Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- espirros
- prurido nasal
Other diagnostic factors
- prurido em palato, garganta, ouvido e olhos
- vermelhidão dos olhos, edema e lacrimejamento
- fadiga e irritabilidade
- congestão nasal
- rinorreia
- olhos arroxeados devido à alergia
- hiperemia conjuntival
- secreção ocular mucoide
- prega nasal
- palidez da mucosa nasal
- inchaço da mucosa nasal e dos cornetos
- secreções nasais claras e abundantes
- linhas de Dennie-Morgan (pregas presentes nas pálpebras inferiores)
Risk factors
- outras afecções atópicas ou história familiar de atopia
- idade <20 anos
- exposição a aeroalérgenos (pólen, bolor, ácaro, poluição)
- exposição a pelos/penas de animais
- etnia
- testes de punção cutânea positivos para alérgenos
Diagnostic investigations
1st investigations to order
- tentativa terapêutica de anti-histamínico ou corticosteroide intranasal
Investigations to consider
- teste de punção cutânea para alérgenos
- determinação de IgE específica in vitro
Treatment algorithm
sintomas leves ou intermitentes
sintomas persistentes e moderados a graves
terapia habitual ineficaz ou pouco tolerada
Contributors
Authors
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
Disclosures
GCS has taken part in sponsored research for the ALK clinical trial of the house dust mite SLIT tablet for use in paediatric patients. He is a member of the Joint Task Force on Practice Parameters Workgroup on the Allergic Rhinitis Practice Parameter.
Acknowledgements
Dr Gary C. Steven would like to gratefully acknowledge Dr Alexander Greiner, a previous contributor to this topic.
Disclosures
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.
Peer reviewers
Mark Davis-Lorton, MD
Clinical Immunology Coordinator
Division of Rheumatology, Immunology and Allergy
Winthrop-University Hospital
Mineola
NY
Disclosures
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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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
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
Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (rev ed 2017). Clin Exp Allergy. 2017 Jul;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
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.
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