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IP 3 > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

Define rhinitis

A 
inflammation of the nasal mucous membrane with one or more of the following:
nasal congestion
rhinorrhea
sneezing
itching
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2
Q

Define allergic rhinitis

A

rhinitis caused by a mucous membrane exposure to inhaled allergenic materials that elicit a specific response mediated by IgE

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3
Q

Define allergic conjunctivitis

A

inflammation of the conjunctiva that is mediated by IgE and is associated with itching, erythema, tearing

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4
Q

seasonal allergic rhinitis

A

occurs in response to specific allergens present at predictable times of the year

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5
Q

perrennial allergic rhinitis

A

allergic rhinitis that occurs year round

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6
Q

episodic allergic rhinitis

A

allergic rhinitis that occurs by sporadic exposures to allergens that are not usually encountered in the patient’s indoor/outdoor environment

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7
Q

Seasonal Allergic Rhinitis allergens

A

Tree pollen - spring
Grass pollens - late spring to early summer
Weed pollens - late summer to early fall

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8
Q

Perrennial Allergic Rhinitis allergens

A

Mold spores
House dust mite fecal proteins
Animal dander
Cockroaches

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9
Q

Risk factors for allergic rhinitis

A

Family history of atopy
Higher socioeconomic class
Higher serum IgE levels (>100 IU/mL) before age 6
Positive allergy skin prick test

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10
Q

Most common causes of drug induced rhinitis

A

ACE inhibitors
a-receptor antagonists
Phosphodiesterase-5 selective inhibitors

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11
Q

Structure of nasal cavity

A

Posterior to external nose
Surface area lined by mucous membrane
Serous glands - lysozyme chemical destroys bacteria
Epithelial cells - natural anitbiotics
Cilia - moves toward throat
Nasal mucousa - warms air
Nasal conchae - mucous covered projections

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12
Q

Functions of nasal cavity

A 
Airway for respiration
Moistens and warms entering air
Filters and cleans inspired air
Resonating chamber for speech
Houses olfactory receptors
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13
Q

Structure and function of the mucous membrane

A

Epithelium supported by underlying layer of connective tissue, coated with viscous fluid (mucus) secreted by goblet cells and/or mucus glands

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14
Q

What is the function of nasal turbinates and what is the impact on airflow through the nasal cavity?

A

Mucus covered projections

Can increase mucosal surface area when engorged with blood; swelling can reduce airflow and cause nasal congestion

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15
Q

Structure and function of conjunctiva

A

Thin, transparent mucous membrane that lines the eyelids and covers the visible part of the eye. It functions to lubricate the eye by secreting oils and mucus.

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16
Q

Hypersensitivity reactions

A

immune responses that are excessive, injurious, or pathologic

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17
Q

Four types of hypersensitivity reactions

A
  1. Immediate Hypersensitivity (Type 1; allergies)
  2. Antibody-Mediated Diseases (Type II)
  3. Immune complex-mediated diseases (Type III)
  4. T cell mediated diseases (Type IV)
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18
Q

Type I Hypersensitivity

A

Rapid IgE anitbody and mast cell-mediated vascular and smooth muscle reaction, often followed by inflammation

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19
Q

Type II Hypersensitivity

A

Antibodies other than IgE against cells/extracellular components may react with any tissue that expresses specific antigen
Antibodies self-reactive - injury by local inflammation

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20
Q

Type III Hypersensitivity

A

Immune complexes of circulating/soluble antigens and antibodies can deposit in blood vessels in tissues - inflammation and injury

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21
Q

Type IV Hypersensitivity

A

T cell-mediated autoimmune reactions against cell antigens with restricted tissue distribution

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22
Q

Allergens

A

foreign molecules, antigens?, that aren’t harmful normally but can cause an immune response

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23
Q

Sensitization

A

occurs when IgE antibodies bind to receptors in the plasma membrane of mast cells and basophils and become sensitive to subsequent encounters to the same allergen

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24
Q

Process of sensitization

A
  1. APCs digest and process allegen - display class II MHC
  2. Activation of CD4 Helper Cells
  3. Secretion of cytokines IL-4 and IL-13
  4. Stimulate B cells specific for same allergen to switch to IgE producing plasma cells
  5. Sensitization
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25
Q

Role of mast cells, eosinophils, and basophils in allergic rhinitis

A

Degranulation - mast cells and basophils rapidly release contents of secretory vesicles after exposure to allergen cross links IgE. Molecules cause immune reaction. Eosinophils release chemical mediators that promot the migration of additional immune cells to site and chemicals destructive to epithelia

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26
Q

Most important products of mast cell activation

A

Histamine - vasodilation, increased vascular permeability, contraction smooth muscle
Proteases - damage to local tissues
Prostaglandins - vacular dilation
Leukotrienes - prolonged smooth muscle contraction
Cytokines- local inflammation and recruitment

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27
Q

Role of TH2 cells

A

Stimulate mast cell and eosinophil mediated immunity

Secretion of mucus

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28
Q

Histamine role and effects

A

Binds to and activates Histamine -1 (H1) receptos

  • Rhinorrhea - from reflexive stimulation of PNs
  • Itching/Sneezing - stimulation of H1 receptors on nerve endings
  • Nasal congestion, redness, heat - vasodilation, increased vascular permeability
29
Q

symptoms of allergic rhinitis

A
  • Rhinorrhea
  • Sneezing
  • Nasal congestion
  • Pruritic ears, nose, or palate
  • Allergic conjunctivitis (itchy eyes and tearing)
30
Q

Complications of allergic rhinitis

A

-Inability to sleep
-Fatigue
-Poor work/school efficiency
-Post nasal drip with cough
-Loss of smell or taste
-High arched, V shaped palate
-Permanent transverse crease
-Dark circles around eyes
Asthma
-Recurrent and chronic sinusitis
-Epistaxis (nosebleed)
-Nasal polyps
-Sleep apnea

31
Q

Epicutaneous skin test

A

Superficial wound with drop on antigen on it
Fastest and least expensive
Positive test - flare within 15-30 min

32
Q

Intradermal skin test

A

Inject diluted allergen between layers
Negative prick test, but still suspect
15-30 min

33
Q

Radioallergosorbent test (RAST)

A

In vitro assay
More expensive and less sensitive
Helpful when antihistamine therapy can’t be discontinued

34
Q

Non pharmacotherapy

A 
Identify triggers and avoid
Maintain household humidity <50%
Clean house - mold, carpet, bedding
Seasonal - close windows, use mask
Cold compress, saline, artificial tears
Nasal irrigation
35
Q

Advantages of intranasal drug delivery

A

Directly to the site of problem

Minimizes systemic drug exposure

36
Q

Counseling points for intranasal

A

Clear nose before admin
Don’t blow nose ~10 min after
Direct spray away from nasal septum (don’t use in patients with nasal septum ulcers, recent nasal surgery/trauma)
Local irritation may occur

37
Q

Immunotherapy

A

The gradual process of injecting increasing doses of antigens responsible for eliciting allergic symptoms with hope of increasing tolerance

38
Q

Adverse effects of immunotherapy

A 
Mild local reactions
Generalized urticaria (hives)
Bronchospasms
Laryngospasm
Vascular collapse
Anaphylactic reactions
39
Q

Good candidates for immunotherapy

A

Strong history of severe symptoms unsuccessfully controlled
Unable to tolerate adverse effects of properly managed drug therapy
Committed to necessary regular office visits
Evidence of specific IgE antibodies to clinically relevant allergens

40
Q

Poor candidates for immunotherapy

A

With any medical condition that would compromise the ability to tolerate an anaphylactic reaction
Impaired immune systems
History of nonadherance

41
Q

Acrivastine/Pseudophedrine

A

Second Gen. Antihistamine

42
Q

Azelastine

A

Intranasal Antihistamine

43
Q

Azelastine/Fluticasone

A

Intranasal Antihistamine

44
Q

Olopatidine

A

Intranasal antihistamine

45
Q

brompeniramine

A

first gen antihistamine

46
Q

cetirizine

A

second gen antihistamine

47
Q

levocetirizine

A

second gen antihistamine

48
Q

fexofenadine

A

second gen antihistamine

49
Q

loratadine

A

second gen antihistamine

50
Q

chlorpheniramine

A

first gen antihistamine

51
Q

desloratadine

A

second gen oral antihistamine

52
Q

carbinoxamine

A

first gen

53
Q

clemastine

A

first gen

54
Q

cyproheptadine

A

first gen

55
Q

diphenhydramine

A

first gen

56
Q

promethazine

A

first gen

57
Q

pyrilamine

A

first gen

58
Q

alcaftadine

A

ophthalmic antihistamine

59
Q

antazolineine

A

ophthalmic antihistamine

60
Q

azelastine

A

ophthalmic antihistamine

61
Q

bepotastine

A

ophthalmic anti

62
Q

emedastine

A

ophthalmic anti

63
Q

epinastine

A

ophthalmic anti

64
Q

ketotifen

A

ophthalmic

65
Q

levocabastine

A

ophthalmic

66
Q

olopatidine

A

ophthalmic

67
Q

Systemic Decongestants

A

Phenylephrine

Pseudoephedrine

68
Q

Intranasal decongestants

A 
Naphazoline
Phenylephrine
Oxymetazoline
Tetrahydrozoline
Xylometazoline
69
Q

Ophthalmic Decongestants

A

Naphazoline

Tetrahydrozoline

IP 3 (4 decks)

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