39 - Allergic Rhinitis Flashcards
Etiology of
PERENNIAL ALLERGIES
WHAT TREATMENT FOR PERENNIAL?
Dust Mites / INDOOR Molds / Occupational Allergens
PET dander / Cockroaches
Cetirizine + Levocetirizine
Desloratadine / Azelastine
Etiology of
SEASONAL ALLERGIES
WHAT TREATMENT FOR SEASONAL?
FALL + SPRING
Tree / Grass / Pollen / Mold Spores / Ragweed
ALL DRUGS INDICATED FOR SEASONAL
Environmental Controls
for ALLERGIES
LOWER HUMIDITY <40%
HEPA FILTERS
Vacuum Often / remove Carpets
ALLERGEN COVERS
Wash Clothes / Clean Mold
Elminiate Cockroaches / Keep pets OUT of bedroom / Remove Plants
Non-Pharmacologic Therapy
Allergies
EXERCISE
increases Sympathetic Tone
effective if produces perspiration for 15-30 min daily
Saline Irrigation
Soothes nasal tissues
<6 y/o = 2-3 drops QID
>6 y/o = 2 sprays QID
1st Gen Antihistamines
Uses
Prevent & Relieve: Wet Symptoms
does NOT relieve NASAL CONGESTION
- *SEDATING -** crosses BBB
- *Ethanolamines > alkylamines** in sedation
AC Symptoms
Alkylamines
- less sedating*
- *1st Gen Antihistamine**
Bromphe-niramine
Chlorphe-niramine
Dexbromphe-niramine
Ethanolamines
- *MORE SEDATING** > Alkylamine
- *1st Gen Antihistamine**
Clemastine
Diphenhydramine
Loratadine
Indication / Dose / ADR
Seasonal Rhinitis
2y/o +
>6 y/o - 10mg QD
HA / Somnolence / Fatigue / Dry mouth
Cetirizine
Indication / Dose / ADR
BOTH
seasonal + perennial rhinitis
2 y/o+
>6yo - 10mg QD
DROWSINESS WARNING
tiredness / dry mouth
Levocetirizine
Indication / Dose / ADR
BOTH
seasonal & perennial rhinitis
IN PM & GOOD FOR 6MONTHS+
6-11 y/o = 2.5 mg daily in PM
12+ = 5mg QD in PM
- SLEEPINESS*
- *diarrhea / nose bleeds**
Desloratadine
Indication / Dose / ADR
RX ONLY
BOTH
seasonal & perennial rhinitis
GOOD FOR 6MO+
12 y/o + = 5mg QD
- Somnolence*
- *pharyngitis / dry mouth / fatigue**
Fexofenadine
Seasonal Rhinitis Only
2 y/o+
12y/o+ = 60mg BID or 180mg QD
LEAST EFFECTIVE
Which ORAL Allergy Medications are
CATEGORY C - Pregnancy
FEXOFENADINE // DES-Loratadine
Brompheniramine
most other drugs are CATEGORY B
Lactation:
Recommend to AVOID
Azelastine = Astepro 0.5%
Type / Indication / ADR
INTRANASAL ANTIHISTAMINE
- *BOTH**
- *Seasonal + Perennial**
12 y/o +
2 sprays EN QD
Pregnancy CAT C & caution in nursing
ADR:
Bitter Taste / SEDATION / nasal discomfort / epistaxis
Which INTRANASAL Antihistamines
are PREGNANCY CATEGORY C?
AZELASTINE
OLOPADINE
Olopatadine = Patanase
Type / Indication / ADR
Intranasal ANTIHISTAMINE
Seasonal Only
6+ y/o
12 y/o + = 2S EN BID
Pregnancy CAT C & caution in Nursing
BITTER TASTE & SEDATION
Intranasal Decongestants
Drugs / Use / ADR
-ZOLINE
Naphazoline / Oxymetazoline / Tetrahydrozoline / Xylometazoline
+ Phenylephrine
REDUCE NASAL CONGESTION
ADR:
Nasal Irritation / dryness / Sneezing
REBOUND CONGESTION = RHINITIS MEDICAMENTOSA
Use only for 3-5 Days MAX
Use b4 Intranasal Corticosteroid
Intranasal Decongestants
Drugs & Doses
- *-ZOLINE**
- *TNPXO** - 4-6-6-8-12
–Tetrahydrozoline: 3 sprays Q4H
–Naphazoline: 2 sprays Q6H
–Phenylephrine: 2 sprays Q6H
–Xylometazoline: 2 sprays Q8H
–Oxymetazoline: 2 sprays Q12H
Pseudophedrine
Type / Indication / ADR
Oral Decongestant
2+ y/o
>12 y/o
60 mg Q6H
ADR:
CNS / CV Stimulation
↑BP / HR / IOP
Contraindications:
MAO inhibitors / uncontrolled HT / CAD / Glaucoma
Phenylephrine
Type / Indication / ADR
Oral Decongestant
> 12 y/o
10mg po q4h
max 60mg qd
CI:
MAOi / uncontrolled HTN / HYPERthyroidism / BPH
Ipratropium Bromide 0.06% = Atrovent
Type / Indication / ADR
- *ANTICHOLINERGIC**
- Seasonal Rhinitis Only*
Decreases NASAL MUCUS secretion
Dose: 2S EN QID
ADR: HA + Epistaxis
CI:
Angle closure glaucoma / Prostatic Hypertrophy
Cromolyn Sodium = NasalCrom
Type / Indication / ADR
- *Mast Cell Stabilizer**
- not as effective*
PROPHYLACTIC USE
prevents & relieves : sneezing / rhinirrhea + itching
ADR:
sneezing / nasal STINGING / burning / irritation
- *Intranasal Corticosteroids**
- *for Allergic Rhinitis**
Uses / MoA / ADR
-NIDE / -LIDE or -SONE / -LONE
ALL SYMPTOMS
sneezing / nasal itching / rhinorrhea / congestion
Mild VasoCONSTRICTION / decrease Leukotrienes & prostoglandins
- *DAILY ADMIN** –> 2week for full response
- rather than AS NEEDED*
ADR:
local irritation / SNEEZING / mucosal erosion / HA + epistaxis
Triamcinolone = Nasacort
Intranasal Corticosteroid
2 y/o+
12+ = 2S EN QD –> titrate down to 1S
Scent Free
Alcohol Free
No bitter after taste
Fluticasone = Flonase
Intranasal Corticosteroid
4 y/o+
4-11 = GROWTH STUNTING
12+ = 2S EN QD –> 1 week 1-2S EN QD PRN
LIGHT FLORAL SCENT
RELIEVES ITCHY & WATERY EYES!
Flonase SENSIMIST
Intranasal Corticosteroid
2 y/o+
ALCOHOL FREE
SCENT FREE
VIRTUALLY NO DRIP
Budesonide = Rhinocort
Intranasal Corticosteroid
2 y/o+
Scent Free
Alcohol Free
LOWER VOLUME PER SPRAY
vs Flonase
Indoor & Outdoor
Allergy
Which Intranasal Corticosteroid:
LOWEST VOLUME PER SPRAY
BUDESONIDE
RHINOCORT
Monelukast = Singulair
Type / Uses
Leukotriene Modifiers
- *2+ y/o**
- *>15 yo** = 10 mg QD
Improves:
Daytime nasal sx / Nasal Congestion / Itching / Sneezing / Runny ose
Helpful if patient has ASTHMA
IMMUNOTHERAPY
for Allergic Rhinitis
- *SC Injection**
- *1-2x / week** –> until MAX tolerated dose
3-5 Years
For:
Severe / Persistent Symptoms
& pts who CANT avoid allergen exposure
Oral Immunotherapies
for Allergic Rhinitis
GRASTEK
Grass Allergy // 5-65 yo
ORALAIR
Grass Allergy // 10-65 yo
RAGWITEK
RAGWEED allergy // 18-65 yo
Recommendation #1 = STRONG
Initial Treatment for SEASONAL AR in 12 y/o+
INTRANASAL CORTICOSTEROID Monotherapy
rather than
Intranasal Corticosteroid PLUS Oral AntiHistamine
Recommendation #2 - STRONG
For Initial Treatment of SEASONAL AR
in persons 15 y/o +
Intranasal Corticosteroid
- over a*
- *Leukotriene receptor Antagonist (Singulair**)
Recommendation #3 = WEAK
For treatment of:
Moderate - SEVERE Seasonal AR
in those 12 y/o +
WEAK RECOMMENDATION
Intranasal Corticosteroid
+
Intranasal Antihistamine
What are the
INTRANASAL ANTIHISTAMINES
-INE
Azelastine = Astepro
CAT C // BOTH + Perennial / 12yo+
Olopatadine = Patanase
CAT C also // only seasonal // 6 y/o+
