Allergic Rhinitis Flashcards
Allergic Rhinitis
Inflammatory disorder of the upper airway
Allergic Rhinitis symptoms
– Sneezing – Rhinorrhea – Pruritus – Nasal congestion – For some people: Conjunctivitis, sinusitis, and asthma
Seasonal
pollen - grass, tree, ragweed
perennial
dust mites, cat and dog dander
allergic rhinitis
Allergens bind to immunoglobulin E (IgE)
on mast cells
Triggers release of inflammatory mediator
– Histamine, leukotrienes, prostaglandins
Three pollen seasons
in Minnesota
Tree
Grass
Weed
Ragweed
Tree
early
April until the end of
May.
Grass
– early
June to mid-July
Weed
– midJune until a hard frost
occurs
ragweed
early August through
mid-October
Classes of Drugs Used for
Allergic Rhinitis
- Glucocorticoids (intranasal)
- Antihistamines (oral and intranasal)
- Sympathomimetics (oral and intranasal)
Intranasal Glucocorticoids are the first
choice—most effective for treatment and
prevention of rhinitis
Intranasal Glucocorticoids exampoles
Budesonide [Rhinocort Aqua], fluticasone
propionate [Flonase], triamcinolone [Nasacort
Allergy}
Intranasal Glucocorticoids adverse effects
– Drying of nasal mucosa or sore throat – Epistaxis (nosebleed) – Headache – Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
Intranasal Glucocorticoids preferred treatment choice in
in pregnancy for moderate
to severe AR, use lowest effective dose (typically
choose budesonide – pregnancy category B)
Oral Antihistamines are
H1 receptor antagonists
H1 are 1st line for
• 1st line – mild to moderate AR
H1 do not reduce
Do not reduce nasal congestion
H1 are most effective
• Most effective if taken prophylactically
H1 should be taken
regularly throughout the allergy season, even
when symptoms are absent, to prevent an initial histamine
receptor activation
Antihistimine types
• 1st and 2nd/3rd generation
– 2nd and 3rd generation – less
tendency to cause sedation
preferred fewer CNS effects
• Mild adverse effects: Sedation with
first generation (much less with second generation)
• Anti-cholinergic effects – drying of nasal secretions, dry mouth,
constipation, urinary hesitancy – common with
1st generation,
rare with 2nd-generation
Intranasal Anti-histamines
examples
Azelastine and Olopatadine
Intranasal Anti-histamines
indicated for
Indicated for allergic rhinitis in adults and in
children over 12 years old
Intranasal Anti-histamines
systemic absorption can be
can be sufficient to
cause somnolence
Intranasal Anti-histamines
SE
Nosebleeds, headaches
• Unpleasant taste
Intranasal Anti-histamines
combination
corticosteroid/anti-histamine
sprays
Intranasal Anti-histamines have
rapid onset. 15 min
Intranasal Cromolyn Sodium is
Mast cell stabilizer
Intranasal Cromolyn Sodium reduces
Reduces symptoms by suppressing the
release of histamine and other inflammatory
mediators from mast cells
Intranasal Cromolyn Sodium is used as
Prophylaxis
Intranasal Cromolyn Sodium administer before
Administer before symptoms start
Intranasal Cromolyn Sodium response develops in
develops in 1 to 2 weeks
Intranasal Cromolyn Sodium minimal
adverse reactions: Less than with
any other drug for allergic rhinitis
Other drugs that can be used for allergic rhinitis
• Anti-leukotriene agents • Ipratropium bromide • Short courses of oral glucocorticoids usually abolish symptoms of allergic rhinitis and may be indicated for severe allergic rhinitis symptoms that are preventing the patient from sleeping or going to work. • Nasal saline irrigation
animal dander avoidence
– remove from house. Or keep animal
out of patient’s bedroom. HEPA room air filter. Seal or
put filter on air ducts that leave to the individual’s
bedroom.
house mites avoidance
encase pillows and mattresses in a DM
cover, was bedding in hot water weekly (>130 degrees).
Remove carpet from bedrooms.
cockroaches avoidance
– professional extermination, vacuum and
wet wash home, use poison bait o r traps, no food or
garage exposed, repair plumbing leaks, cracks, crevices.
indoor mold avoidence
– reduce indoor humidity to 50%, are
condition, fix all leaks and eliminate water sources, clean
moldy surfaces.
Refer
• Children with moderate-to-severe allergic rhinitis.
• Prolonged or severe symptoms of rhinitis or significant residual
symptoms despite pharmacologic therapy and avoidance measures.
• Patients whose management might be enhanced by identification of
allergic triggers.
• Patients with coexisting asthma or nasal polyposis
• Patients with significant complications of allergic rhinitis, such as
recurrent otitis media or recurrent sinusitis.
• Patients with intolerable adverse effects from medications or side
effects that interfere with school/work productivity.
• Patients who are interested in immunotherapy as a treatment option.
• Patients who have required systemic glucocorticoids to control
symptoms
