Allergic rhinitis
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- sneezing
- nasal pruritus
Outros fatores diagnósticos
- palate, throat, ear, and eye itching
- eye redness, puffiness, and watery discharge
- fatigue and irritability
- nasal congestion
- rhinorrhea
- allergic shiners
- conjunctival injection
- ocular mucoid discharge
- nasal crease
- pale nasal mucosa
- swelling of the nasal mucosa and turbinates
- abundant clear nasal secretions
- Dennie-Morgan lines (creases present under the lower eyelids)
Fatores de risco
- other atopic conditions or family history of atopy
- age <20 years
- exposure to aeroallergens (pollen, molds, house dust mites, pollution)
- exposure to animal dander
- ethnicity
- positive allergen skin-prick tests
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- therapeutic trial of antihistamine or intranasal corticosteroid
Tests to avoid
- immunoglobulin G (lgG) testing
- sinonasal imaging
Investigações a serem consideradas
- allergen skin-prick testing
- in vitro specific IgE determination
Algoritmo de tratamento
mild or intermittent symptoms
persistent and moderate to severe symptoms
usual therapy ineffective or poorly tolerated
Colaboradores
Autores
Gary C. Steven, MD, PhD, CPI, FAAAAI, FACAAI, FAPCR
Medical Director
American Academy of Allergy, Asthma & Immunology Registry
Assistant Clinical Professor of Medicine
Medical College of Wisconsin
Adjunct Clinical Instructor
College of Nursing
University of Wisconsin-Milwaukee
Allergy, Asthma & Sinus Center
Milwaukee
WI
Declarações
GCS has taken part in sponsored research for the ALK clinical trial of the house dust mite SLIT tablet for use in pediatric patients. He is a member of the Joint Task Force on Practice Parameters Workgroup on the Allergic Rhinitis Practice Parameter.
Agradecimentos
Dr Gary C. Steven would like to gratefully acknowledge Dr Alexander Greiner, a previous contributor to this topic.
Declarações
AG has received grant/research support from: AstraZeneca; Boehringer Ingelheim; Cephalon Circassia Ltd; Clement Clarke Cytos biotechnology; GlaxoSmithKline; Glenmark Specialty, S.A.; Hoffman-LaRoche/Genentech; HRA/Novartis; Janssen Research & Development; Kalypsys , Inc.; Lupin; Merck; Mylan Pharmaceuticals, Inc.; Nestle (Nestec Ltd); Novartis Ono Pharmaceutical Co., Ltd.; Perrigo; Rigel Pharmaceuticals, Inc.; Roxane Laboratories Inc.; Shionogi Inc.; Sunovion TEVA Branded Pharmaceutical Products; UBC (United Biosource Corporation)/Amgen Pharmaceuticals; and sponsorship for pharmaceutical trials from Allergen Research Corporation/Aimmune Therapeutics, Inc. and AstraZeneca.
Revisores
Mark Davis-Lorton, MD
Clinical Immunology Coordinator
Division of Rheumatology, Immunology and Allergy
Winthrop-University Hospital
Mineola
NY
Declarações
MDL declares that he has no competing interests.
Glenis Scadding, MD
Consultant Allergist/Rhinologist
Allergy & Rhinology Department
Royal National Throat, Nose and Ear Hospital
London
UK
Divulgaciones
GS is a consultant/advisory board member for ALK, Britannia Pharmaceuticals, CMP Therapeutics, Grupo Uriach, GSK, Merck, Sanofi-Aventis, Schering Plough, and UCB. She has received research funds from ALK, GSK, UCB, and Schering Plough. She has given talks for ALK, GSK, Merck, Schering Plough, and UCB and has co-written articles for Schering Plough and GSK.
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Divulgaciones
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Referencias
Artículos principales
Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: a practice parameter update. J Allergy Clin Immunol. 2020 Oct;146(4):721-67.Texto completo Resumen
Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (revised edition 2017). Clin Exp Allergy. 2017 July;47(7):856-89.Texto completo Resumen
Wise SK, Lin SY, Toskala E, et al. International consensus statement on allergy and rhinology: allergic rhinitis. Int Forum Allergy Rhinol. 2018 Feb;8(2):108-352.Texto completo Resumen
Bousquet J, Schünemann HJ, Togias A, et al. Next-generation Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020 Jan;145(1):70-80.e3.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Nonallergic rhinitis
- Acute sinusitis
- Chronic sinusitis
Más DiferencialesGuías de práctica clínica
- Clinical practice guideline: immunotherapy for inhalant allergy
- Australasian guidelines for allergic rhinitis 2022
Más Guías de práctica clínicaFolletos para el paciente
Hay fever
Hay fever: avoiding pollen and mold
Más Folletos para el paciente
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