Allergic Rhinitis Flashcards
What causes allergic rhinitis?
Environmental allergens -> allergic inflammatory response in nasal mucosa
What type of reaction causes allergic rhinitis?
IgE mediated type I hypersensitivity reaction
Why can allergic rhinitis have a big impact?
Very comomn
Affect sleep, work, mood, hpbbies, school, QOL
What is perennial allergic rhinitis?
Year round eg house dust mite allergy
Occupational vs seasonal allergic rhinitis?
Seasonal = hay fever
Occupational is ass with work or environment
Presentation of allergic rhinitis
Runny, blocked, itchy nose
Sneezing
Itchy, red,, swollen eyes
What other conditions is allergic rhinitis ass with>
Eczema
Asthma
What can be used to help diagnosing allergic rhinitis?
Skin prick testing - pollen, dust, house mite allergy
Triggers ofr allergic rhinitis?
Tree pollen or grass - seasonal
house dust mites and pets
Pets
Mould
How to manage allergic rhinitis/
Avoid trigger
Oral antihistamines
Nasal corticosteroid sprays
How to manage allergic rhinitis/
Avoid trigger
Oral antihistamines
Nasal corticosteroid sprays
Nasal antihistamines
Grass pollen allergy management
Avoid grassy open spaces especially early morning
avoid drying washing outdoors pollen count
Windows shut
Shower after high pollen exposyre
house dust mite allergy how to manage around house
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
First line generation for mild to moderate intermittent or mild persistent allergic rhinitis
As needed intranasal antihistamine or non sedating oral antihistamine (2nd gen)
What is most effective and fastest onset of action antihistamine?
Intranasal more effective and faster onset of action than orals
What to use if antihistamines are contraindicated or not tolerated?
Chromone - sodium cromoglicate as needed. Need to be used up to 4 x a dya
What to recommend if moderate to severe persistent symtpoms or intial drug treatment ineffective?
Regular intranasal corticosteroid during periods of allersgen exposure
How long is onset of action of intranasal corticosteroid? Maximum effect?
6-8 hours
2 weeks
Options for intranasal corticosteroids?
Mometasone furoate, fluticasone furoate or fluticasone propionate
How long before re-exposure to causative allergens reintroduce intranasal steroids?
2 weeks
What to treat nasal congestion with when refractory to intranasal corticosteroids?
Short term intranasal decongestant eg xylometazoline
What to treat nasal congestion with when refractory to intranasal corticosteroids?
Short term intranasal decongestant eg xylometazoline
What to do if If there is persistent watery rhinorrhoea despite combined use of an intranasal corticosteroid and oral antihistamine
add in an intranasal anticholinergic such as ipratropium bromide
What can you give when also history of asthma?
Oral leukotriene receptor antagonists
When do you prescribe a short course of oral corticosteroids for allergic rhinitis?
Severe, uncontrolled symptoms significantly affecting quality of life
What is RAST?
Radioallergoasborbent test - skin prick allergy testing to measure IgE serum specific reaction to allergens
When is specialist immunotherapy used in allergic rhinitis?
Appropriate for people with symptoms on allergen exposure, objective confirmation of IgE sensitivity and persistent symptoms
What are examples of non sedating antihistamines?
Cetirizine, loratadine and fexofenadine
What type of antihistamines are chlorphenamine (piriton) and promethazine?
Sedating
What treatment is best for rapid onset symptoms in response to a trigger?
Nasal antihistamines
Nasal spray technique
-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)
