the nasal mucosa. It is usually associated with a similar type involvement of the conjunctiva, and often of the mucosa of the oropharynx. Symptoms consist of rhinorrhea, sneezing, nasal congestion, pruritis of the nose and conjunctiva, lacrimation, and pruritis of the oropharynx. Physical examination usually shows edematous nasal mucosa which is often pale and bluish in appearance, in contrast to the normal pink appearance of the mucosa. The conjunctiva is erythematous. A major diagnostic aid in allergic rhinitis is a history of seasonal occurrence or the occurrence of symptoms in relation to an identified exposure to allergen such as animals. The diagnosis is primarily made by such a history and confirmed by demonstration of the presence of IgE antibodies by cutaneous testing which demonstrates an immediate-type, wheal-and-flare reaction. In vitro laboratory tests, demonstrating serum IgE antibody, may provide equivalent information with certain allergens. A typical case of allergic rhinitis usually does not provide a difficult diagnostic problem when there is a clear seasonal and geographic or environmental relation of the symptoms. Perennial allergic rhinitis may be more difficult to define, particularly if the cause of the nasal symptoms is nonallergic rhinitis occurring in the subject who has IgE antibodies against common inhalant antigens.