3 - Respiratory Allergic Disorders + Sleep-Disordered Breathing

Rhinitis ภาษาไทย

จมูกอักเสบ

• specifically เยื่อบุ

Rhinitis split by etiology

1. Infectious: Viral(acute), bacterial(often secondary, can be chronic), fungal

2. Non-infectious: Allergic, non-allergic, occupational

How do we know when allergic rhinitis is persistent and how do we know when the severity is more than mild?

• Persistent: 4 days a week or more for 4 weeks or more

• Moderate-severe: Starts to affect sleep and daily activities like work, driving, sport

Allergic rhinitis simple mechanism and diagnosis of allergic rhinitis

Mechanism: Body develops specific IgE antibodies against certain allergens(Like dust or pollen) and every time it’s introduced, it causes mast cells to degranulate

Diagnosis: Patient w symptoms can do a skin prick test, intradermal test, and specific serum IgE(Used if a patient isn’t compatible w the first two tests)

Allergen immunotherapy is also a name for ___

Vaccine

Allergic rhinitis cellular level process

APC presents antigen to naive CD4+ → It becomes Th2 → Th2 secretes IL-4 and IL-13 to act on B cells to cause them to make IgE

How does immunotherapy interrupt that process?

Repeated + gradually escalating allergen exposure thru vaccine allows the body to increase Treg response → secretes IL-10 and TGF-beta → suppresses Th2 directly and redirects class switching to IgG

Allergic rhinitis symptoms and why?

1. Sneezing: Due to histamine release

2. Rhinorrhea: Histamine boosts mucous gland production and blood vessel leakiness, allowing fluid to build up in the nose

3. Nasal congestion: Late phase reaction 4-8 hrs in often due to eosinophils

Mechanism and symptom difference between allergic and non-allergic rhinitis

• Mechanism: Non-allergic involves no IgE

• Symptom: Sneezing and rhinnorhea less common, nasal congestion still prominent

NARES

• Stands for

• Cause

• Significance

• Non-allergic rhinitis with eosinophilia syndrome

• Unsure

• Can respond to corticosteroids

Vasomotor rhinitis

• Idiopathic NAR that makes the body more vulnerable to non-immune triggers like temp. change, strong smells, stress

• Most common

Rhinitis medicamentosa

• Decongestant sprays can cause a rebound effect and lead to excess vasodilation(If used for over 5 days)

Hormonal rhinitis

• An example is pregnancy, where elevated estrogen increases blood flow and vascular engorgement that makes congestion

Senile rhinitis

• Age related increase of parasymp. tone → more nasal gland secretion

Atrophic rhinitis

• Nasal mucosa and turbinates atrophy, leading to a wider nasal cavity, but this actually leads to a feeling of congestion due to damaged nerve endings

Vasomotor, hormonal, and rhinitis medicamentosa mucosa is often ___, due to ___, while atrophic is ___

• Red from active vasodilation while atrophic is often pale and dry

What are these listed conditions, except for NARES?

• Non-allergic rhinitis(NAR)

Why is occupational rhinitis classified on it’s own?

• Because it can be allergic or non-allergic

How are nasal polyps, deviated septum, sinonasal tumors the same kind of issue, but what makes nasal polyps unique here?

• They occupy space physically, however, nasal polyps have inflammatory origins

Polyps are often seen with ___

pus

Adenoid hypertrophy and hypertrophic tonsilitis

• What they are

• Location

• What they cause

• Lymphoid tissue enlargement

• Adenoid is a single mass in the nasopharynx, while the tonsils are a pair at the back of the throat

• When they enlarge, they cause airflow obstruction and obstructive sleep apnea specifically

OSDB

• Stands for

• What is it

• Types and their differences

• Demographic

• Consequences

• Diagnosis

• Treatment

• Obstructive, sleep disordered breathing

• An umbrella term for things from snoring all the way to obstructive sleep apnea

• Partial obstruction makes sound(snoring) when the air moves turbulently, but if there’s complete obstruction(apnea), there’s no airflow

• OSDB is found often in kids, but OSA specifically is found most commonly in obese, older males

• Snoring, gasping in sleep, hyperactivity/irritability in children, but daytime sleepiness in adults

• Polysomnography

• Weight loss, CPAP, intranasal corticosteroids/antihistamines(If nasal inflammation/allergic rhinitis is contributing), positional therapy, oral appliances, surgery

Relationship between OSDB and nasal obstruction

1. Nasal obstruction increases resistance, so we have to breathe in harder(more negative pressure in the chest and pharynx, making it more collapsible) and makes it worse

2. Unstable mouth breathing, which pulls the tongue back more and narrows space more

3. Impaired nasal reflexes, because airflow stimulates nerve receptors which helps activate muscles that dilate/stiffen pharynx so they don’t close down, so a lack of airflow leads to this reflex being blunted