Allergic Rhinitis Flashcards
When do immediate phase reactions occur?
Within minutes
What is released in immediate phase reactions?
Histamine, LT, C4, D4, E4, PG D2, tryptase, and kinins
What do histamines produce?
Rhinorrhea, itching, sneezing, and obstruction
What causes nasal obstruction?
Histamin
LTs
PGs
Kinins
When do late phase reactions occur?
4-6 hours after initial exposure
What are late phase reactions d/t?
Cytokine release by mast cells
What are allergens?
Protein components of airborne pollen grains
What are the most common allergens in the US?
Ragweed
Grass pollen
What is allergic rhinitis?
Inflammation of the nasal mucous membrane
What is the classification of seasonal allergic rhinitis?
Less than 4 days/week or less than 4 consecutive weeks
What is the classification of perennial allergic rhinitis?
Greater than 4 days/week or greater than 4 consecutive weeks
What are RFs for allergic rhintis?
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
What is allergic conjunctivitis more closely associated with?
Seasonal
What are late phase reaction sx?
Nasal congestion
When do we need to stop 1st generation antihistamines before a skin prick test?
3 days prior
When do we need to stop 2nd generation antihistamines before a skin prick test?
10 days prior
When do we need to stop H2-receptor antagonists before a skin prick test?
3 days prior
What is sinusitis?
Nasal inflammation predisposing sinuses to bacterial infection
What is sinusitis associated with?
Purulent nasal discharge Postnasal drip Fever HA Facial pain
What action do first generation antihistamines have?
Nonselective
Which generation of antihistamines is the most sedating?
First
What action does second generation antihistamines have?
Peripherally selective
Which 2nd generation antihistamine has the shortest onset?
Levoceterizine
What are the intranasal antihistamine agents?
Azelastine
Oloptadine
What is the different between Astelin and Astepro?
Astepro has a sweetener added
How do IN antihistamines compare to PO and INC?
Not as effective as INC but as good as PO antihistamines
How do INCs work?
Reduce inflammation
Inhibit mast cell mediated late phase reactions
How are INCs most effective?
QD use
How long until INC effects are seen?
2-3 weeks
What is the first line treatment for perennial rhinitis?
INCs
How long can nasal decongestant sprays be used?
3-5 days
What should not be used in allergic rhinitis?
Nasal decongestant sprays
What are alternative options for allergic rhinitis?
Intranasal cromolyn
Intranasal ipratropium (Atrovent)
LTMs
How should intranasal cromolyn be used?
Prophylaxis
How should intranasal ipratropium be used?
Not
Last line
What is an AE of intranasal ipratropium?
Nose bleeds
What patients should not receive allergen immunotherapy?
Noncompliant
BB use
Pts w/o visible sign of allergen specific IgE
