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PHAR 153 > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

Why do we have allergies?

A

Humanity developed a robust immune system against real invaders, but now we are reacting to benign substances

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2
Q

What causes allergic responses?

A

Mast cells release histamines once a specific allergen has been identified. Histamines mediate some inflammatory activities

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3
Q

What is sensitization?

A

Sensitization is the first exposure to a potential allergen and it becomes ready for subsequent exposure. Mast cells have developed immunoglobulins against a particular protein

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4
Q

What happens in early phase reaction in allergies?

A

Lots of rhinorrhea and itching

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5
Q

What happens in the late phase reaction in allergies?

A

asthma
reccurent ear infections
sinusitis
nasal polyps
sleep apnea

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6
Q

What are some common allergens? seasonal or perrenial

A

Seasonal allergens:
trees
grasses
outdoor moulds

Perrenial allergens:
house dust mite
animal danders
indoor moulds

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7
Q

How do allergy tests work?

A

Allergens are exposed to small sections of skin and compared against positive and negative controls

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8
Q

What are some non-allergy causes for rhinorrhea?

A

Vasomotor rhinitis (temp. changes cause runny nose)

Rhinitis medicamentosa (decongestant-induced and rebound decongestant)

Hormonal (getting on birth control can cause runny nose)

Geriatric rhinitis (very common and idiopathic and usually not alergies because people don’t develop them in old age)

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9
Q

What are some symptoms of allergic rhinitis?

A

Rhinnorhea
itchy eyes
headaches
sore throat
ear pain

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10
Q

How to differentiate between seasonal and perrenial allergies?

A

Nasal congestion is usually seen in perrenial allergies and not so much in seasonal allergies

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11
Q

How to differentiate between colds and allergies?

A

Allergies occur at the same time(especially if seasonal)
more sneezing and itching
Runny nose and congestion are back and forth
Allergies last longer than colds
PND
and more effects on the eyes

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12
Q

How can allergies be misdiagnosed for ADHD?

A

The symptoms of allergies can cause children to be uneasy. This can result in misdiagnosis of ADHD

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13
Q

How to control allergies?

A

Avoid allergens/triggers (hard to do if allergens are everywhere)

Nasal irrigation helps flush out pollens and other allergens (pouring water into nostril sucks for kids and adults)

Lubricants help provide relief if nose is raw on the inside

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14
Q

What are antihistamines?

A

These drugs target histamine receptors and they have best effectivity if taken before allergen exposure.

take it everyday if you need it, don’t take it once in a while. Antihistamines do not develop tolerance

This is the best agent for seasonal allergies, topical steroids are meant for perrenial allergies.

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15
Q

What are some first generation antihistamines?

A

Promethazine (in a category of its own)

Ethanolamines:
diphenhydramine
doxylamine
clemastine

Alkylamines:
chlorpheniramine
brompheniramine
dexbrompheniramine
triprolidine

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16
Q

How do antihistamines cause drowsiness?

A

First generation histamines cross the blood brain barrier and induce drowsiness

Ranking of drowsy effects
alkylamine (least drowsy)<ethanolamine<promrthazine (most drowsy)

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17
Q

What are the anticholinergic effects of antihistamines?

A

Drying effect on mucous membrances like mouth and lungs.

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18
Q

What is a paradoxical reaction from antihistamines?

A

Makes kids hyper rather than tired (usual effect)

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19
Q

Why do we have to be cautious with asthma patients who take antihistamines?

A

1st gen antihistamines have anticholinergic effects (drying out of tissues)

20
Q

What generation of antihistamines is used to help with allergic rhinitis?

A

2nd gen antihistamines are used more often today because they have fewer adverse effects.

21
Q

Should seniors avoid first generation antihistamines?

A

There is increased concern for the anticholinergic effects(drying) in seniors. They respond to these drugs more severely than younger adults

22
Q

What are some interesting qualities of second generation antihistamines?

A

Second gen antihistamines are less sedating, don’t cross blood brain barrier, and it has greater affinity for histamine receptors

the dosing is also more convienient (once daily vs. BID)

They take slightly more time to show full effects vs, 1st gen antihistamines

23
Q

Is there a difference between Reactine 5mg and 10mg?

A

There is no clinical difference between the two doses

24
Q

Can kids under 6 take second generation antihistamines?

A

Yes, all second generation antihistamines can be given to kids older than 2 except fexofenadine(legal history, it is safe though)

25
Q

What is an advantage of diphendhyramine in pediatrics?

A

Diphendyramine can be given to kids under 2.

26
Q

Why does grapefruit an other citrus fruit juices affect some drugs?

A

Grapefruit juice inhibits absorption in the gut, which limits the amount of drug that enters circulation

27
Q

Issues with antihistamines?

A

Might have to try different antihistamines to find one that works

If condition is perrenial and long-term, might have to go with topical steroids

Plan drug holidays to se how effective the drug is on symptoms

When should I start? (start before allergies become common)

28
Q

Is patient adherance important for ensuring antihistamines work?

A

Yes, patients must take antihistamines as directed for the entire period that they have allergies

29
Q

Can you develop a tolerance for antihistamines?

A

No, it works the 600th time just as good as the first time. It can be used for years

30
Q

What are intranasal antihistamines?

A

They were not the best products because they were usually made with 1st gen antihistamine + decongestant(concern for rebound congestion)

Dymista is a new product that doesn’t have decongestant. It contains a steroid+antihistamine

31
Q

What are ocular antihistamines?

A

Like old school intranasal antihistamine products, they also contained decongestants (concern with rebound congestion)

Emedastine and ketotifen are better as they are antihistamines alone

32
Q

What are intranasal steroids?

A

Once steroids go in the nose, there are almost no classic steroid oveuse effects.

Try 2nd gen antihistamine first, but go to steroids if congestion is particularly bad

ex. Nasacort, budesonide

33
Q

Do oral decongestants cause rebound congestion?

A

No, only long-term use of topical decongestants causes rbound congestion

34
Q

How effective are intrasnasal steroids?

A

These allow even more relief than second generation antihistamines. They cover almost all symptoms (runny nose, decongestion)

The only downside is that these drugs take longer to acheive max effect vs antihistamines

35
Q

How to use intranasal steroids?

A

Can be taken once daily or twice a day. Regular dosing(once a day, once a week, etc) is the best for symptom management.

Side effects:
local irritation

PND-esque throat irritation caused by spray running down back of throat

These drugs can be used long-term, take drug holidays to check your symptoms

36
Q

Can intranasal steroids cause stunted growth?

A

Theoretically yes, but this is largely a legal liability

Bioavailability(absorption=potential growth stunting) is very small for an agent like nasonex. avoid budesonide for kids, fine for adults bc they are done growing

37
Q

Can kids under 6 use intranasal steroids?

A

Yes

Avamys can be used in 2 year olds and up
Flonase can be used in 4 year olds and up

38
Q

How to spray intranasal steroids?

A

Spray inside the nose away from the nasal septum and don’t need to breath in

39
Q

What is Cromolyn?

A

It is a mast cell stabilizer and it prevents the release of histamines. This product is still developing and must be used multiple times a day(6x per day)

40
Q

What is something we can use for eye-related symptoms of allergic rhinitis?

A

Patanol: mast cell stabilizer and antihistamines. This should be prescibed all the time for eye symptoms

Cromolyn works great and there are no side effects

41
Q

What are allergy shots?

A

Exposes body to allergens and allows immune response to develop in preparation for the real deal

sublingual options are also available

42
Q

How do leukotriene antagonists work?

A

Leukotrienes are relased by mast cells and it is like histamine as it helps promote inflammation

This product didn’t live up to hopes

43
Q

Why is ipratropium used?

A

This drug has anticholinergic effects and it is used for vasomotor rhinitis therapy

44
Q

How does pregnancy effect allergic rhinitis?

A

It is a wild card, allergies may get worse or get better

We try not to use agents in pregancy, but first-generation histamines are safe(long history) but their efficacy is unknown

45
Q

How should asthmatics approach allergic rhinitis therapies?

A

Most asthmatics are on interlung inhaled steroids. We can easily use intranasal steroids for congestion, no concern about overdose. This is in the realm of physicians

46
Q

How should kids use allergic rhinitis therapies?

A

Antihistamines are very safe

newer topical steroids are also safe (growth stunting is an overstated side effect)

47
Q

Should a topical steroid be using in conjuction with an antihistamine?

A

There is no real value in doing both because the topical steroid is already doing all of the heavy lifting. The antihistamine does not improve the situation significantly

PHAR 153 (20 decks)

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