Rhinitis is an inflammatory disorder of the nasal mucosa and may be due to various reasons. It can be examined as infectious, non-infectious, allergic and non-allergic rhinitis. Allergic rhinitis (AR=hay fever) is the most common type (10-25%); Like other allergic diseases, it appears with increasing frequency. Hay fever can be divided into three groups, clinically, seasonal, lasting year-round, and seasonal increases throughout the year.
In addition to this classification, nowadays intermittent (intermittent) or persistent (continuous); light or medium/heavy classifications are also used. Hay fever is characterized by at least two or more of the symptoms of nasal congestion, runny nose, sneezing, nasal itching. Findings should last more than an hour a day. allergens responsible for the disease; pollen, mold spores, house dust mites, animal protein and cockroach extracts. Rarely, food allergens can also cause respiratory allergies such as hay fever. Diagnosis in hay fever, a detailed disease history with some specific questions about this disease; It can be diagnosed with the help of laboratory tests together with a general physical examination along with a detailed examination of the nose, sinuses, throat area and lungs.
While learning the complaints from the patient, the situation can be clarified by asking closed-ended questions (Is there a nasal congestion? In addition, the patient’s eye, ear, throat and sinus findings should be asked. After questioning the upper airway, it is absolutely necessary to question the symptoms of asthma such as cough, shortness of breath, wheezing and asthma attacks in this patient group, who is also at great risk for allergic asthma. The family histories of the patients can also be a guide. It should be asked whether there is allergy in other members of the family. A patient with hay fever may also have an allergic disease (such as rhinitis, asthma, atopic dermatitis) in their family. In patients with seasonal hay fever, watery nasal discharge and sneezing are the most prominent findings; however, in cases with year-round allergic rhinitis, nasal obstruction is more frequently observed. The periods of the patients’ symptoms are also important. Pollen is the most important cause of hay fever. For this reason, pollen allergy can be diagnosed while taking the disease history.
Although it varies from country to country, according to vegetation and climate diversity, mostly pollen can cause seasonal hay fever in other seasons except winter. In our country, tree pollens are the allergens that cause the earliest pollination and symptoms. It is known that tree pollen pollinates from the middle of February until the end of April. Meadowgrass pollen pollinates from mid-May to early August. In autumn (mid-July to October) weed pollens are the allergens responsible for the symptoms. Fungal spores are also an important cause of allergic rhinitis and can be an important source of allergens throughout the year. However; They are mostly encountered between May and October. Along with the nose, the other upper respiratory tract should also be carefully examined during the examination.
Head and neck, chest and adjacent areas should also be examined. Diagnosis of allergic rhinitis; It should be supported by the history and tests to be done after a good examination. Today, many allergens have been prepared in a standardized form for application in skin tests. The most reliable test that can be applied with these test materials is the skin prick test. However, the test must be performed and interpreted by an allergist and immunology specialist. The sensitivity and specificity of the test are quite high, and the most important advantages are that it can be easily repeated. Patients should stop their treatment, such as antihistamines (allergy drugs), antidepressants, flu drugs, if they are taking them at least 1 week-10 days before. Positive and negative control must be applied during the test. Intradermal tests may rarely be necessary. Apart from these, blood eosinophilia (cells in allergic reactions) and total IgE (allergy antibodies) studies are tests with very limited benefits. As a screening test in patients, the search for IgE antibodies specific to common allergens by methods called multi-RAST or phadiotop method can be used. For young children who are afraid of the skin prick test, who cannot stop antihistamine therapy, who have co-lesional skin disease or who have dermographism, allergen-specific IgEs are investigated by taking a little blood.
For this purpose, tests such as ELISA, FAST and RAST are used. However, the sensitivity of these tests is less than skin tests. Examination of the swab material taken from the nasal discharge for eosinophilia may also be supportive. Nasal provocation test (nasal stimulation test) applied with non-specific or allergen is also an extremely sensitive test; It can also be used to follow the course of the disease. Specific nasal allergen challenge tests are extremely valuable; However, it is still mostly used for research, because it requires expensive equipment and takes time, and its routine application is limited. It may also be useful, especially in the diagnosis of occupational rhinitis. Radiological examinations may rarely be necessary. Apart from these, pulmonary function test for asthma and, if necessary, lung provocation tests can be applied. Wishing you healthy days… Prof. Dr. Cengiz KIRMAZ
