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Allergic rhinitis, Siddiqui, Z. A., Walker, A., Pirwani, M. M., Tahiri, M.…

- - - - None of the following are present:
      - Sleep disturbance
      - Impairment of daily activities, leisure, and/or sport
      - Impairment of work or school
  - - - One or more of the following are present:
      - Sleep disturbance
      - Impairment of daily activities, leisure, and/or sport
      - Impairment of work or school
- - - - Loci involved in allergic rhinitis include MRPL4 (19q13): Immunity and inflammation, BCAP (PIK3AP1; 10q24): B cell function, epithelial barrier regulation, C11orf30–LRRC32 (11q13): Immune tolerance, and FERD3L (7p21): Unknown function, involved in immune processes.
    - - Intense physical activity in adolescents
- - - - Provides symptom relief (~3 years)
        
        Not a long-term solution
        
        Requires pre-/post-procedure commitment to medical therapy (intranasal corticosteroids)
  - - - Mild Symptoms
        
        1st line: Allergen avoidance + oral/intranasal antihistamine
        2nd line: Allergen avoidance + leukotriene receptor antagonist
      - Intermittent Moderate to Severe Symptoms
        
        1st line: Mild treatment ± oral/nasal decongestant ± nasal irrigation
        2nd line: Allergen avoidance + intranasal corticosteroid ± oral/nasal decongestant ± nasal irrigation
        3rd line: Immunotherapy (sublingual or subcutaneous)
      - Persistent Moderate to Severe Symptoms
        
        1st line: Allergen avoidance + intranasal corticosteroid ± antihistamine ± intranasal ipratropium ± decongestant ± nasal irrigation
        2nd line: Immunotherapy (sublingual or subcutaneous)
- - - - Late-Phase Response
        
        Recruitment of Inflammatory Cells
        
        Eosinophils, basophils & Th2 lymphocytes
        
        Cytokine Release by Th2 Cells
        
        IL-4, IL-5, IL-13
        
        Eosinophil Activation
        
        Release of Pro-Inflammatory Mediators
        
        1 more item...
        
        Epithelial Barrier Dysfunction
        
        Tight Junctions Disrupted
        
        ↑ allergen penetration
        
        Histamine, IL-4, TNF-α impair the barrier function
        
        Chronic inflammation
        
        Neuroimmune Interactions
        
        Neuropeptides
        
        ↑ nasal hyperresponsiveness & modulates immune response
        
        ↑ inflammation and prolonged symptoms
        
        FINAL EFFECTS
        
        Persistent symptoms
        
        ↑ mucosal permeability
        
        ↑ allergen exposure
        
        1 more item...
        
        Chronic inflammation & hyperreactivity
      - Allergen Cross-Links IgE on Mast Cells
      - Mast Cell Degranulation
        
        Release of:
        
        Histamine: Nasal congestion, itching
        Leukotrienes: ↑ production of mucus
        Prostaglandins: Vasodilatation & inflammation
        
        Beginning of clinical symptoms
    - - Pollen, mold, dust mites
    - - Present to naive cells
    - - IL-4 & IL-13 → Stimulates B cells → Produce allergen-specific IgE
        IL-5 → Activates eosinophils
        
        IgE binds to Mast Cells & Basophils
        
        Completed sensitization
- - - - Tidke, M., Borghare, P. T., Pardhekar, P., Nasre, Y., Gomase, K., & Chaudhary, M. (2024). Recent Advances in Allergic Rhinitis: A Narrative Review. Cureus. https://doi.org/10.7759/cureus.68607
        
        La rinitis alérgica, una pequeña mirada a su universo. (2023, 7 septiembre). Medicina y Cultura Revista Digital de la División de Estudios de Posgrado FACMED UNAM. https://www.revistamedicinaycultura.fmposgrado.unam.mx/index.php/2023/01/25/la-rinitis-alergica-una-pequena-mirada-a-su-universo/