Allergic rhinoconjunctivitis J30.3

Inflammatory disease of the mucous membranes of the nose and eyes, which is related in time to exposure to inhalation - (more rarely nutritive) allergens in the presence of specific sensitization (mostly pollen allergens, house dust mites, more rarely animal epithelia or molds).

The following classifications are common:

• Seasonal Rhinoconjunctivitis
• Perennial (year-round) rhinoconjunctivitis

Further subdivisions concern the duration of the allergic symptoms:

• Intermittent rhinoconjunctivitis (< 4 days/week; < weeks)
• Persistent rhinoconjunctivitis (>4 weeks)

Frequent form of allergic diseases of the atopic type. m<w.

The prevalence of perennial rhinitis in Europe is 14%. There are large regional variations with a west-east and a north-south gradient. Studies show a predominance of sensitization in the urban population compared to the rural population. A "western lifestyle" seems to favour allergies. Certain infections in early childhood (e.g. measles) have a protective effect. Familial exposure (first-degree relatives) is the greatest risk factor for the development of allergic disease. Other factors are: type of allergen exposure, environmental factors, infections.

Allergic and non-allergic factors. About 50% of all forms of perennial rhinitis are allergic in nature.

The following inflammatory mediators play a role in perennial rhinitis:

• Histamine: from mast cells and basophilic granulocytes (sneezing, itching, vascular dilatation, increased permeability)
• Leukotrienes: from mast cells, basophilic granulocytes, thrombocytes (vascular dilatation, increase in permeability)
• further: PAF, kinins, tryptase, interleukine-1, -3,-4,-8, -13; RANTES, eotaxin, gamma-interferon, eosinophilic cationic protein (ECP)
• Relevant allergens: in principle, the rate of sensitization depends on the prevalence of allergies, deficiencies in the nature and aggressiveness of the allergies.
• Common allergens in perennial allergic rhinitis are: dust mites and storage mites
• Molds (Aspergillus fumigatus and others, Penicillium notatum, Mucor racemosus, Rhizopus nigricans, Serpula lacrymans)
• Animal allergens (cat, dog, guinea pig, rat, mouse, horse, birds)
• Occupational allergens (flour and cereals, animal hair, feathers, plant allergens, insects, fungal spores, wood, wood dusts, animal feed, detergent ingredients, medicines)

In principle possible at any age. In children under 5 years of age the incidence is <5%. It is highest between 6 and 15 years of age. About 75% of the patients develop symptoms before the age of 25.

Nasal obstruction (stick sniffing); serous rhinorrhea, nasal pruritus and sneezing attacks are rather rare.

The peak of the complaint is usually in the morning hours (for example, sensitization to house dust mites).

There is a relatively high risk of developing bronchial hyperreactivity, chronic sinusitis, bronchial asthma. Children are conspicuous by increased mouth breathing (adenoid face). The consequences of increased oral respiration can be the development of a high tip palate, tooth position anomalies, enamel defects and hyperplasia of the Waldeyer's pharyngeal ring.

Children suffer from sleep disorders up to and including sleep apnoea, as well as from an increased tendency to infection of the upper and lower respiratory tract.

Furthermore, there is a hyperreactivity of the mucosa against specific and non-specific stimuli. The so-called nasal cycle (= mutual swelling and decongesting of the nasal mucosa with a duration of 2-8 hours) is disturbed. Disturbances of the mucociliary clearance and the sense of smell are characteristic.

Transversely running skin fold over the bridge of the nose (allergy sufferer's greeting) = is caused by frequent pressing of the tip of the nose with the palm of the hand upwards and back. Action to widen the airway of the nasal cavity as well as against itching.

In many patients with allergic rhinoconjunctivitis, periorbital shadows, especially in the lower eyelid area (allergic shiners) and lower eyelid oedema are conspicuous.

Subdivision of the clinical severity:

• No symptoms
• low (symptoms rare, do not disturb daily activities)
• Moderate (symptoms are frequent to frequent, daily activities or sleep are hardly disturbing)
• strong (symptoms constantly, disturb daily activities and sleep considerably)

Diagnostics, therapy see below Rhinitis allergica seasonal

Allergic rhinoconjunctivitis rarely occurs in isolation. More often, combinations of different diseases from the atopic form are present simultaneously. About 40% of patients with atopic eczema develop perennial rhinoconjunctivitis or allergic bronchial asthma. 30-40% of children with allergic rhinitis develop allergic bronchial asthma later in life. The majority of patients with allergic bronchial asthma also suffer from allergic rhinoconjunctivitis or allergic sinusitis.

1. Ring J et al (2018) Immediate type allergy: Rhinoconjunctivitis, bronchial asthma, anaphylaxis. In: Braun-Falco`s Dermatology, Venerology Allergology G. Plewig et al. (Hrsg) Springer Verlag S 454-456