Allergic rhinitis

Pollen grains from a variety of common plants can cause hay fever.
ICD-10	J30
ICD-9	477
OMIM	607154
DiseasesDB	31140
MedlinePlus	000813
eMedicine	ent/194 med/104, ped/2560
MeSH	D012221

Allergic rhinitis is an allergic inflammation of the nasal airways. It occurs when an allergen, such as pollen, dust or animal dander (particles of shed skin and hair) is inhaled by an individual with a sensitized immune system. In such individuals, the allergen triggers the production of the antibody immunoglobulin E (IgE), which binds to mast cells and basophils containing histamine. When caused by pollens of any plants, it is called "pollinosis", and if specifically caused by grass pollens, it is known as "hay fever". Ironically, in hay fever, there is neither any fever nor any hay, but since grasses shed their pollens into the air at about the same time that hay is being cut, the common term hay fever is used.

IgE bound to mast cells are stimulated by pollen and dust, causing the release of inflammatory mediators such as histamine (and other chemicals).^[1] This usually causes sneezing, itchy and watery eyes, swelling and inflammation of the nasal passages, and an increase in mucus production. Symptoms vary in severity between individuals. Very sensitive individuals can experience hives or other rashes. Particulate matter in polluted air, and chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate allergic rhinitis. The physician John Bostock first described hay fever in 1819 as a disease.

Allergies are common. Heredity and environmental exposures may contribute to a predisposition to allergies. It is roughly estimated that one in three people have an active allergy at any given time and at least three in four people develop an allergic reaction at least once in their lives. In Western countries between 10–25% of people annually are affected by allergic rhinitis.^[2]

Classification[link]

Allergic rhinitis may be seasonal or perennial. Seasonal allergic rhinitis occurs particularly during pollen seasons. It does not usually develop until after 6 years of age. Perennial allergic rhinitis occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.^[3]

Allergic rhinitis may also be classified as Mild-Intermittent, Moderate-Severe intermittent, Mild-Persistent, and Moderate-Severe Persistent. Intermittent is when the symptoms occur <4 days per week or <4 consecutive weeks. Persistent is when symptoms occur >4 days/week and >4 consecutive weeks. The symptoms are considered mild with normal sleep, no impairment of daily activities, no impairment of work or school, and if symptoms are not troublesome. Severe symptoms result in sleep disturbance, impairment of daily activities, and impairment of school or work.^[4]

Signs and symptoms[link]

The characteristic symptoms of allergic rhinitis are: rhinorrhea (excess nasal secretion), itching, and nasal congestion and obstruction.^[5]

Characteristic physical findings include conjunctival swelling and erythema, eyelid swelling, lower eyelid venous stasis, transverse nasal crease, swollen nasal turbinates, and middle ear effusion.^[6]

Other physical signs include folds in the skin below the lower eyelid known as Dennie–Morgan folds, and rings under the eyes, known in patients with allergic rhinitis as "allergic shiners".

Sufferers might also find that cross-reactivity occurs.^[7] For example, someone allergic to birch pollen may also find that they have an allergic reaction to the skin of apples or potatoes.^[8] A clear sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling potatoes or apples. This occurs because of similarities in the proteins of the pollen and the food.^[9] There are many cross-reacting substances.

Some disorders may be associated with allergies: Comorbidities include eczema, asthma and depression

Allergy testing[link]

Allergy testing may reveal the specific allergens to which an individual is sensitive. Skin testing is the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. Less commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. This test should only be done by a physician, never the patient, since it can be harmful if done improperly. In some individuals who cannot undergo skin testing (as determined by the doctor), the RAST blood test may be helpful in determining specific allergen sensitivity.

Allergy testing can either show allergies that aren't actually causing symptoms, or miss allergies that do cause symptoms. The intradermal allergy test is more sensitive than the skin prick test but is more often positive in people who do not have symptoms to that allergen.^[10]

Even if a person has negative skin-prick, intradermal and blood tests for allergies, they may still have allergic rhinitis, from a local allergy in the nose. This is called local allergic rhinitis.^[11] Specialized testing is necessary to diagnose local allergic rhinitis.^[12]

Pollen allergies[link]

Allergic rhinitis triggered by the pollens of specific seasonal plants is commonly known as "hay fever", because it is most prevalent during haying season. However, it is possible to suffer from hay fever throughout the year. The pollen which causes hay fever varies between individuals and from region to region; generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the predominant cause. Pollens of insect-pollinated plants are too large to remain airborne and pose no risk. Examples of plants commonly responsible for hay fever include:

• Trees: such as pine (Pinus), birch (Betula), alder (Alnus), cedar, hazel, hornbeam (Carpinus), horse chestnut (Aesculus), willow (Salix), poplar, plane (Platanus), linden/lime (Tilia) and olive (Olea). In northern latitudes birch is considered to be the most important allergenic tree pollen, with an estimated 15–20% of hay fever sufferers sensitive to birch pollen grains. A major antigen in these is a protein called Bet V I. Olive pollen is most predominant in Mediterranean regions. Hay fever in Japan is caused primarily by sugi (Cryptomeria japonica) and hinoki (Chamaecyparis obtusa) tree pollen.
  • "Allergy friendly" trees include: ash, red maple, yellow poplar, dogwood, magnolia, double-flowered cherry, fir, spruce and flowering plum.^[13]

• Grasses (Family Poaceae): especially ryegrass (Lolium sp.) and timothy (Phleum pratense). An estimated 90% of hay fever sufferers are allergic to grass pollen.
• Weeds: ragweed (Ambrosia), plantain (Plantago), nettle/parietaria (Urticaceae), mugwort (Artemisia), Fat hen (Chenopodium) and sorrel/dock (Rumex)

Management[link]

The goal of rhinitis treatment is to prevent or reduce the symptoms caused by the inflammation of affected tissues. Measures which are effective include avoiding the allergen.^[5] Intranasal corticosteroids are the preferred treatment if medications are required with other options used only if these are not effective.^[5] Mite proof covers, air filters, and withholding certain foods in childhood do not have evidence supporting their use.^[5]

Steroids[link]

Intranasal corticosteroids are used to control symptoms associated with sneezing, rhinorrhea, itching and nasal congestion. It is an excellent choice for perennial rhinitis.^[14] Steroid nasal sprays are effective and safe, and may be effective without oral antihistamines. They take several days to act and so need be taken continually for several weeks as their therapeutic effect builds up with time.

Systemic steroids such as prednisone are effective at reducing nasal inflammation, but their use is limited by their short duration of effect and the side effects of prolonged steroid therapy.

Other[link]

Other measures that may be used second line include: antihistamines, decongestants, cromolyn, leukotriene receptor antagonists, and nonpharmacologic therapies such as nasal irrigation.^[5]

Antihistamine drugs can have undesirable side-effects, most notably drowsiness. First generation antihistamine drugs such as diphenhydramine cause drowsiness, but not second- and third-generation antihistamines such as cetirizine and loratadine.^[15]

Antihistamine drugs can be taken orally to control symptoms such as sneezing, rhinorrhea, itching and conjunctivitis. It is best to take the medication before exposure, especially for seasonal allergic rhinitis. Ophthalmic antihistamines (such as ketotifen) are used for conjunctivitis; intranasal forms are used for sneezing, rhinorrhea and nasal pruritus.^[15]

Pseudoephedrine is also indicated for vasomotor rhinitis. It is only used when nasal congestion is present and can be used with antihistamines. In the United States, oral decongestants containing pseudoephedrine must be purchased behind the pharmacy counter by law to combat the making of methamphetamine.^[16]

Topical decongestants: may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa).

For nocturnal symptoms, intranasal corticosteroids can be combined with nightly oxymetazoline, an adrenergic alpha-agonist, without risk of rhinitis medicamentosa.^[17]

Desensitization[link]

More severe cases of allergic rhinitis not responding to medication may benefit from allergen immunotherapy (allergy shots).^[5]

Alternative treatments[link]

Therapeutic efficacy of complementary-alternative treatments is not supported by currently available evidence.^[18][19] Some evidence shows that acupuncture is effective for rhinitis while other evidence does not. The overall quality of evidence, however, is poor.^[20]

Local allergic rhinitis[link]

Local allergic rhinitis is an allergic reaction in the nose to an allergen, without systemic allergies. So skin-prick and blood tests for allergy are negative, but there are IgE antibodies produced in the nose that react to a specific allergen. Intradermal skin testing may also be negative.^[12]

The symptoms of local allergic rhinitis are the same as the symptoms of allergic rhinitis, including symptoms in the eyes. Just as with allergic rhinitis, people can have either seasonal or perennial local allergic rhinitis. The symptoms of local allergic rhinitis can be mild, moderate or severe. Local allergic rhinitis is associated with conjunctivitis and asthma^[12].

In several studies, over 40% of people who had been diagnosed with nonallergic rhinitis were found to actually have local allergic rhinitis.^[11]

Steroid nasal sprays and oral antihistamines have been found to be effective for local allergic rhinitis.^[12] A preliminary study found that allergy shots were also effective.^[21]

References[link]

External links[link]

•  "Hay fever". Encyclopedia Americana. 1920. 

Adam Buxton and Joe Cornish are British comedy performers known together as Adam and Joe. They are best known for presenting Adam and Joe on BBC 6 Music, and The Adam and Joe Show on Channel 4 from 1996 to 2001.

History[link]

Adam and Joe began working on comedy material during their time at Westminster School together, where they created numerous amateur films along with their friend Louis Theroux. Some of these films were submitted to Channel 4's home video showcase Takeover TV in 1994 and led to Adam hosting that show in 1995.^[1]

Together they hosted The Adam and Joe Show on Channel 4 from 1996 - 2001. They won the Royal Television Society Best Newcomers Award in 1998, published The Adam and Joe Book in 1999, and presented BBC Three's coverage of the Glastonbury Festival in 2000 and 2002. Other spin-off projects included Adam & Joe's Fourmative Years in 1998 and Adam and Joe's American Animation Adventure in 2001.^[2]

They directed pop promos for Frank Black and Gorky's Zygotic Mynci, as well as appearing in two Surf washing powder commercials, in which they comically set upon Laurence Llewelyn-Bowen and Keith Harris and Orville.^[3]

In 2003, Buxton and Cornish presented Adam and Joe Go Tokyo, a Tokyo-based magazine show covering Japanese pop culture for BBC Three and BBC One.^[4] The same year they began hosting a show on UK radio station Xfm, filling in for Ricky Gervais on Saturday afternoons. When Gervais left the station they took over permanently, and continued to present the Saturday morning show, until Summer 2006. The best parts of these shows were condensed into a series of twenty podcasts.

Bizarrely, their most-repeated^{[citation needed]} is their 2001 E4 series Shock Video, in which the duo provide an often totally irrelevant comic commentary on soft-core porn clips from around the world.

From August 2006 until October 2007, they hosted the monthly "Coca-Cola New Music Podcast", which showcased unsigned bands from around Europe, presented in a similar style to their Xfm shows.

They sometimes write a column for The Idler, a yearly literary magazine.^[5]

Present[link]

Adam and Joe began presenting the BBC 6 Music Saturday morning show in October 2007.

Features on the show include 'Song Wars', where they both compose original compositions based on a common theme. Listeners then vote for which song they think is the best.

'Text the Nation' is another regular feature where listeners provide anecdotes based on a theme or question set by Adam and Joe. Themes have included 'Childhood Misconceptions' and 'Horror Film Ideas'. The 'Text the Nation' feature was also instrumental in the uncovering and subsequent popularisation of the Stephen! call and response.

Their show won a Broadcasting Press Guild Award in 2008 for best radio programme of the year.^[6]

References[link]

External links[link]

• Adam and Joe fansite
• Adam and Joe Blog
• Adam and Joe on BBC 6 Music
• Adam and Joe BBC 6 Music on Facebook
• Rubapedia: online encyclopedia of Adam and Joe
• The Adam and Joe appreciation society on Facebook
• Guardian Online live chat transcript
• Independent Interview