Pathogenesis of allergic rhinitis (rhinosinusitis)
- Richard D deShazo, MD
Richard D deShazo, MD
- Billy S Guyton Distinguished Professor
- Professor of Medicine and Pediatrics
- University of Mississippi Medical Center
- Stephen F Kemp, MD
Stephen F Kemp, MD
- Professor of Medicine and Pediatrics
- University of Mississippi Medical Center
Allergic rhinitis is associated with a symptom complex characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, and itching of the eyes, nose, and palate. It is also frequently associated with postnasal drip, cough, irritability, and fatigue [1-3].
The pathogenesis of allergic rhinitis is presented in this topic review. The clinical manifestations, diagnosis, and treatment of this condition are discussed separately. (See "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis" and "Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis" and "Pharmacotherapy of allergic rhinitis".)
MECHANISMS OF UPPER AIRWAY ALLERGIC REACTIONS
Upon exposure to an allergen, atopic individuals respond by producing allergen-specific immunoglobulin E (IgE). These IgE antibodies bind to IgE receptors on mast cells in the respiratory mucosa and to basophils in the peripheral blood. When the same allergen is subsequently inhaled, the IgE antibodies are bridged on the cell surface by allergen, resulting in activation of the cell. Mast cells in the nasal tissues release preformed and granule-associated chemical mediators, which cause the symptoms of allergic rhinitis.
Models of nasal allergen challenge in patients with allergic rhinitis have provided information about the pathogenesis of allergic rhinitis [4,5]. In this model study system, individuals known to have allergic rhinitis on exposure to a particular allergen are exposed to incremental doses of that allergen placed in the nose. The subsequent reaction is then monitored over time with nasal biopsies or washes. This allows direct quantitation of cell types by stains and surface markers, assessment of message for transcription, or direct measurement of cellular cytokines and other inflammatory mediators . Rhinomanometry, the measurement of nasal airway resistance, permits measurement of both resistance and airflow following allergen provocative challenge . (See "Occupational rhinitis", section on 'Rhinomanometry techniques'.)
Immunogenetics — The expression of allergic diseases of the upper airways reflects an autosomal dominant pattern of inheritance with incomplete penetrance. This inheritance pattern is manifested as a propensity to respond to inhalant allergen exposure by producing high levels of allergen-specific IgE. The IgE response appears to be controlled by immune response genes located within the major histocompatibility complex (MHC) on chromosome 6. (See "Major histocompatibility complex (MHC) structure and function".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- MECHANISMS OF UPPER AIRWAY ALLERGIC REACTIONS
- Th2 lymphocytes and IgE production
- Mast cell activation
- - Histamine
- - Prostaglandins and leukotrienes
- - Other mediators
- Cellular infiltration
- IMMEDIATE AND LATE NASAL REACTIONS
- ALTERATIONS OF NASAL PHYSIOLOGY
- INVOLVEMENT OF THE PARANASAL SINUSES
- INFORMATION FOR PATIENTS