Allergic rhinitis

Question 1

Inappropriate or exaggerated response to an antigen or an allergen

Answer 1

Hypersensitivity

Question 2

antigens that enters the body, trapped in antigen presenting cells ( Macrophages/ Dendritic cells)

Answer 2

Exogenous

Question 3

Body’s own cell or sub fragments

Answer 3

Endogenous

Question 4

normal proteins or complexes that is recognized by the immune system of someone with an autoimmune condition

Answer 4

Auto antigen

Question 5

Exogenous examples

Answer 5

Microorganisms, allergens

Question 6

Endogenous examples

Answer 6

Blood group antigen, histocompatibility leucocyte antigen

Question 7

Auto antigen examples

Answer 7

Thyroglobulin

Question 8

IgE mediated release of histamine, mast cells and basophils

Answer 8

Type 1: Allergic reaction ( immediate hypersensitivity)

Question 9

Allergic reaction examples

Answer 9

Bee sting, latex allergy, medications (penicillin), urticaria, anaphylaxis, atopy

Question 10

refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis (eczema)

Answer 10

Atopy

Question 11

Commonly associated with heightened response of IgE

Answer 11

Atopy

Question 12

Involves IgG and IgM bound cell surface antigens

Answer 12

Type 2: Cytotoxic reaction

Question 13

Type 2: Cytotoxic reaction duration

Answer 13

Hours to days

Question 14

Type 1: Allergic reaction duration

Answer 14

Reaction within 1 hour

Question 15

Involves circulating IgG and IgM immune complex that deposits in post-capillary venules

Answer 15

Type 3: Immune complex reaction

Question 16

Type 3: Immune complex reaction duration

Answer 16

1-3 weeks

Question 17

Type 3: Immune complex reaction examples

Answer 17

SLE, Serum sickness

Question 18

Cell mediated immunity

Answer 18

Type 4: Delayed hypersensitivity

Question 19

Mediated by T-cells rather than antibodies

Answer 19

Type 4: Delayed hypersensitivity

Question 20

Type 4: Delayed hypersensitivity duration

Answer 20

Days- weeks

Question 21

Type 4: Delayed hypersensitivity examples

Answer 21

nickel allergy, SJS, poison ivy

Question 22

involves inflammation of nasal mucous membranes in sensitized individuals when inhaled allergenic particles contact mucous membranes and elicit a response mediated by immunoglobulin E (IgE).

Answer 22

Allergic rhinitis

Question 23

Mediators of immediate hypersensitivity

Answer 23

Histamine, leukotrienes, prostaglandin, tryptase, and kinins

Question 24

late-phase reaction may occur ___ after initial allergen exposure due to cytokine release from mast cells and thymus-derived helper lymphocytes.

Answer 24

4 to 8 hours

Question 25

Intermittent

Answer 25

Response lasting <4 days/ week or <4 weeks per year

Question 26

Persistent

Answer 26

Response lasting >4 days/week or >4 weeks/ year

Question 27

Mild

Answer 27

Symptoms that do not interfere with quality of life

Question 28

Moderate to severe

Answer 28

Symptoms that interfere with quality of life such as sleep disturbance and work performance

Question 29

Symptoms include

Answer 29

clear rhinorrhea sneezing nasal congestion postnasal drip allergic conjunctivitis pruritic eyes, ears, or nose.

Question 30

In children, physical examination may reveal

Answer 30

dark circles under the eyes (allergic shiners) a transverse nasal crease caused by repeated rubbing of the nose adenoidal breathing edematous nasal turbinates coated with clear secretions tearing periorbital swelling.

Question 31

Medical history

Answer 31

Careful description of symptoms Environmental factors and exposures Results of previous therapy Use of medications Previous nasal injury or surgery Family history

Question 32

Determines whether rhinitis is caused by immune response to allergens

Answer 32

Allergy testing

Question 33

commonly used allergy testing

Answer 33

Immediate-type hypersensitivity skin tests

Question 34

is safer and more generally accepted than intradermal testing, which is usually reserved for patients requiring confirmation.

Answer 34

Percutaneous testing

Question 35

can detect IgE antibodies in the blood that are specific for a given antigen, but it is less sensitive than percutaneous tests

Answer 35

radioallergosorbent test (RAST

Question 36

Pharmacologic Therapy

Answer 36

Histamine H1-receptor antagonists Decongestants Nasal Corticosteroids Cromolyn Sodium Ipratropium bromide Montelukast Immunotherapy

Question 37

Antihistamines are more effective when taken ___ before anticipated exposure to the offending allergen

Answer 37

1 to 2 hours

Question 38

sympathomimetic agents that act on adrenergic receptors in nasal mucosa to produce vasoconstriction, shrink swollen mucosa, and improve ventilation

Answer 38

Decongestants

Question 39

(rebound vasodilation with congestion) may occur with prolonged use of topical agents (>3–5 days).

Answer 39

Rhinitis medicamentosa

Question 40

____ has replaced ___ in many nonprescription antihistamine–decongestant combination products because of legal restrictions on pseudoephedrine sales

Answer 40

Phenylephrine pseudoephedrine

Question 41

relieve sneezing, rhinorrhea, pruritus, and nasal congestion with minimal side effects

Answer 41

Nasal Corticosteroids

Question 42

They reduce inflammation by blocking mediator release, suppressing neutrophil chemotaxis, causing mild vasoconstriction, and inhibiting mast cell–mediated, late-phase reactions.

Answer 42

Intranasal corticosteroids

Question 43

Nasal Corticosteroids examples

Answer 43

Beclomethasone Budesonide Flunisolide Fluticasone Mometasone Triamcinolone

Question 44

a mast cell stabilizer, is available as a nonprescription nasal spray for symptomatic prevention and treatment of allergic rhinitis.

Answer 44

Cromolyn Sodium

Question 45

It prevents antigen-triggered mast cell degranulation and release of mediators, including histamine.

Answer 45

Cromolyn Sodium

Question 46

an anticholinergic agent that may be useful in persistent allergic rhinitis.

Answer 46

Ipratropium bromide

Question 47

It exhibits antisecretory properties when applied locally and provides symptomatic relief of rhinorrhea.

Answer 47

Ipratropium bromide

Question 48

a leukotriene receptor antagonist approved for treatment of persistent allergic rhinitis in children as young as 6 months and for seasonal allergic rhinitis in children as young as 2 years.

Answer 48

Montelukast

Question 49

The process of administering doses of antigens responsible for eliciting allergic symptoms into a patient with the intent of inducing tolerance to the allergen when natural exposure occurs.

Answer 49

Immunotherapy

Question 50

for ___ very dilute solutions are given initially once or twice weekly.

Answer 50

subcutaneous immunotherapy

Question 51

is available for ragweed and certain grass allergies

Answer 51

Sublingual immunotherapy

Question 52

Adverse reactions with subcutaneous immunotherapy include

Answer 52

mild local adverse reactions include induration and swelling at the injection site

Question 53

More severe reactions with subcutaneous immunotherapy

Answer 53

generalized urticaria bronchospasm laryngospasm vascular collapse death from anaphylaxis

Question 54

Severe reactions with subcutaneous immunotherapy are treated with

Answer 54

epinephrine antihistamines systemic corticosteroids

Question 55

The most common reactions with sublingual immunotherapy are

Answer 55

pruritus of the mouth, ears, and tongue throat irritation mouth edema.

Question 56

Non-Pharmacologic Treatment

Answer 56

Avoiding offending allergens Removing pets from the home, if feasible. Reducing exposure to dust mites Prevent poor air quality in homes

Question 57

An immediate reaction occurs within seconds to minutes, resulting in rapid release of preformed and newly generated mediators from the ___

Answer 57

arachidonic acid cascade

Question 58

These mediators of immediate hypersensitivity cause

Answer 58

Vasodilation, increased vascular permeability, and production of nasal secretions

Question 59

Histamine produces

Answer 59

rhinorrhea, itching, sneezing, and nasal obstruction.