Allergic Rhinitis Flashcards
What is allergic rhinitis?
Very prevalent allergic disorder, all age groups (Except asthma children), strong genetic basis
High prevalence highest between 25 and 44 years, ACT, WA
Lowest Rates QLD, NSW
What is the Atopic Triad?
Atopic dermatitis, atopic asthma, allergic rhinitis
What factors should be considered in someone presenting with allergic rhinitis?
Age of the patient (les likely in young and old)
Atopy family history
Timing of the year, exposure to triggers
Freq/severity of symptoms, recurrent symptoms?, signs of infection?, potential cold?
Risk of complications, impacts of quality of life
Comorbidities, smoking status
What are common triggers and duration of intermittent allergic rhinitis?
Pollen, fungal spores
<4x/week or <4 consecutive weeks
What are common triggers and duration of persistent allergic rhinitis?
Dust mites, mould, animals
> 4x/week or >4 consecutive weeks
What are the symptoms of early phase reaction in rhinitis?
Nasal itch, rhinorrhoea, sneezing, nasal congestion
What are the symptoms of late phase reaction in rhinitis?
nasal congestions (main symptoms)
What are the general nasal symptoms of allergic rhinitis?
itchy nose, sneezing, runny/blocked nose, post-nasal drainage
What are the general eyes and other symptoms of allergic rhinitis?
itchy eyes, watery discharge, itchy mouth, puffy red eyes, headache, cough, poor smell/taste, tiredness, nsorking
What is the classification of mild symptoms in allergic rhinitis?
All of the following:
symptoms present but not troublesome
No sleep disturbances
no impairment of daily activities, leisure, or sport
No impairment of school or work performance
What are the classifications of moderate to severe symptoms in allergic rhinitis?
One or more of the following:
Troublesome symptoms
sleep disturbances
impaired daily activities, leisure, or sport
Impairment of school or work performance
What are some sever allergic rhinitis symptoms?
worsening snoring, poor sleep, inability to concentrate, exacerbated asthma, chronic sinusitis
What are the consequences of improper treatment of allergic rhinitis?
Poorer quality of sleep = fatigue, impaired learning, worsening snoring, inc sleep apnoea risk
More prone to sinus, ear infection, eye infection
Asthma is difficult to control, abnormal development of mouth and teeth (from mouth breathing)
When should you refer someone with allergic rhinitis?
Symptoms unresponsive to treatment, medicine induced rhinitis, symptoms of uncontrolled asthma/undiagnosed
Nasal obstruction (not clearing), unilateral discharge (esp. children), severe impact on quality of sleep
impaired sense of smell
First episode <12 y/o
Infectious symptoms = purulent discharge, facial pain, severe headache, fever, earache, hearing loss
Key history questions to ask for allergic rhinitis
Describe symptoms? how start? how long? any other symptoms?
When do symptoms arise? what are triggers? how is your exposure to triggers
When are symptoms worse? any fam history of allergies?
what have you done to manage this so far?
Any other health conditions? pregnancy?
What do we aim to do in allergic rhinitis treatment?
Relieve symptoms, improve QoL, Improve daily function, allergen avoidance
How is allergic rhinitis commonly treated?
Intranasal corticosteroids, oral antihistamines
other potential = intranasal saline, anti-allergy eye drops, ipratropium bromide
Allergen avoidance
List the intranasal corticosteroids used to treated allergic rhinitis
beclomethasone (beconase 12 hr), mometasone (nasonez allergy), fluticasone (beconase 24 hours)
Budesonide (rhinocort hayfever), traimcinolone (telnase)
What are some differential diagnoses for allergic rhinitis?
Common cold = sore throat, nasal congestion, potential cough
Acute rhinosinusitis = facial pain/pressure, loss of smell, congested nose, upper airway cough, mild localised pain initially
Nasal blockage = no nasal itch, sneezing, rhinorrhoea, progressive and accompanied by loss of smell
What role do INCS have in treatment of hayfever/allergic rhinitis?
Work locally on nasal mucosa, dec capillary permeability and mucous production
Relieves nasal symptoms = congestion, may reduce ocular symptoms
Onset of action: 3-7 hours (for congestion & rhinorrhoea), optimal effect several days w/ reg use
Local ADR = stinging, itching, sore throat, dry mouth, taste
List the oral antihistamines used to treated allergic rhinitis
2nd generation preferred due to less sedation
Fexofenadine (telfast), cetirizine (Zyrtec), loratadine (Claratyn), desloratadine (Claramax), levocetirizine (Xyzal)
What role do oral antihistamines have in the treatment of hayfever/allergic rhinitis?
Reduce nasal itching, sneezing, rhinorrhoea, eye symptoms
Less effective on nasal congestion, symptoms reduce and prevention
List the intranasal antihistamine used to treated allergic rhinitis
Azelastine (Azep) = bitter taste in mouth
Levocabastine (Livostin)
What role do intranasal antihistamines have in the treatment of allergic rhinitis?
Rapid onset % long lasting (up to 12 hours)
Not recommended in persistent allergic rhinitis
Can be used with nasal decongestant or INCS
Less effective than INCS alone
What is the role on intranasal ipratroium bromide in allergic rhinitis?
Effective to treat Rhinorrhoea, indicated for persistent AR
Rapid onset of action, prolonged effect (4-12 hours)
Used with INCS or antihistamine
ADS = nasal dryness, nosebleed, taste disturbances, dry mouth
What is the role of intranasal cromoglycate in the treatment of allergic rhinits?
Mast cell stabiliser = prevent histamine release
Prophylactic use only, efficacy determined with at least 4-6 weeks of use
Less effective INCS or antihistamines for mild-moderate AR
Preferred as first line in children
Disadv = req freq use 4-6x/day
What is the role of intranasal saline in the treatment of allergic rhinits?
Nasal wetting agent –> moistens mucosa
Counteracts drying from INCS
Clears nasal passage by washing out allergens, sticky mucus, reduce congestion and irritation
When to refer a patient with allergic rhinitis
Symptoms unresponsive to treatment, medicine induced
Nasal obstruction not clearing, unilateral discharge (Esp in kids), impaired sense of smell
Quality of life severely impacted, symptoms of uncontrolled asthma/undiagnosed
First episode in child <12 y/o
symptoms of infection = purulent discharge, facial pain, severe headache, fever, earache, hearing loss
Tips on avoiding pollen
stay inside when count is high, avoid outdoor activities when trees/grass/related triggers are present
Shower after being outside (Remove pollen), close doors/windows of house/car to limit pollen
Tips on avoiding mould
Keep house ventilated, use air-conditioner to limit humidity
clean anti-mould cleaners
Tips on avoiding dust mites
wash bedding weekly (hot water), vacuum weekly with heap filter in vacuum cleaner
use mattress covers, limit dust collecting furniture
