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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Allergic rhinitis

Chapter:
Allergic rhinitis
Author(s):

Stephen R. Durham,

Hesham Saleh

DOI:
10.1093/med/9780199204854.003.1806

Allergic rhinitis affects more than 20% of the population of Westernized countries and has a significant impact on quality of life and school/work performance.

Aetiology and clinical features—important environmental factors include tree and grass pollens (seasonal allergic rhinitis); house dust mite and domestic pets, most often cats (perennial allergic rhinitis); and a variety of occupational exposures (occupational rhinitis). Many genetic loci confer susceptibility. Immediate symptoms (itching, sneezing, and watery nasal discharge) occur as a consequence of allergen cross-linking adjacent IgE molecules on the surface of mast cells in the nasal mucosa, resulting in the release of histamine and tryptase, and the generation of bradykinin.

Diagnosis and classification—diagnosis is usually straightforward and based on the history, examination and (when indicated) the results of skin prick tests and/or serum allergen-specific IgE levels. Classification is according to the severity and duration of symptoms as defined by ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines, which describe four categories of disease: (1) mild intermittent, (2) moderate/severe intermittent, (3) mild persistent, and (4) moderate/severe persistent. Differential diagnosis and management of more complex cases are helped by flexible or rigid nasal endoscopy and CT of the nose and paranasal sinuses.

Management—allergen avoidance, topical intranasal corticosteroids, and nonsedating oral antihistamines are the mainstay of treatment and are effective and safe. Treatment failure often results from poor compliance or inadequate technique in use of nasal sprays. Allergen injection immunotherapy, which has been shown to induce long-term disease remission, is indicated in patients with severe seasonal allergic rhinitis who fail to respond to usual measures. Rhinitis is often accompanied by significant comorbidities that include conjunctivitis, sinusitis, otitis media, and bronchial asthma: these require separate recognition and treatment.

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