Allergic Rhinitis

Question 1

Allergic rhinitis affects patients either
1.
2.

Answer 1

Seasonally
Perennially

Question 2

Moderate-severe allergic rhinitis is classified as
1.
2.
3.sleep disturbance
4. troublesome symptoms

Answer 2

1. impaired school/work
2. impaired ADL

Question 3

Red flags for referral in allergic rhinitis:
1. Children < __ yo
2.
3.
4. Unilateral symptoms
5. AOM
6. uncontrolled asthma

Answer 3

1. 2 yo
2. mod-severe
3. treatment failure/persistent symptoms (tried OTC 2 weeks)

Question 4

The following classes of OTC medications can help with allergic rhinitis
1.
2.
3.

Answer 4

1. oral antihistamines
2. decongestants
3. intranasal corticosteroids

Question 5

______________ help relieve most symptoms of acute allergic rhinitis such as sneezing, rhinorrhea, nasal itch and conjunctivitis

Answer 5

Antihistamines

Question 6

Antihistamines are most effective if used _______________

Answer 6

prophylactically

Question 7

Of the less-sedating antihistamines, ____________ is more likely to cause some sedation, especially at higher doses.

Answer 7

Cetirizine

Question 8

Patients whose occupations require vigilance or concentration should receive only less-sedating antihistamines, as they do not affect performance and have no anticholinergic effects. ___________ and ____________ were shown to have no effect on driving performance.

Answer 8

Bilastine and rupatadine

Question 9

First generation antihistamines are not recommended due to?

Answer 9

Side effects: CNS sedation fatigue impaired cognitive function

anticholinergic urinary retention dry eyes, mouth constipation

Question 10

What is the onset of second-generation antihistamines?

Answer 10

1 hour

Question 11

Second generation antihistamines require dose adjustment in?

Answer 11

Renal impairment

Question 12

Oral decongestants (_____________, _______________) relieve nasal obstruction

Answer 12

Pseudoephedrine, phenylephrine

Question 13

Avoid oral decongestants in those receiving _____

Answer 13

MAOi (Serotonin syndrome risk)

Question 14

Avoid use of oral decongestants in
1.
2.
3.

Answer 14

Uncontrolled HTN
Hyperthyroidism
pregnancy / BF

Question 15

Oral decongestants can lead to side effects like:
1.
2.
3.

Answer 15

1. restlessness
2. tachycardia
3. increased BP

Dysglycemia (caution in DM patients)

Question 16

The two long acting topical nasal decongestants available in Canada include:
1.
2.

Answer 16

Oxymetazoline
Xylometazoline

Fast onset, 5-10 minutes

Question 17

The use of intranasal decongestants for more than 3–7 days may result in ____________

Answer 17

Rebound congestion

Question 18

Decongestants are typically contraindicated in < __ yo

Answer 18

12

Question 19

Consider _____________ as monotherapy or add-on therapy with INCS or oral antihistamines in patients with concomitant asthma or nasal polyps, or in patients who have failed to respond to adequate trials of first-line therapies (INCS or oral or intranasal antihistamines).

Answer 19

Montelukast

Question 20

____________ _______________ are the mainstay of therapy for moderate to severe rhinitis symptoms

Answer 20

Intranasal corticosteroids (INCS, e.g., beclomethasone, budesonide, ciclesonide, fluticasone furoate, fluticasone propionate, mometasone and triamcinolone)

Question 21

INCS peak effect may take __ - __ weeks

Answer 21

1-2

Question 22

If allergic rhinitis is not adequately controlled with intranasal corticosteroid monotherapy, the addition of an _____________ may be considered but should be discontinued if no benefit is observed within 2–4 weeks.

Answer 22

antihistamine

Azelastine/​fluticasone combination intranasal spray is available for treatment of allergic rhinitis and ocular symptoms in patients over 12 years of age. Studies found that the combination is superior to fluticasone propionate or azelastine alone for nasal congestion, rhinorrhea, sneezing, nasal itch and eye symptoms. Consider using the combination product for patients who continue to have symptoms despite an adequate trial of INCS

Question 23

Patients primary allergic rhinitis symptom is rhinorrhea, what could you consider?

Answer 23

Intranasal anticholinergic

Ipratropium bromide (Atrovent)

Question 24

Rare side effect associated with Montelukast therapy?

Answer 24

Psychiatric Symptoms

Question 25

When oral antihistamines, INCS or leukotriene receptor antagonists provide insufficient relief, topical ophthalmic antihistamines _________, _________ can be used to provide ocular symptom relief

Answer 25

Ketotifen
Olopatadine

Onset Few minutes
Duration 12 hours

Question 26

______________ is indicated only when there is evidence of IgE-dependent sensitivity to a specific antigen the patient cannot effectively avoid and when frequency and severity of symptoms are difficult to control with conventional drug therapy.​

Answer 26

Immunotherapy or allergy shots

costly

Question 27

Children with allergic rhinitis can use:
1.
2.

Answer 27

2nd gen antihistamines
Intranasal corticosteroids

Question 28

Preferred initial therapy for nasal symptoms during pregnancy is ________

Answer 28

Saline Drops/Spray

Question 29

Options for managing allergic rhinitis in pregnancy
1.
2.
3.
4.

Answer 29

1. Antihistamines
2. Corticosteroids
3. Monteklukast
4. Intranasal decongestant

Question 30

Which intranasal corticosteroid should be avoided in pregnancy ?

Answer 30

Triamcinolone in 1st trimester

Question 31

Desloratadine, loratadine and rupatadine are available as ________. _______ is available as a chewable tablet, an oral solution and a fast-dissolve tablet.

Answer 31

Syrups, Cetirizine (Reactive)

Question 32

Which of the 2nd gen oral antihistamines is dosed BID?

Answer 32

Fexofenadine (Allegra)