Allergic Rhinitis Flashcards
Define: Allergies
an inflammatory, IgE-mediated disease characterized by nasal congestion, rhinorrhea (nasal drainage), sneezing, and/or nasal itching caused by allergens (pollen, dust, mold, flakes, skin)
Define: Types of Allergies
seasonal, perennial, episodic environmental and indoor vs outdoor
Classification: Intermittent Allergies
<4 days/week or <4 consecutive weeks with mild or moderate-severe symptoms
Classification: Persistent Allergies
> = 4 days/week or >= 4 consecutive weeks with mild or moderate-severe symptoms
Classification: Mild symptoms
-normal sleep
-no impairment of daily activities
-no bothersome symptoms
Classification: Moderate-severe symptoms
-abnormal sleep
-impairment of daily activities
-bothersome symptoms
What are the risk factors for allergies?
family history, asthma, atopic dermatitis/eczema, higher socioeconomic class
What are the protective factors for asthma?
multiple older siblings and growing up in a farming enviroment
Signs/Symptoms: Allergies
-red, itchy, watery eyes
-sneezing, congestion, runny nose
-itchy/sore throat, cough
-fatigue
Consequences: Allergies
-acute = sinusitis, otitis media with effusion
-chronic= nasal polyps, sleep apnea, hyposomnia
-impaired quality of life and possible need for tubes or tonsils removed
What are the pharmacological treatment options for allergies?
intranasal corticosteroids, antihistamines, leukotriene receptor antagonist, decongestants
What is the pharmacological treatment suggestion for mild symtoms?
intranasal corticosteroids
What is the pharmacological treatment suggestion for moderate-severe symptoms?
intranasal corticosteroids with or without antihistamine may need referred for allergy testing or immunotherapy
What is the pharmacological treatment suggestion for congestion symptoms?
intranasal or oral decongestant
Who is excluded from Self-Care?
-children <12 years old
-pregnant/lactating women
-symptoms of infection
-undiagnosed/uncontrolled asthma/COPD
-uncontrolled symptoms after 2-4 weeks of therapy
MOA: Intranasal steroids
reduction of inflammatory mediators and cytokine release
Indication: Intranasal steroids
congestion, sneezing, and itching
Side Effects: Intranasal steroids
-burning, itching, stinging
-epistaxis
-headache
-aftertaste/smell
Describe: Mometasone (Nasonex)
intranasal steroid
-indication= allergic rhinitis (seasonal and perennial), nasal congestion, nasal polyps, seasonal allergic rhinitis (prophylaxis)
-dose= 100mcg (2 sprays) in each nostril once a day
-adverse effects= viral infection, headache, blood in nasal mucosa, epistaxis
Counseling Points: Intranasal steroids
-tilt head forward and point tip of bottle towards ear
-may take 36 hours to see effect
-better result if taken continuously
-may start several days before pollen season if taking for seasonal allergic rhinitis
-no systemic symptoms
MOA: Antihistamines
block the action of histamine at the H1 receptor
Indication: Antihistamines
sneezing or itching
Side Effects: Antihistamines
-anticholinergic (anti-SLUDGE)
-CNS effects= confusion or drowsiness
Describe: Diphenhydramine (Benadryl)
antihistamine
-indication= relief of allergic symptoms, anaphylaxis, and insomnia
-dose= 25-50 mg every 4-6 hours
-contraindications= <6 years old and not recommended to take with nasal steroids
Describe: Cetirizine (Zyrtec)
antihistamine
-indication= allergic rhinitis
-dose= 10mg once a day
Describe: Olopatadine (Patanol/Patanase)
antihistamine
-indication= seasonal allergic rhinitis
-dose= 2 sprays in each nostril twice a day
Counseling points: Antihistamines
-tolerance may develop if taken for several months
-can be taken daily or as needed due to their quick onset of action, but maximal benefit seen if taken continuously
-intranasal agent have better efficacy
-do not take Allegra with fruit juice
MOA: Decongestants
vasoconstriction of the mucosa and relaxation of the bronchial
Side Effects: Decongestants
-insomnia, nervousness
-headache, dry mouth
-increased blood pressure and heart rate
Counseling Points: Decongestants
nasal sprays are associated with rebound congestion
Describe: loratadine 5mg/pseudoephedrine 120mg (Claritin D)
decongestant
-indication= cold, allergy symptoms
-dose= 1 tablet every 12 hours
-contraindications= MAOi’s
Describe: Leukotriene receptor antagonist
montelukast= prescription only
-MOA= inhibit cysteinyl leukotriene receptors
-SE= headache, and black box warning of neuropsychiatric events
-counseling points= limited benefit as a monotherapy, expensive, and inferior to nasal steroids
