Allergic Rhinitis Flashcards
Allergic Rhinitis
IgE mediated inflammation
- Clear nasal drip
- Sneezing, congestion
- Pale/blue discoloration/swelling of nasal mucosa
- Itchy eyes
Allergic Rhinitis treatment targets
Congestion, Rhinorrhea, Sneezing, Nasal itching, Ocular symptoms
Persistent AR
> 4 days per week AND
4 weeks per year
Intermittent ER
<4 days per week OR
<4 weeks per year
Mild ER
No interference of QOL
Moderate-severe ER
Interference of QOL
Non-pharmacologic AR options
Nasal saline irrigations, adhesive nasal strips
INCS
Targets all symptoms of AR
- Few hours for response
- 1 week for efficacy, 2-3 weeks for maximum response
- Avoid with nasal septum ulcers, nasal surgery, trauma
Oral antihistamines
For everything except congestion (minimal)
- Take 1-2h before exposure for best response
- 1st gens sedating, 2nd gens are favorable (cetirizine and levocetirizine are more sedating)
- Combined with decongestants to cover congestion (-D products)
Intranasal antihistamines
Treats all symptoms except ocular
More targeted delivery, rapid onset 15-30min
- INAH > OAH for congestion
- Can be used if failed OAH
Ophthalmic antihistamines
Relieves allergic conjunctivitis, only for ocular symptoms
- Monotherapy or with oral agents
Topical decongestants
Rapid onset, short term solution
- Rebound congestion in more than 3 day use
Oral decongestants
Slower onset
- Increases blood pressure, avoid with MAOis
- Can be combo’d with antihistamines
Cromolyn
First line for pregnant/breastfeeding*
- Treats everything except ocular
- Runny nose, stuffy nose, sneezing, itching (not ocular symptoms)
- Slow onset of action, frequent dosing
Ipratropium
Treats rhinorrhea
