Pathophysiology

Antigen-presenting cells (APCs), such as dendritic cells, will process allergens and their peptides on the major histocompatibility complex (MHC) class II molecule. The MHC class II molecule will then function as the ligand of T-cell receptors on Naive

CD4+ T cells, and differentiate into allergen-specific Th2 cells. These cells secrete various cytokines and cause B cells to produce specific IgE with the proliferation of eosinophils, neutrophils, and mast cells. Specific IgE binds to IgE receptors found on mast cells or basophils. 

Patients exposed to allergens can have an early or late reaction. An early reaction consists of sneezing and rhinorrhea, which develops in 30 minutes and disappears. When mast cells face the offending allergen, it stimulates the mast cells to secrete histamine, prostaglandins, and leukotrienes and cause early reaction symptoms. 

Late reaction consists of nasal obstruction that occurs approximately 6 hours after exposure to allergens. Eosinophil chemotaxis causes a late reaction due to the chemical mediators found in the early reaction. Inflammatory cells, eosinophils, mast cells, and T cells cause nasal obstruction by migrating to the nasal mucosa and breaking then remodeling the normal nasal tissue.

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