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Seriousness of allergy rhinitis


									What is actually allergy rhinitis? Allergy rhinitis is an allergic
disease, which is caused by the sensitinogen that reacting on the mucous
membranes in the nasal cavity. It consists two types that are perennial
and seasonal allergic rhinitis. Perennial allergic rhinitis occurs
throughout the year; whereas, seasonal allergic rhinitis usually occurs
during the blossoming or flowering season. In this season, plants start
to release their pollen for breeding purpose. Pollen is one of the
sensitinogens to the allergic rhinitis. Clinical features of allergic
rhinitis are; itching in the nose, sneezing, watery nasal discharge and
nasal obstruction. There are about 20 % of adults and children have
seasonal or perennial allergic rhinitis [Otolaryngol Head Neck Surg
1986;94:470-5]. Although it is prevalence in most of the countries
regardless tropical or seasonal, most of the conditions are not treated
adequately and the consequence is that allergic rhinitis becomes chronic.
The chronic state of allergic rhinitis usually will lead to more serious
complications of the upper and lower airways such as asthma, sinusitis
and otitis media with effusion. Otitis media is an inflammation of the
middle ear. Fluid is built up in the middle ear and causes temporary lose
of hearing. However, if this chronic disease is not treated properly, it
may lead to permanent hearing impairment. A few medical scientists had
carried out surveys to study the epidemiologic links between allergic
rhinitis and other airway diseases. What they had found out were, 78% of
patients who had asthma were also had allergic rhinitis [Allergy
1983;38:25-9]. They also found out that 99% of adults and 93% of
adolescents, who had allergic asthma, also had allergic rhinitis [J
Allergy Clin Immunol 1997;99:S138]. Besides, the other study that had
been carried out for 23 years was found out that college students who
previously had allergic rhinitis had three times higher the possibility
to have asthma compared to those students who had not had allergic
rhinitis before [Allergy Proc 1994;15:21-5]. Many researches and works
had been carried out to study the epidemiologic link between allergic
rhinitis and sinusitis. The results had been well documented. The earlier
study showed that 53% of children, who had allergic rhinitis, also had
sinusitis [J Allergy Clin Immunol 1978;61:310-4]. They proved this from
the children abnormal sinus radiographs. Whereas, recent study showed
that up to 70% of children, who had allergy and chronic rhinitis, had
abnormal sinus radiographs [J Allergy Clin Immunol 1988;82:935-40]. 78%
of the patients who had recurrent sinus infection, rhinitis allergy was
coming together with their extensive sinus disease. For the children who
had otitis media with effusion, 40 to 50% of them had allergic rhinitis
[J Allergy Clin Immunol 1997;99:S787-97.]. This was confirmed by positive
allergy skin tests or increased serum IgE antibodies to specific
allergens test. Scientist had proposed a model for the development of
sinusitis and otitis media. Their proposed model assumes that the
earliest cause for sinusitis is not bacterial infection but it is due to
the obstruction in the nasal cavity, which hinders the normal movement of
air and secretions in and out of sinuses. Virus that causes nasal
inflammation is upper respiratory tract infection (URTI) type, which is
called rhinovirus. Research had been carried out to study the effect of
this virus to the nasal diseases. The result showed that when rhinovirus
is inoculated into the nasal passage of a group people, one third of
these people would develop sinus abnormities and typical sinus disease
symptoms [J Allergy Clin Immunol 1992;90:474-8]. Another study also
showed that 87% of healthy adult, who voluntarily went through self-
diagnosed colds, had maxillary sinuses illness [Engl J Med 1994;330:25-
30]. Fluid inside the sinus cavity must be drained normally to keep the
nasal healthy. When nasal being infected by bacteria or virus, or
exposure to allergen, dust or chemicals, thicken secretion will be
developed and it has higher possibility blocks the narrowed sinus ostia
(opening that connect to the sinus cavity). Accumulation of these
secretions in the sinus cavity will lead to further obstruction, mucosal
swelling and also thicken the sinus mucosa. This will create an anaerobic
environment that further favorite the bacterial growth and lead to
infection. Congested sinus ostia must be resolved if not, it will lead to
recurrent acute and eventually chronic nasal disease. This model also
explained why chronic sinusitis is resistant to the antimicrobials
treatment alone. To treat the sinusitis properly, antihistamines and
corticosteroids have to be used as a combination with the antimicrobials
treatment. A similar model had been developed by scientist to explain
the occurrence of otitis media with effusion. 83% of the children had at
least once occurrence of acute otits media by the time they reach 3 years
old [J Infect Dis 1989;160:83-94]. This model hypothesizes that nasal
inflammation that is caused by allergens or URTIs virus will further
cause inflammatory swelling and obstruction of the Eustachian tube.
Obstruction of the Eustachian tube will increase negative pressure in the
middle area and without improper ventilation; fluids will accumulate in
the middle ear. Obstructed Eustachian tube will open occasionally with an
effusion and this will suck the inner nasal secretion, which contain
bacteria, virus and allergens into the middle ear cavity. Consequently,
this will cause acute bacterial otitis media. From the information above
that have been gathered from various scientific publications, we know
that common nasal allergy should not be left untreated. This is because
it will lead to obstruction, fluid accumulation, bacterial infection and
acute disease. If these diseases are not treated properly or
successfully, a chronic state of inflammation, nasal congestion, and
sinus infection will be developed and it can cause mucosal damage and
ultimately, chronic disease. If the disease spreads to the middle ear, it
will cause permanent hearing impairment

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