Allergic Rhinitis

Question 1

What causes allergic rhinitis?

Answer 1

Environmental allergens -> allergic inflammatory response in nasal mucosa

Question 2

What type of reaction causes allergic rhinitis?

Answer 2

IgE mediated type I hypersensitivity reaction

Question 3

Why can allergic rhinitis have a big impact?

Answer 3

Very comomn
Affect sleep, work, mood, hpbbies, school, QOL

Question 4

What is perennial allergic rhinitis?

Answer 4

Year round eg house dust mite allergy

Question 5

Occupational vs seasonal allergic rhinitis?

Answer 5

Seasonal = hay fever
Occupational is ass with work or environment

Question 6

Presentation of allergic rhinitis

Answer 6

Runny, blocked, itchy nose
Sneezing
Itchy, red,, swollen eyes

Question 7

What other conditions is allergic rhinitis ass with>

Answer 7

Eczema
Asthma

Question 8

What can be used to help diagnosing allergic rhinitis?

Answer 8

Skin prick testing - pollen, dust, house mite allergy

Question 9

Triggers ofr allergic rhinitis?

Answer 9

Tree pollen or grass - seasonal
house dust mites and pets
Pets
Mould

Question 10

How to manage allergic rhinitis/

Answer 10

Avoid trigger
Oral antihistamines
Nasal corticosteroid sprays

Question 10

How to manage allergic rhinitis/

Answer 10

Avoid trigger
Oral antihistamines
Nasal corticosteroid sprays
Nasal antihistamines

Question 11

Grass pollen allergy management

Answer 11

Avoid grassy open spaces especially early morning
avoid drying washing outdoors pollen count
Windows shut
Shower after high pollen exposyre

Question 12

house dust mite allergy how to manage around house

Answer 12

Synthetic pillows and acrylic duvets
Wash all bedding and furry toys at least once a week at high temperatures
Wooden or hard floor over carpets
Fit blinds can be wiped clean instead of curtains

Question 13

First line generation for mild to moderate intermittent or mild persistent allergic rhinitis

Answer 13

As needed intranasal antihistamine or non sedating oral antihistamine (2nd gen)

Question 14

What is most effective and fastest onset of action antihistamine?

Answer 14

Intranasal more effective and faster onset of action than orals

Question 15

What to use if antihistamines are contraindicated or not tolerated?

Answer 15

Chromone - sodium cromoglicate as needed. Need to be used up to 4 x a dya

Question 16

What to recommend if moderate to severe persistent symtpoms or intial drug treatment ineffective?

Answer 16

Regular intranasal corticosteroid during periods of allersgen exposure

Question 17

How long is onset of action of intranasal corticosteroid? Maximum effect?

Answer 17

6-8 hours
2 weeks

Question 18

Options for intranasal corticosteroids?

Answer 18

Mometasone furoate, fluticasone furoate or fluticasone propionate

Question 19

How long before re-exposure to causative allergens reintroduce intranasal steroids?

Answer 19

2 weeks

Question 20

What to treat nasal congestion with when refractory to intranasal corticosteroids?

Answer 20

Short term intranasal decongestant eg xylometazoline

Question 20

What to treat nasal congestion with when refractory to intranasal corticosteroids?

Answer 20

Short term intranasal decongestant eg xylometazoline

Question 21

What to do if If there is persistent watery rhinorrhoea despite combined use of an intranasal corticosteroid and oral antihistamine

Answer 21

add in an intranasal anticholinergic such as ipratropium bromide

Question 22

What can you give when also history of asthma?

Answer 22

Oral leukotriene receptor antagonists

Question 23

When do you prescribe a short course of oral corticosteroids for allergic rhinitis?

Answer 23

Severe, uncontrolled symptoms significantly affecting quality of life

Question 24

What is RAST?

Answer 24

Radioallergoasborbent test - skin prick allergy testing to measure IgE serum specific reaction to allergens

Question 25

When is specialist immunotherapy used in allergic rhinitis?

Answer 25

Appropriate for people with symptoms on allergen exposure, objective confirmation of IgE sensitivity and persistent symptoms

Question 26

What are examples of non sedating antihistamines?

Answer 26

Cetirizine, loratadine and fexofenadine

Question 27

What type of antihistamines are chlorphenamine (piriton) and promethazine?

Answer 27

Sedating

Question 28

What treatment is best for rapid onset symptoms in response to a trigger?

Answer 28

Nasal antihistamines

Question 29

Nasal spray technique

Answer 29

-good coating throughout oassage
Hold spray in L hand -> R nostril
Spray out, away from nasal septum
Dont sniff at same time as spraying (-> back of throat - shouldnt be able to taste)