Rhinorrhoea means discharge from the nose, and in this chapter it is taken to
imply a non-suppurative nasal discharge.
Certain people produce an abnormal response to various foreign substances,
especially proteins, which are called allergens. Whereas in non-sensitive
subjects the reticulo-endothelial system reacts to foreign proteins by producing
a specific antibody, susceptible individuals produce additional reagmic
antibodies associated with the IgE immunoglobulins. In these allergic
subjects there is often a highJgE level in the blood. The sensitization process
is essentially due to the combination of the IgE readme antibody with cells
such as tissue mast cells. On exposure to the foreign protein the allergen
combines with the cell-bound reaginic antibody to release histamine and
similar amines. Thisjeads Jo^aspdilatation and an increase in capillary
permeability resulting in focal oeaieniaT'There is a 6eII^jrl5&|tration of
ecfcfnQpfiils, and the seromucinous glands of the nasal muŁosa are stimulated
to anjncreased activity wjtli the outpouring of thin mucus.
AETIOLOGY. The condition of riasallfllergyls hereditary in about half of the
cases, and the chance of a child of two atopic parents developing nasal allergy
is about 75 per cent. With one atopic parent the chance is about 50 per cent.
It is frequent in children and young adults who are often of the highly strung
emotional type. Nasal allergy is more common in certain geographical
localities, occurring with greater frequency in low-lying areas rich in vegetation
than in hilly districts. While some children with allergic manifestations appear
to outgrow them at puberty, others may start their symptoms at that time.
There tends to be an increase of symptoms in pregnant women or in women
during their menstniaticm aScTgt the menopause.
There are many aHergensTAmong the inhalants are pollens, house dust,
animal emanations, moulds, feathers, wool,^etc. while the aromatic oils from
soaps and cosmetic preparations"are frequent offenders. Foods^sucElis fish,
eggs, milk, wheat anchntrus fruits; drugs such as aspirin, iodine, antibiotics
and sulphohamides;1and bacteria including streptococci, staphylococci and
pneumpcocci may all produce allergic responses in certain individuals, and
the list is by no means exhaustive. """
SYMPTOMS. The complaints are of nasal stuffiness, profusejwatery, mucoid,
nasal discharge, and sneezing which in hay fever sufferers may prove exhaust-
ing. These symptoms may erupt suddenly on contact with the allergen, and
such exacerbation is often preceded by an. itching injhejipse. This occurs in
hay fever in which the patient is sensitive to the pollen of plants, trees or