Allergic Rhino-conjunctivitis

Janet Beausoleil, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Meredith L. Heltzer, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

The Planners of this activity have no relationships to disclose.

Janet M. Beausoleil, MD, is an assistant professor of pediatrics at the University of Pennsylvania School of Medicine and attending physician at the Children's Hospital of Philadelphia (CHOP). Meredith M. Heltzer, MD, is a fellow in asthma, allergy and immunology at CHOP. Here, they discuss allergic rhinitis and conjunctivitis and their epidemiology, allergic and nonallergic causes, risk factors, diagnosis, and treatment.

Dr. Beausoleil wishes to disclosure that she has appeared as a speaker for GlaxoSmithKline and Merck. Dr. Heltzer has no relationships with commercial interests related to the content of this presentation.

This lecture and the post-test is worth 1.5 credit hours.

Even though the prevalence of allergic rhinitis is high and getting substantially higher, say the authors, it's a disorder that is often undiagnosed. They discuss its causes, classification, pathophysiology; its association with other diseases; and enumerate not only risk factors but also "negative risk factors" including early exposure to multiple potential allergens.

In a discussion of mediators of allergic inflammation, the authors explain the action of histamine in causing sneezing, pruritis, and rhinorrhea, and how cytokines and chemokines propagate allergy.

The key to diagnosis, Drs. Beausoleil and Heltzer contend, is awareness of signs and symptoms ... and particularly of various pollen types and their seasons, which they illustrate with a series of maps. Treatment, clearly, involves avoidance of pollens, with IgE antibody testing being used to detect specific antigens. In a discussion of treatment, the authors cover the control of mold, dust mites, cockroaches – and recommend High Energy Particulate Air (HEPA) filters to minimize the allergy-producing effects of domestic pets. Pharmacotherapy includes antihistamines, decongestants, and intranasal corticosteroids.

For allergic conjunctivitis, over-the-counter decongestants and antihistamines are useful, as are tear substitutes, but the several prescription ophthalmic preparations, including Mast Cell Stabilizers, are the most effective.

The lecture concludes with the indications for and against immunotherapy in allergic rhinitis and conjunctivitis.