Anterior rhinoscopy showing an obviously hypertrophied and pale
inferior turbinates (arrows).
[V - vestibule (hair bearing area between the nasal introitus to mucocutaneous junction), C - columella]
Swollen inferior turbinate with excess
mucous production and reduced nasal patency.
Nasal endoscopy appearance of untreated severe allergic rhinitis.
Symptoms of allergic rhinitis include rhinorrhea, nasal obstruction,
nasal itchiness, and recurrent bouts of sneezing. It can occur intermittently
or persistently with its severity varies from mild to moderate-severe.
Tail of inferior turbinate hypertrophy (T) in a patient with allergic rhinitis made visible by nasal endoscopy.
[IT - inferior turbinate, V - vomer, N - nasopharyx, R - roof of nasopharynx]
Watch video of nasal endoscopy in allergic rhinitis @ YouTube
Nonallergic rhinitis has to be differentiated from allergic rhinitis as its clinical presentations are similar. Nasal inflammation is non-immunoglobulin-E mediated and can be diagnosed by allergic skin test or RAST. The entities classified under this syndrome includes: (1) vasomotor rhinitis, (2) infectious rhinitis, (3) hormonal rhinitis, (4) occupational rhinitis, (5) gustatory rhinitis, (6) drug-induced rhinitis, and (7) nonallergic rhinitis with eosinophilia syndrome (NARES).
Figure 2[a] Figure 2[b]
Allergic conjunctivitis No allergic conjunctivitis
Conjunctival irritations, watery eyes, suffusion, and increased vascular
patterns, are amongst its prominent clinical manifestations. These occur
in association with allergic rhinitis which need to be treated as well.
Allergic shiner's (lower eyelid oedema) is common.
Conjunctival smear or brushing reveals eosinophils.
Watch video of allergic rhinoconjunctivitis @ YouTube
Submucosal petechial lesion of inferior turbinate head (+) complicating hard pinching of nasal alar and nasolabial fold in attempt to stop intense itchiness and to prevent sneezing in allergic rhinitis. [V - nasal vestibular skin, S - nasal septum]
Right Little's area hyperaemia and patechiae occurring in a patient with pronounce nasal itchiness and severe bouts of sneezings. [V - vestibule, IT - inferior turbinate, MT - middle turbinate]
The common groups of allergen tested includes house dust mites,
fungi, epidermals and insects, grass and pollens.
The array of allergens used for skin prick test.
Positive test is conluded when there is erythema of at least 3 mm diameter, with or without the presence of wheal.
Patterson’s system for scoring skin tests (wheals diameter grade):
0 : no reaction
1+ : < 4mm
2+ : 5 - 10 mm
3+ : 10 - 15 mm
4+ : > 15 mm
Sensitization should be considered when the allergen extract's diameter:
i. superior to negative control (saline) wheal diameter by at least 3 mm; and
ii. at least equal to half the positive control (histamine) wheal diameter.
(Positive control- histamine; negative control- saline)
Tripathi A, Patterson R. Clinical interpretation of skin test results. Immunol Allergy Clin North Am. 2001;21: 291 – 300 .
Itchy papules of various sizes.
Acute onset maculopapular rashes with intense itchiness in a patient allergic to prawns. The lesion is generalized and symmetric.
An example of cutaneous reaction due to antibiotic allergy.
[CF - cubital fossa, R - right]