 Good evening to all the viewers who are watching me live on Facebook, I am Dr. Arun Raikar, a consultant at BNU, and I am next to him as Dr. Malikar Nautra Dr. Malikaran. I would like to share few of my experiences with allergy granitis. Allergy is a very broad terminology. Allergy has been seen as a quite common condition in the medical practice. We have a global prevalence of 50 to 20 percent of diseases suffering from allergic disorders. I would like to restrict my discussion only to the topic allergy granitis. Let us know what is allergy? Allergy is something like a hyporesponsive stimuli by the body to any environmental stimuli. Today we will just restrict only to the allergic granitis. The definition of allergic granitis says that it is an intense inflammation of the nasal mucosa epithelium, the nasal mucosa to any environmental stimuli. Allergy we are going to divide it into the duration of symptoms as seasonal and familial allergic granitis. We do have another classification where depending on the duration of symptom and allergy we classify it as intermittent and persistent allergic granitis. Intermittent allergic granitis is one where the symptoms last for less than four days in a week and it usually subsets within the four weeks. Normally if it is a persistent allergic granitis the symptoms usually last for more than four days in a week and it stays for more than four weeks. That is how we divide whether it is intermittent or persistent allergic granitis. So what causes this allergy granitis? Because the excessive urbanization and the lifestyle changes and all this could lead to the symptoms of allergy granitis. The causative factors could be the occupational irritants, something like those who are working more in the industry, something like the cement industry or the paint industries. Even the occupations were like the teachers were of course much to the sharpest and even the fungal spores which usually will be in the old piles, dust or even fungal moors on the walls, wet walls. All this can lead to allergy. Even the animals what we have is better animals at home. The cat dog, the tenders of these usually leads to intense allergic granitis. Even the dust, the house dust which is interested by the house dust might. So that usually leads to, there is a commonest cause for most of the aero allergic granitis and we have the pollens, the pollutants that the automobile adverse are. So all this will act as something like a complete for the allergic granitis. So coming to the ecology, the ecology is what we have discussed now. The symptomatology includes there will be intense nasal irritation, sneezing, canine nose, blood nose and the other symptoms which could be the allergic conjunctivities, watering of eyes, redness in the eyes. Some individuals do present with the other associated symptoms of allergic granitis such as mouth bleeding. In children we usually do see that most individuals present with mouth bleeding difficult to breathe at night. And some kind of early onset of very mild hearing loss, they have, that does affect their work productivity and the school performance. So it is better to evaluate for any nasal block or runny nose at the earliest. I will just tell you the pathophysiology. So the moment and inciting antigen or environmental stimuli reaches the nasal mucosa. So it leads to intense self-penetration into the nasal mucosa layer which includes the giosnucleus, monocytes, these are the immune cells of a body. There will be intense infiltration in the T and B cells which stimulate the mass cells and there will be IgE antibodies which is response by the body for any antigen. So once this cascading event of immune complex starts, so there will be intense degranulation by the mass cells. It secretes chemical mediators such as histamines, leucotrines, the quinines and the prostaglandins. So all this acts as a chemical mediators for the allergic information. So once there is release of these chemical mediators by the degranating mass cells, so it leads to intense vasodilatation that is where the blood vessels engorge causing slight nasal gauze and there will be secretions. It says secretions which causes a lot of mucorrhinuria of the nasal discharge which is passively seen in allergic realities and because of the stimulation of nerve endings, it leads to a cascading event of sneezing, cough and these are the symptoms we generally find. But in pediatric populations, most of the kids with allergic realities present with a lot of mouth bleeding, decreased work productivity, school performance and some individuals do present with hard of hearing. So that is because there is a, the nose connects with the ear through a tube called a station tube. So that maintains the ventilation into the little ear clap because the intense allergic stimulation of the nose and the sinuses, the institution tube function will be deteriorated. So that is when the secretions tend to accumulate in the middle ear clap leading to a condition called as blue ear or the allergic blue ear which is seen in allergic realities. So this leads to amount of mild hearing loss that is going to be the conductive type of hearing loss. It is an easily reversible type of hearing loss. So then coming to the other symptomatology, so an allergy is not an, allergic rate is not an individual entity by itself. So once there is an allergic stimuli so it is not the nose which just responds it denotes the surrounding organs, the eyes, the ear. So the individual who has allergic realities will never have just the symptoms of a block nose and a nose. They usually present with the injection of the eyes, the condition in the eyes, watery eyes. They will have a postnessal drip that is the secretions which is pulled in the nose gradually trickled back to their oropharynx so leading to a condition called as postnessal drip which leads to the allergy, allergic stimulus spreading towards the oropharynx, the soft palate where they have a itching in their soft palate, a repeated hacking cough, dryness in the throat and the nocturnal cough, muscle time is a sign of allergic rhinitis which remains unattended. So these are the normal symptomatology we find in allergic rhinitis. So we will move into the treatment part. So the treatment includes first is the avoidance of allergens. That is the easy and most cost effective way of treating allergic rhinitis. So by what we mean by allergen avoidance is not to expose if a individual is sensitive to certain type of allergen stimuli. So it could be even like the occupational irritants maybe the softness dust or the pain, the fumes of pain. So these things needs to be avoided so better to wear a mask then to decrease the priming of the nose with the environmental irritants. The wearing a mask is a good idea of preventing or reducing, it comes under the allergen avoidance and then regular nasal breathing exercise so that again helps in reducing the priming of the nasal tissues then comes the regular cleaning at home and better to change the bedspreads frequently to vacuum clean the so far the furnitures to keep the leather upholstries or whatever furniture we use at home in Christianity with proper cleaning with vacuum dusting the curtains. So all these things to a great extent helps in reducing the initial trigger of allergic rhinitis. So this comes under allergen avoidance and the treatment part usually we have various category of medications which we will be using for treating and managing allergic rhinitis. The first time the foremost treatment remains the allergen avoidance then comes the in the medical line of management we have the antihistamines the nicotrin inhibitors, the anti-nicotrin master stabilizers and the intranasal corticosteroids and the nasal douching. So to a great extent it helps in reducing the allergic response of the nasal epithelium. The antihistamines these are the drugs which we usually prefer in mind to very mind cases of allergic rhinitis where the primary complaint of the patient will be the sneezing, running nose and slight nasal block. But most of the symptoms will be temporary that is only whenever they are exposed to interstimuli they usually react in the form of sneezing. So we have something called as the early phase reaction and the late phase reaction whenever they are exposed to the dust or any inside stimuli which leads to allergic rhinitis. So in the early phase reaction the patient usually will have a individual sneezing there will be watering of nose and there will be even the congestion of the eyes. So this comes under the early phase reaction to an allergic stimuli. The late phase reaction ensues with nasal block, a thick mucoid discharge this goes in favor of the late phase reaction. And whenever there is any allergic stimuli to the nose it does involve the sinuses also. So the complications what we see if the allergic matrix is not treated is, so it could lead to a condition called as allergic rhinitis where there is intense inflammation within the nasal mucosal epithelium can involve the sinus also leading to form of polyps. So polyps are nothing but a inflamed mucosal which just pops from the sinus towards the nose causing obstruction to the earway. And longer the polyps are there that usually causes the chronic nasal obstruction and it affects the ventilation of the institution which leads to a mine conductive hearing loss. And longer the duration of polyps the patient resort to do more of molubating and the other problems could be the obstructive sleep apnea that is the patient usually have very loud snoring because of block nose and whenever the snoring increases again there are other comorbidities with symptoms like the hypotension and the poor work poor activity as I mentioned earlier. So all this will be attributed to the effect of nasal polyps causing chronic obstructive sleep apnea. So these things has to be managed surgically. So now next I can come into the other line of medical treatment that is the nucleotide receptor antagonists or anti nucleotide. So the monodicast they help in reducing the nucleotide that is the chemical mediator again which helps in reducing the priming response of the nasal mucosa whenever it comes in contact with the antigen. So this anti nucleotide helps in reducing the nasal itching, the nasal discharge and the nasal blockage. So this we usually use for short duration and most of the time when they are not responding to this primary line of management we resort to the intranisal corticosteroids which students the nasal epithelium and reduces the priming time. To a great extent it reduces the symptoms of sneezing, the itching of the nose, the rhinorrhoea and the block nose. So after this line of management the patient is doing well, he can continue with a good amount of nasal breathing exercise lifestyle modifications and normally the nose does the job of a humidifier so it helps in increasing the temperature. So normally when we are outside, so the outside temperature if it is around 22 degrees, our body temperature is 37.5. So that is the normal temperature. So at this temperature normally the shift of 15.5 degrees is done by the nose. So this happens only because of heat exchange which takes place in the turbinates. So that helps in the job of increasing the temperature of the outside the air to the body's temperature and it helps in lubrication of the air and it helps in filtration of the air with the pollens, allergens or the bacteria as well as that it gets really neutralized in the nose. So this will be the function of nose. So coming to the second part that is how we manage allergicitis surgically. So when all this medical end of management phase or if it is not giving any effective symptom-free interval for the patients, so then the surgical option it has a very limited outcomes. That is normally we suggest surgery if they have any analytical deformities in the nose and they are compromising with the allergy that is a deviated level symptom and whenever the allergic response is intense it leads to the formation of polys into the sinus. So that leads to chronic obstructive blockage of the nose. So that needs to be corrected with surgery like functional endoscopic sinus surgery. So that helps in addressing the issues of the sinus as well as the anatomical abnormities of the nose. So to conclude I would say that it is always with a good amount of exercise and detecting the inciting cause avoidance. So this becomes the best way to address allergy and whenever any such issues of nascent block or runny nose which is not subsiding in a beam. So never take it lightly or manage with any over the counter medications. Better to take an opinion from the specialist and go accordingly and this is how we can manage allergy. Thank you. We have question from Mr. Sampar. So he says I said have dust allergies how to work out. So first we have to know like what your allergy are really allergic to. There are certain tests such as the skin prick test which helps to isolate or identify what you are really allergic to. It is a skin prick test where the antigens for what you are allergic to will be injected into the skin and we look for the response of the skin based on that that can be treated with immunotherapy where increasing those of antigens will be injected. So that helps in nullifying the allergy.