allergic disorders

Question 1

tx of allergic rhinitis

Answer 1

antihistamines, decongestants, or intranasal steroids
leukotriene inhibitors (indicated for both allergic rhinits and maintenance therapy for persistent asthma)

desensitization when all else fails

Question 2

PE for allergic rhinitis

Answer 2

“allergic shiners”-dark circles around eyes due to vasodilation or nasal congestion

“nasal crease”-across lower half of the bridge of nose

nose-mucosa swollen and pale, bluish gray color
thin , watery seretion (as opposed to thick and purulent fro sinusitis)

look for polyps or tumors. look for deviation of nasal septum or septal performation as a consequence of chronic rhinitis, granulomatous disease, cocaine abuse, prior surgery, topical decongestant abuse, or topical steroid overuse

otoscopy for typanic membrane retraction, air fluid levels, bubbles. abnormal tympanic membrane mobility on pneumatic otoscopy can suggest allergic rhinitis

ocular-injection, swelling of papebral conunctivae, excess tear production. Dennie Morgan lines (creases below inferior eyelid) are linked to allergic rhinitis

“cobblestoning” of posterior pharynx, tonsillar hypertrophy can be seen

examine neck for lymphadenopathy

examine for asthma-wheezing, tachypnea, prolonged expiratory phase

Question 3

causes of allergic rhinitis

Answer 3

weeds, pollen, pets

house dust mites

Question 4

antihistamines

Answer 4

first gen: diphenhydramine, chlorpheniramine, hydroxyzine

second gen: loratadine, desloratadine, fexofenadine, cetirizine (less penetration into CNS so less sedation except for cetirizine, and fewer anticholinergic effects)

for mild and intermittent symptoms

Question 5

most effective tx and first line therapy for long term management of mild to moderate persistent symptoms of allergic rhinitis

Answer 5

corticosteroid nasal sprays