الفهرس | Only 14 pages are availabe for public view |
Abstract Allergic rhinitis is one of the most important and common problems that affects about 10-20% of population or may be more and increasing. Many years ago scientists tried to understand the mechanism of allergic rhinitis and tried to deal with it by different means.It is an IgE mediated response in which an antigen attacks the nasal mucosa, on first exposure the nasal mucosa forms IgE specific to that antigen, these IgE antibodies are then linked to mast cells, then on re-exposure the antigen binds to its specific antibodies leading to immune complex and rupture of these mast cells and release of mediators.These mediators are responsible for the allergic reaction which consists of sneezing, rhinorrhea, itching of the nose, oedema of the nasal mucosa, obstruction.In addition to eye symptoms in the form of lacrimation and itching.In some cases the repeated exposure and the reaction of the mucosa may lead to formation of nasal polypi.It is classified to seasonal (in certain seasons of the year as summer or autumn), or perennial(all over the year).Options for treatment include pharmacotherapy as the commonest line which includes anti-histaminics as loratadine and cetirizine, mast cell stabilizers as ketotifen and di-sodium chromoglycate, also corticosteroids is another option of pharmacotherapy. Surgical treatment is only indicated when complications are present as nasal polyposis and turbinate hypertrophy.Immunotherapy is an alternative modality in patients who fail to respond to the usual lines of treatment. Options for immunotherapy include injection immunotherapy by injection of gradually increasing doses of the antigen after identification of it by skin prick test, And local nasal immunotherapy administrated by insufflators used by the patient himself. Most recently there is much evidence that leukotriene enzyme inhibitors are effective in treating patients with allergic rhinitis and sinusitis as well as asthma by the use of montelukast and zafirlukast. The effect of anti H2 on allergic rhinitis is another new option of treatment.Immunotherapy is also used in treatment of allergic fungal sinusitis after surgical treatment to avoid recurrence.A new and very important line for future treatment of allergic rhinitis is Gene therapy which is intended to cure the disease as it is concerned with genes so it will alter the progress of the disease.This line of therapy is under clinical trials and it is expected to be an important treatment for allergic airway diseases in the near future specially for severe uncontrolled cases. The techniques of gene therapy are either gene silencing technicques or transgene overexpression technicques. |