Nasal cavity
Inflammatory / infectious lesions
Allergic rhinitis

Author: Jihong Sun, M.D. (see Authors page)
Editor: Margie Brandwein-Gensler, M.D.

Revised: 14 April 2016, last major update April 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Allergic rhinitis nasal cavity

Definition / General
  • Common IgE mediated sinonasal hypersensitivity reaction provoked by reexposure to a specific antigen, including plant pollen, fungi, dust mites, animal allergens
  • May be acute or chronic
  • Also called hay fever
Terminology
  • Also called Type I IgE immunological rhinitis
  • Acute allergic rhinosinusitis: develops 2 to 5 minutes after antigen-antibody exposure, reaching its peak about 15 minutes later
  • Chronic allergic rhinosinusitis: lasts more than 6 weeks; includes aspirin exacerbated respiratory disease
Epidemiology
Sites
  • Bilateral nasal cavity and paranasal sinuses
Pathophysiology
  • IgE antibody binding and mast cells release various mediators (histamine, prostaglandins and leukotrienes) causing vasodilation, edema, eosinophilia, nasal congenstion, rhinorrhea, sneezing and itching
Etiology
  • Type I IgE hypersensitive reaction to allergens, including pollen, animal dander, dust mites, mold spores and food
  • Aspirin exacerbated respiratory disease (AERD, also known as Samter's triad) refers to the syndrome of allergic nasal polyps with eosinophils, aspirin intolerance and bronchial asthma, which affects 4-10% of asthmatics
  • AERD is due to inhibition of the cyclooxygenase pathway in sensitive individuals; this shunts metabolism of arachidonic acid to the 5-lipooxygenase pathway, leading to increased proinflammatory leukotrienes and decreased PGE2, a protective prostaglandin
Clinical Features
  • Rhinorrhea, sneezing, itching
Laboratory
  • Stained smears of nasal secretion slow >25% eosinophils
  • Elevated total serum IgE
Treatment
  • Avoidance of allergens, use of environmental controls, sublingual immunotherapy
Clinical Images
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Boggy inferior turbinate in an allergic patient

Swollen pale turbinates with thick secretions

Micro Description
  • Mucous secretions have neutrophils and prominent eosinophils
Micro Images
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Nasal polyp with prominent eosinophils

Eosinophils, neutrophils, plasma cells

Cytology Description
  • Stained smears of nasal secretion: >25% eosinphils
Cytology Images
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Nasal secretion smear

Differential Diagnosis
  • Infectious rhinosinusitis