Allergic Rhinitis

Question 1

When do immediate phase reactions occur?

Answer 1

Within minutes

Question 2

What is released in immediate phase reactions?

Answer 2

Histamine, LT, C4, D4, E4, PG D2, tryptase, and kinins

Question 3

What do histamines produce?

Answer 3

Rhinorrhea, itching, sneezing, and obstruction

Question 4

What causes nasal obstruction?

Answer 4

Histamin
LTs
PGs
Kinins

Question 5

When do late phase reactions occur?

Answer 5

4-6 hours after initial exposure

Question 6

What are late phase reactions d/t?

Answer 6

Cytokine release by mast cells

Question 7

What are allergens?

Answer 7

Protein components of airborne pollen grains

Question 8

What are the most common allergens in the US?

Answer 8

Ragweed

Grass pollen

Question 9

What is allergic rhinitis?

Answer 9

Inflammation of the nasal mucous membrane

Question 10

What is the classification of seasonal allergic rhinitis?

Answer 10

Less than 4 days/week or less than 4 consecutive weeks

Question 11

What is the classification of perennial allergic rhinitis?

Answer 11

Greater than 4 days/week or greater than 4 consecutive weeks

Question 12

What are RFs for allergic rhintis?

Answer 12

FH
Exposure to allergen
Birth during pollen season
Early introduction of formula or food
Early use of abx
Serum IgE > 100 before 6yo
Presence of allergen specific IgE
Heavy exposure to second hand smoke

Question 13

What is allergic conjunctivitis more closely associated with?

Answer 13

Seasonal

Question 14

What are late phase reaction sx?

Answer 14

Nasal congestion

Question 15

When do we need to stop 1st generation antihistamines before a skin prick test?

Answer 15

3 days prior

Question 16

When do we need to stop 2nd generation antihistamines before a skin prick test?

Answer 16

10 days prior

Question 17

When do we need to stop H2-receptor antagonists before a skin prick test?

Answer 17

3 days prior

Question 18

What is sinusitis?

Answer 18

Nasal inflammation predisposing sinuses to bacterial infection

Question 19

What is sinusitis associated with?

Answer 19

Purulent nasal discharge
Postnasal drip
Fever
HA
Facial pain

Question 20

What action do first generation antihistamines have?

Answer 20

Nonselective

Question 21

Which generation of antihistamines is the most sedating?

Answer 21

First

Question 22

What action does second generation antihistamines have?

Answer 22

Peripherally selective

Question 23

Which 2nd generation antihistamine has the shortest onset?

Answer 23

Levoceterizine

Question 24

What are the intranasal antihistamine agents?

Answer 24

Azelastine

Oloptadine

Question 25

What is the different between Astelin and Astepro?

Answer 25

Astepro has a sweetener added

Question 26

How do IN antihistamines compare to PO and INC?

Answer 26

Not as effective as INC but as good as PO antihistamines

Question 27

How do INCs work?

Answer 27

Reduce inflammation

Inhibit mast cell mediated late phase reactions

Question 28

How are INCs most effective?

Answer 28

QD use

Question 29

How long until INC effects are seen?

Answer 29

2-3 weeks

Question 30

What is the first line treatment for perennial rhinitis?

Answer 30

INCs

Question 31

How long can nasal decongestant sprays be used?

Answer 31

3-5 days

Question 32

What should not be used in allergic rhinitis?

Answer 32

Nasal decongestant sprays

Question 33

What are alternative options for allergic rhinitis?

Answer 33

Intranasal cromolyn
Intranasal ipratropium (Atrovent)
LTMs

Question 34

How should intranasal cromolyn be used?

Answer 34

Prophylaxis

Question 35

How should intranasal ipratropium be used?

Answer 35

Not

Last line

Question 36

What is an AE of intranasal ipratropium?

Answer 36

Nose bleeds

Question 37

What patients should not receive allergen immunotherapy?

Answer 37

Noncompliant
BB use
Pts w/o visible sign of allergen specific IgE