[17] Allergic Rhinitis Flashcards
What is allergic rhinitis?
Inflammation of the nose that occurs when the immune system overreacts to allergens in the air
How can allergic rhinitis be further categorised?
- Seasonal allergic rhinitis
- Perennial rhinitis
- Occupational rhinitis
When does seasonal allergic rhinitis occur?
Only at certain times of the year
If seasonal allergic rhinitis is due to pollen or grass what is it known as?
Hay fever
When does perennial rhinitis occur?
Throughout the year
What are some common allergens in perennial rhinitis?
- House dust mites
- Domestic pets
What causes occupational rhinitis?
Exposure to allergens at work
What occupational allergens can cause rhinitis?
- Flour
- Wood dust
- Latex
What immunoglobulin mediates allergic rhinitis?
IgE
What does IgE cause in response to allergen exposure?
Release of inflammatory mediators from mast cells in the nasal mucosa leading to migration of inflammatory cells
What is the most important inflammatory mediator in allergic rhinitis?
Histamine
Does allergic rhinitis have a genetic or environmental underlying cause?
Mixture of factors
What are the risk factors for allergic rhinitis?
- History of atopy
- Family history of atopy
- Exposure to common allergens
- Air pollution
- Reduced exposure to infection
- Exposure to cigarette smoke
What are the typical symptoms of allergic rhinitis?
- Sneezing
- Rhinorrhoea and nasal congestion
- Itchy nose and/or palate
- Eye symptoms
What colour is the rhinirrhoea usually in allergic rhinitis?
Clear
What does yellow rhinorrhoea suggest?
Allergy or infection
What does green rhinorrhoea suggest?
Infection
What does blood tinged rhinorrhoea raise concern of?
Tumour
Is rhinorrhoea in allergic rhinitis bilateral or unilateral?
Bilateral
What are the eye symptoms of allergic rhinitis?
- Watering
- Itching
- Redness
- Swelling
How is allergic rhinitis usually diagnosed?
Clinically
What additional test may be helpful in determining the causative allergen in allergic rhinitis?
Allergy testing
What allergy testing methods are used in allergic rhinitis?
- Skin prick testing
- Blood assays
What are the advantages of skin prick testing?
- Reliable
- Immediate results
What can suppress response and obscure results of skin prick testing?
- Antihistamines
- Topical corticosteroids
- TCAs
What is involved in allergy testing blood assays for allergic rhinitis?
Total allergen-specific IgE concentrations are determined
What are the differentials for allergic rhinitis?
- Non-allergic rhinitis
- Infective rhinitis
- Nasal polyps
- Sinusitis
- Adenoidal hypertrophy
- CF
- SLE
- Granulomatous conditions
What are the main lines of treatment for allergic rhinitis?
- Education
- Allergen avoidance
- Anti-histamines
- Topical steroids
What are the first line ‘as-required’ treatments for allergic rhinitis?
Nasal anti-histamines
What are the advantages of nasal anti-histamines in treating allergic rhinitis?
- Equal efficacy to oral anti-histamines for treating rhinitis symptoms
- Fast acting (less than 15 minutes)
What is the disadvantage of nasal histamines in treating allergic rhinitis?
Do not reduce symptoms at other sites unlike oral anti-histamines
Who should nasal anti-histamines not be used in for allergic rhinitis?
Under 5’s
When are oral anti-histamines advised in allergic rhinitis?
When sneezing or nasal discharge are predominant and regular preventer therapy is required
What types of oral anti-histamines are recommended in allergic rhinitis?
Once-daily, non sedating
Give an example of a once-daily, non-sedating anti-histamine?
Cetirizine
When are topical intranasal steroids more useful than anti-histamine for treating allergic rhinitis?
When nasal blockage is predominant or polyps are present
What symptoms of allergic rhinitis are intranasal steroids effective at treating?
All symptoms
Are intranasal steroids faster or slower in onset than anti-histamines?
Slower
How long may intranasal steroids take to develop maximum efficacy when used to treat allergic rhinitis?
Days to weeks
When may surgery be an indicated treatment for allergic rhinitis?
When drugs fail and structural abnormalities are present
What surgeries may improve the airway or entry of topical medications in allergic rhinitis?
- Reduction of inferior turbinates
- Correction of deviated septum
What does immunotherapy for allergic rhinitis involve?
Exposure to increasing amounts of allergens to develop tolerance
What are the complications of allergic rhinitis?
- Poor quality of life
- Poor asthma control
- Sinusitis
- Nasal polyps
- Chronic otitis media
