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allergic rhinitis Flashcards

1
Q

an inflammatory disorder of the nasal mucosa
marked by nasal congestion, rhinorrhea, and itching, often accompanied by sneezing and conjunctival inflammation

A

allergic rhinitis

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2
Q

recognition as a major chronic respiratory disease of children rests largely on its high prevalence

A

detrimental effects on quality of life and school performance, and comorbidities.

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3
Q

Children with AR often have related

A

conjunctivitis, sinusitis, otitis media, serous otitis, hypertrophic tonsils and adenoids, and eczema

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4
Q

Childhood AR is associated with a ___ increase in risk for asthma at an older age.

A

3-fold

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5
Q

In prosperous ___ societies of children suffer from AR

A

20-40%

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6
Q

The symptoms may appear in infancy; with the diagnosis generally established by the time the child reaches age

A

6 yrs

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7
Q

The prevalence peaks early in childhood.

A

false late

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8
Q

Risk factors of allergic rhinitis family history of atopy and serum immunoglobulin (Ig) E higher than ___

A

100 IU/mL before age 6 yrs

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9
Q

late life exposures and/or their absence have a profound influence on the development of the allergic phenotype.

A

false- early

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10
Q

The risk increases in children whose mothers smoke heavily, even before delivery and especially before the infants are

A

1 yr old

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11
Q

The risk increases in children with

A

heavy exposure to indoor allergens

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12
Q

A critical period exists early in infancy when the genetically susceptible individual is at greatest risk of

A

sensitization

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13
Q

delivery by _____ is associated with AR and atopy in children with a parental history of asthma or allergies

A

caesarean section

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14
Q

cesarean section delivery association may be
explained by the

A

lack of exposure to maternal vaginal/fecal flora during
delivery.

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15
Q

Children between ___ who have elevated anticockroach
and antimouse IgE are at increased risk of wheezing, AR, and atopic dermatitis.

A

2-3 yrs old

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16
Q

The occurrence of 3 or more episodes of rhinorrhea
in the first year of life is associated with AR at

A

age 7 yr

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17
Q

The occurrence of _____ of rhinorrhea
in the first year of life is associated with AR at age 7 yr

A

3 or more episodes

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18
Q

Intriguingly, the exposure to __ early in childhood protects against the development of atopy

A

dogs, cats, and endotoxin

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19
Q

is beneficial, but it does not need to be exclusive

A

Prolonged breastfeeding

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20
Q

There is also a decreased risk of
asthma, AR, and atopic sensitization with

A

early introduction to wheat,
rye, oats, barley, fish and eggs.

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21
Q

Two factors necessary for expression of AR a

A

sensitivity to an allergen
and the presence of the allergen in the environment

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22
Q

AR classification

A

seasonal and perennial

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23
Q

perennial is giving way to the designations

A

intermittent
and persistent.

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24
Q

The 3 sets of terms are based on different suppositions, but oral allergens are not the main cause of all forms of AR irrespective of terminology

A

false

3 sets
inahalant allergens
main cause

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25
Q

AR may also be categorized as

A

mild-intermittent, moderate-severe intermittent, mild-persistent, and moderate severe persistent

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26
Q

The symptoms of intermittent AR occur
on

A

<4 days per week or for <4 consecutive weeks

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27
Q

In persistent AR
symptoms occur on

A

> 4 days per week and/or for >4 consecutive weeks.

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28
Q

The symptoms are considered severe when they are not troublesome, the sleep is normal, there is impairment in daily activities, and incapacity at work or school

A

false

mild
no impairment
no incapacity

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29
Q

Severe symptoms result

A

sleep disturbance, and impairment in daily activities and school

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30
Q

In temperate climates, airborne pollen responsible for exacerbation of intermittent AR appear in distinct phases:

A

trees pollinate in the spring,
grasses in the early summer,
and weeds in the late summer

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31
Q

In warm climates, mold spores persist outdoors only in the summer, but in cold climates throughout the year.

A

In temperate climates, mold spores persist outdoors only in the summer, but in warm climates throughout the year.

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32
Q

Symptoms of intermittent AR typically cease with the appearance of fire

A

Symptoms of intermittent
AR typically cease with the appearance of frost.

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33
Q

Knowledge of the time of occurrence of symptoms, of the regional patterns of pollination and mold sporulation, and of the patient’s specific IgE is necessary for the recognition of the cause of intermittent AR

A

true

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34
Q

Persistent AR is most often
associated with the indoor allergens:

A

house dust mites, animal danders, mice, and cockroaches

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35
Q

mice allergies are of major importance
in the United States.

A

Cat and dog allergies are of major importance
in the United States.

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36
Q

The allergens from ______
may remain airborne for a prolonged time.

A

saliva and sebaceous secretions

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37
Q

The ubiquitous major cat allergen,

A

fel d 1

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38
Q

may be carried on cat owners’ clothing into such “catfree” settings as schools and hospitals.

A

fel d 1

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39
Q

mild symptoms

A
  • Normal sleep
  • Normal daily activities
  • Normal work and school
  • No troublesome symptoms
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40
Q

Moderate-to-severe

A

One or more items
* Abnormal sleep
* Impairment of daily activities,
sport and leisure
* Difficulties caused at school
or work
* Troublesome symptoms

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41
Q

The exposure of an atopic host to an allergen leads to specific

A

IgE production.

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42
Q

The clinical reactions on reexposure to the allergen have been designated as

A

early-phase and late-phase allergic responses.

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43
Q

Bridging of the IgE molecules on the surface of mast cells by allergen initiates

A

early-phase allergic response,

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44
Q

characterized by degranulation
of mast cells and release of preformed and newly generated inflammatory
mediators

A

early-phase allergic response,

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45
Q

early-phase allergic response, characterized by degranulation of mast cells and release of preformed and newly generated inflammatory
mediators including

A

histamine
prostaglandin 2
cysteinyl leukotrienes

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46
Q

Late-phase allergic response appears ___ following
allergen exposure.

A

4-8 hr

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47
Q

Inflammatory cells, including ____ infiltrate the nasal
mucosa.

A

basophils
eosinophils,
neutrophils
mast cells
mononuclear cells,

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48
Q

Eosinophils release proinflammatory mediators, including

A

cysteinyl leukotrienes
cationic proteins
eosinophil peroxidase
major basic protein

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49
Q

serve as a source of interleukin (IL)-3, IL-5,
granulocyte-macrophage colony-stimulating factor, and IL-13.

A

major basic protein

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50
Q

Repeated intranasal introduction of allergens causes —___a more brisk response even with a lesser provocation.

A

“priming”

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51
Q

Over the course of an allergy season a multifold increase in ______ takes place.

A

submucosal mast cells

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52
Q

once thought to have a role exclusively in the earlyphase allergic response, have an important function in sustaining chronic allergic disease.

A

submucosal mast cells

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53
Q

Allergens, autoantigens, and components of
superimposed infectious agents ________

A

activate the immune system.

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54
Q

Older children snort, but younger children
tend to blow their noses.

A

Older children blow their noses, but younger children
tend to sniff and snort.

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55
Q

Nasal itching brings on grimacing, twitching,
and picking of the nose that may result in

A

epistaxis

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56
Q

Children with AR often perform the

A

allergic salute

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57
Q

an upward rubbing of the nose with
an open palm or extended index finger

A

allergic salute

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58
Q

This maneuver relieves itching
and briefly unblocks the nasal airway.

A

allergic salute

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59
Q

gives rise to the nasal
crease, a horizontal skin fold over the bridge of the nose

A

allergic salute

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60
Q

The diagnosis
of AR is based on symptoms

A

in the absence of an upper respiratory
tract infection and structural abnormalities

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61
Q

Typical complaints of AR include

A

intermittent nasal congestion
itching
sneezing
clear rhinorrhea
conjunctival irritation

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62
Q

Symptoms decrease with greater exposure to the
responsible allergen.

A

increase

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63
Q

The patients may not lose their sense of smell and
taste.

A

The patients may lose their sense of smell and
taste.

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64
Q

Some patients experience

A

headaches, wheezing, and coughing

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65
Q

is often more severe at night, causing mouth breathing and snoring, interfering with sleep, and arousing irritability

A

Nasal congestion

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66
Q

Signs on physical exam include

A

abnormalities of facial development,
dental malocclusion
“allergic gape”
chapped lips,
“allergic shiners
transverse nasal crease

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67
Q

continuous openmouth
breathing,

A

“allergic gape”

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68
Q

(dark circles under
the eyes)

A

“allergic shiners”

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69
Q

Conjunctival edema, itching,
tearing, and hyperemia are not frequent findings.

A

Conjunctival edema, itching,
tearing, and hyperemia are frequent findings.

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70
Q

A nasal exam performed
with a source of light and a speculum may reveal clear nasal secretions;

A

edematous, boggy, and bluish mucus membranes with little or no erythema; and swollen turbinates that may block the nasal airway

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71
Q

It may be necessary to use a____ to perform an adequate examination.

A

topical decongestant

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72
Q

Thick, purulent nasal secretions indicate the presence of infection.

A

true

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73
Q

Evaluation of AR calls for a thorough history, including details of the patient’s environment and diet and family history of allergic conditions such as _____ physical examination, and laboratory
evaluation

A

eczema, asthma, and AR,

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74
Q

Symptoms that include

A

sneezing, rhinorrhea, nasal
itching, and congestion

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75
Q

laboratory findings of ___results typify AR

A

elevated IgE,
specific IgE antibodies, and positive allergy skin test

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76
Q

Intermittent AR differs from persistent AR by

A

history and skin test results

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77
Q

causes sporadic symptoms

A

Nonallergic rhinitides

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78
Q

Nonallergic rhinitides causes

A

often unknown

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79
Q

imitates AR in presentation and response to treatment, but without elevated IgE antibodies.

A

Nonallergic inflammatory rhinitis with eosinophils

80
Q

characterized by
excessive responsiveness of the nasal mucosa to physical stimuli

A

Vasomotor rhinitis

81
Q

nonallergic conditions ____ mimic AR

A

infectious rhinitis
structural problems
rhinitis medicamentosa
hormonal rhinitis associated with pregnancy or hypothyroidism
neoplasms
vasculitides;
granulomatous disorders

82
Q

(caused by the overuse of topical vasoconstrictors);

A

rhinitis medicamentosa

83
Q

structural problems

A

nasal polyps and septal deviation;

84
Q

Occupational risks for rhinitis

A

allergens and irritants

85
Q

allergens

A

grain, dust, insects, latex, enzymes

86
Q

irritants

A

wood dust, paint, solvents,
smoke, cold air

87
Q

frequently associated with complications and comorbid conditions.

A

allergic rhinitis

88
Q

characterized by itching, redness and swelling
of the conjunctivae

A

Allergic conjunctivitis

89
Q

Allergic conjunctivitis has been reported in at least ___ of the population

A

20%

90
Q

Allergic conjunctivitis has been reported in more the ___of patients with AR, most frequently in older
children and young adults

A

70%

91
Q

common complication of AR, sometimes associated
with purulent infection, but most patients have negative bacterial
cultures despite marked mucosal thickening, and sinus opacification.

A

Chronic sinusitis

92
Q

The inflammatory process is characterized by marked

A

eosinophilia

93
Q

Allergens, possibly ____, are the inciting agents.

A

fungal

94
Q

The sinusitis of triad asthma

A

asthma
sinusitis with nasal polyposis
aspirin sensitivity

95
Q

often responds poorly to therapy

A

asthma

96
Q

coexists with asthma may be taken too lightly or completely overlooked.

A

rhinitis

97
Q

Up to ___ of patients with asthma have AR

A

78%

98
Q

__ of patients with AR have asthma.

A

38%

99
Q

Aggravation of AR coincides
with

A

exacerbation of asthma,

100
Q

treatment of nasal inflammation
reduces

A

bronchospasm, asthma-related emergency department visits, and hospitalizations.

101
Q

Postnasal drip

A

associated with AR commonly
causes persistent or recurrent cough

102
Q

Eustachian tube obstruction and
middle ear effusion are frequent complications

A

true

103
Q

Chronic allergic
inflammation causes hypertrophy of adenoids and tonsils that may be
associated with

A

eustachian tube obstruction, serous effusion, otitis
media, and obstructive sleep apnea

104
Q

AR is linked to ____ in children

A

snoring

105
Q

There is association between rhinitis and sleep abnormalities and subsequent daytime fatigue

A

true

106
Q

The Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) is suitable for children

A

6-12 yr old

107
Q

Adolescent Rhinoconjunctivitis
Quality of Life Questionnaire (ARQLQ) is appropriate
for patients

A

12-17 yr of age

108
Q

Children with rhinitis do not have anxiety and
physical, social, and emotional issues that affect learning and the ability to integrate with peers.

A

false- have

109
Q

AR disorder contributes to

A

headaches and fatigue, limits daily activities, and interferes with sleep

110
Q

There is evidence
of impaired cognitive functioning and learning that may be exacerbated by the adverse effects of

A

sedating medications.

111
Q

an important cause of lost school attendance, resulting in more than 2 million days of absence in the United States annually

A

rhinitis

112
Q

Rhinitis is an important cause of lost school attendance, resulting in more than____of absence in the United States annually.

A

2 million days

113
Q

provide the best method for detection of
allergen-specific IgE

A

Epicutaneous skin tests

114
Q

positive predictive value of ___ for the epidemiologic
diagnosis of AR

A

48.7%

115
Q

inexpensive and sensitive, and the
risks and discomfort are minimal

A

Epicutaneous skin tests

116
Q

Responses to seasonal respiratory
allergens are rare before ____ of exposure

A

2 seasons

117
Q

Responses to seasonal respiratory
allergens in children ___- seldom display positive skin test responses to these allergens

A

<1 yr

118
Q

To avoid
false-negative results, montelukast should be withheld for

A

1 day

119
Q

To avoid
false-negative results most
sedating antihistamine preparations should be with held for

A

3-4 days

120
Q

To avoid
false-negative results nonsedating
antihistamines should be with held for

A

5-7 days

121
Q

Serum immunoassays for____ to
allergens provide a suitable alternative

A

specific IgE

122
Q

serum immunoassays positive predictive value

A

43.5%

123
Q

Serum immunoassays for specific IgE to
allergens provide a suitable alternative for

A

patients with dermatographism or extensive dermatitis, those taking medications that interfere with mast cell degranulation, others at high risk for anaphylaxis, and some who cannot cooperate with the
procedure.

124
Q

Presence of___in nasal smear supports the diagnosis
of AR,

A

eosinophils

125
Q

Presence of _____ in nasal smear supports the diagnosis of infectious rhinitis

A

neutrophils

126
Q

Eosinophilia and
measurements of total serum IgE concentrations have relatively

A

low sensitivity.

127
Q

current goals of treatment.

A

Safe and effective prevention and/or relief of symptoms

128
Q

Specific measures to limit indoor allergen exposure
may reduce the risk of sensitization and symptoms of allergic respiratory disease.

A

Sealing the patient’s mattress, pillow, and covers in
allergen-proof encasings
Bed linen and blankets should be washed every week in hot water

129
Q

Sealing the patient’s mattress, pillow, and covers in
allergen-proof encasings

A

reduces the exposure to mite allergen.

130
Q

Bed linen and blankets should be washed every week in hot water . what is the temperature

A

(>54.4°C
[130°F]).

131
Q

The only effective measure for avoiding animal allergens in the home is the

A

removal of the pet.

132
Q

Avoidance of pollen and outdoor
molds can be accomplished by

A

staying in a controlled environment.

133
Q

allows for keeping windows and doors closed, reducing
the pollen exposure.

A

Air conditioning

134
Q

lower the counts of airborne mold spores

A

High-efficiency particulate air filters

135
Q

help reduce sneezing, rhinorrhea and ocular
symptoms.

A

Oral antihistamines

136
Q

Administered as needed they provide acceptable treatment for mild-intermittent disease

A

Oral antihistamines

137
Q

Antihistamines have been classified as
first generation

A

relatively sedating)

138
Q

ntihistamines have been classified as
second generation

A

relatively nonsedating)

139
Q

Antihistamines usually are administered by

A

mouth

140
Q

Antihistamines are also available for

A

topical ophthalmic and intranasal use

141
Q

are preferred because they cause less sedation

A

Second-generation antihistamines

142
Q

Preparations containing _____, typically in combination with other agents, are used for relief of nasal and sinus congestion and pressure and other symptoms such as rhinorrhea, sneezing, lacrimation, itching eyes, oronasopharyngeal itching, and cough.

A

pseudoephedrine

143
Q

is available without prescription

A

Pseudoephedrine

144
Q

Pseudoephedrine is generally in fixed combination with other agents such as first-generation antihistamines:

A

brompheniramine, chlorpheniramine,
triprolidine

145
Q

Pseudoephedrine is generally in fixed combination with other agents such as 2nd-generation antihistamines:

A

desloratadine, fexofenadine,
loratadine; antipyretics: acetaminophen, ibuprofen

146
Q

Pseudoephedrine is generally in fixed combination with other agents such as antitusssive:

A

guaifenesin, dextromethorphan;

147
Q

anticholinergic

A

methscopolamine

148
Q

Pseudoephedrine is an oral vasoconstrictor disfavored for causing ____

A

irritability
and insomnia and for its association with infant mortality.

149
Q

younger children ___ are at increased risk

A

2-3 yr of age

150
Q

younger children (2-3 yr of age) are at increased risk of overdosage and toxicity, some manufacturers of oral nonprescription cough and cold preparations have voluntarily revised their product labeling to warn against the use of preparations containing pseudoephedrine for children younger than

A

4 yrs old

151
Q

Pseudoephedrine is misused as a starting
material for the synthesis of

A

methamphetamine and methcathinone

152
Q

The anticholinergic nasal spray ____is effective for
the treatment of serous rhinorrhea

A

ipratropium bromide

153
Q

Intranasal decongestants ____ should be used for less
than 5 days

A

oxymetazoline and phenylephrine

154
Q

Intranasal decongestants
(oxymetazoline and phenylephrine) should be used for

A

less than 5 days

155
Q

Intranasal decongestants should not to be repeated ____ in order to avoid rebound nasal congestion

A

more than once a month

156
Q

(available as nonprescription drug) is effective but requires frequent administration, q4h.

A

Sodium cromoglycate

157
Q

have a modest effect on rhinorrhea
and nasal blockage

A

Leukotriene-modifying agents

158
Q

is a good adjunctive option
with all other treatments of AR.

A

Nasal saline irrigation

159
Q

Patients with more persistent, severe
symptoms require____-s, the most effective therapy for AR,

A

intranasal corticosteroid

160
Q

a treatment that may be beneficial also for concomitant allergic conjunctivitis

A

intranasal corticosteroid

161
Q

are absorbed from the gastrointestinal
tract, as well as from the respiratory tract

A

Beclomethasone, triamcinolone,
and flunisolide

162
Q

offer greater topical activity with lower
systemic exposure.

A

budesonide, fluticasone,
mometasone, and ciclesonide

163
Q

More severely affected patients may benefit from
simultaneous treatment with

A

oral antihistamines and intranasal corticosteroids.

164
Q

is an effective treatment for AR and allergic
conjunctivitis.

A

Allergy immunotherapy

165
Q

Immunotherapy administered by ____ should be considered for children in whom IgE-mediated allergic symptoms cannot be adequately controlled by avoidance and medication, especially
in the presence of comorbid conditions

A

subcutaneous injection

166
Q

has been used successfully in Europe and South America

A

Sublingual immunotherapy

167
Q

considered investigational in the United
States, and there are no extracts for sublingual administration licensed
by the FDA

A

Sublingual immunotherapy

168
Q

given subcutaneously has a dose-dependent effect on seasonal AR; its role compared with standard therapy has yet to be determined.

A

Omalizumab

169
Q

(anti-IgE antibody)

A

Omalizumab

170
Q

Typically, treatment of AR with oral antihistamines and inhaled corticosteroids provides sufficient relief for most cases of coexisting allergic conjunctivitis.

A

true

171
Q

are of some value for the treatment of ocular symptoms, but ophthalmic corticosteroids remain the most potent pharmacologic agents for ocular allergy.

A

Intranasal
corticosteroids

172
Q

They carry the risk of adverse effects, such as

A

delayed wound healing
secondary infection
elevated intraocular pressure
formation of cataracts.

173
Q

The reported rates of remission
among children are between

A

10% and 23%.

174
Q

Structural/mechanical factors:

A
  • Deviated septum/septal wall anomalies
  • Hypertrophic turbinates
  • Adenoidal hypertrophy
  • Foreign bodies
175
Q

Nasal tumors:

A
  • Benign
  • Malignant
  • Choanal atresia
176
Q

Infectious:

A
  • Acute
  • Chronic
177
Q

Inflammatory/immunologic:

A
  • Granulomatosis with polyangiitis
  • Sarcoidosis
  • Midline granuloma
  • Systemic lupus erythematosus
  • Sjögren syndrome
  • Nasal polyposis
178
Q

Physiologic:

A
  • Ciliary dyskinesia syndrome
  • Atrophic rhinitis
179
Q

Hormonally induced

A
  • Hypothyroidism
  • Pregnancy
  • Oral contraceptives
  • Menstrual cycle
  • Exercise
  • Atrophic
180
Q

Drug induced:

A

Rhinitis medicamentosa
* Oral contraceptives
* Antihypertensive therapy
* Aspirin
* Nonsteroidal antiinflammatory drugs

181
Q

Reflex induced:

A
  • Gustatory rhinitis
  • Chemical or irritant induced
  • Posture reflexes
  • Nasal cycle
  • Environmental factors:
  • Odors
  • Temperature
  • Weather/barometric pressure
  • Occupational
  • Nonallergic rhinitis with eosinophilia syndrome
  • Perennial nonallergic rhinitis (vasomotor rhinitis)
  • Emotional factors
182
Q

Rhinitis > non-allergic> Infective >

A

Acute rhinosinusitis, Chronic rhinosinusitis

183
Q

Rhinitis > non-allergic> Infective >Chronic rhinosinusitis Exclude predisposing causes

A
  • Cystic fibrosis
  • Primary ciliary dyskinesia
  • Immunodeficiency
  • Immunopathology
  • Polyps
184
Q

Rhinitis > non-allergic>non -Infective >Non-allergic rhinitis
with eosinophilia

A

Consider aspirin,
entopy (local nasal IgE)

185
Q

Rhinitis > non-allergic>non -Infective > Immunopathologic
findings

A
  • Churg-Strauss syndrome
  • Wegener granulomatosis
  • Sarcoidosis
  • Relapsing polychondritis
  • Systematic lupus
    erythematosus
186
Q

Rhinitis > non-allergic>non -Infective >Structural abnormalities

A
  • Deviated septum
  • Nasal valve dysfunction
  • Nasal polyps
  • Foreign body
  • Adenoidal hypertrophy
  • Choanal atresia
  • Cerebral fluid leak
  • Nasal or CNS tumors
187
Q

Rhinitis > non-allergic>non -Infective >Hormonal

A
  • Pregnancy
  • Menstrual cycle
  • Puberty
  • Hormone
    replacement
    therapy
  • Acromegaly
  • Hypothyroidism
188
Q

Rhinitis > non-allergic>non -Infective >drug induced

A
  • Oral contraceptive
  • Rhinitis medicamentosa
  • Antihypertensives
  • Cocaine abuse
  • Aspirin or NSAID
189
Q

Rhinitis > non-allergic>non -Infective >others

A
  • Non-infective,
    non-allergic rhinitis
    Neurogenic (gustatory,
    emotional, cold-air
    induced)
  • Atrophic
  • Gastro-esophageal
    reflux
  • Idiopathic
190
Q

Desloratadine
Clarinex Reditabs strength

A

2.5 mg, 5 mg

191
Q

Desloratadine
Clarinex Reditabs formulation

A

Orally disintegrating tablet

192
Q

Desloratadine
Clarinex Reditabs dosing

A

Children 6-11 mo of age: 1 mg once daily

193
Q

LEUKOTRIENE ANTAGONIST
Montelukast
Singulair

A

10 mg Tablets 6 mo-5 yr: 4 mg daily

194
Q

Desloratadine
Clarinex Tablets

A

5 mg Tabs Children 12 mo-5 yr of age: 1.25 mg once daily

195
Q

Clarinex Syrup

A

0.5 mg/mL Syrup Children 6-11 yr of age: 2.5 mg once daily
Adults and adolescents ≥12 yr of age: 5 mg once daily

196
Q

Levocetirizine dihydrochloride
Xyzal Oral Solution

A

0.5 mg/mL Solution 6 mo-5 yr: max 1.25 mg once daily in the P.M.
6-11 yr: max 2.5 mg once daily in the P.M.

197
Q

Singulair Chewables*

A

4 mg, 5 mg Chewable tablets 6-14 yr: 5 mg daily

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