Allergic rhinitis Flashcards
1
Q
What is the most common chronic disease in childhood?
A
- Allergic rhinitis
2
Q
What is AR a RF of?
A
- development of asthma
3
Q
What are the 3 types of AR?
A
- Seasonal allergic rhinitis/hay fever
- due to pollen, grass, mould spores, weeds
- Perennial rhinitis (persistent)
- occurs throughout the year
- Occupational rhinitis
- exposure to allergens at work (eg, flour, wood dust, latex gloves)
4
Q
What is the Px of allergic rhinitis?
A
- exposure to allergens
- immunoglobulin E (IgE)-mediated inflammation of the nasal mucosa
- Release of histamine from mast cells
- increase in epithelial permeability
- migration of inflammatory cells to the area
5
Q
What are the 2 types of immune response in AR?
* think acute and late phases
A
- Acute phase response (minutes)
- Sneezing
- Increase in nasal secretion
- Late phase response (6-12 hrs)
- nasal obstruction
6
Q
What age group is typically affected by AR?
A
- Hay fever - tends to affect school-aged children and adolescents
- persistent allergic rhinitis - tend to affect adults
- majority diagnosed before 20yo
7
Q
What causes AR?
A
- house dust mites
- hair on cats and dogs
8
Q
What disease does AR commonly associate with?
A
- Conjunctivitis
- Atopy (including eczematous dermatitis and asthma) - more common in persistent disease.
- Rhinosinusitis and nasal polyps
- Risk factors include history of atopy and a family history of rhinitis or atopy.
9
Q
What are the sx of AR?
A
- sneezing
- rhinorrhoea & nasal congestion (bilateral)
- itchy nose
- watering, itching, redness or swelling of eyes
- sx controlled by antihistamines or topical nasal steroids
10
Q
Describe the different characteristics of nasal discharge.
A
- Clear - infection unlikely
- Yellow-coloured implies allergy or infection.
- Green-coloured is usually associated with infection.
- Blood-tinged unilateral - tumour, foreign body or nose picking.
- Blood-tinged bilateral - bleeding points, nose picking or granulomatous disorder.
11
Q
What will you ex for AR?
A
- Auriscope - examine nose
- swollen nasal mucosa
- grey-ish
- Look for signs of chronic nasal congestion
- mouth breathing
- cough
- halitosis (bad breath)
- examine eyes - conjunctivitis
- CN exam - rule out rare tumours
12
Q
What are the differential diagnosis of AR?
A
- Non-allergic rhinitis.
- Infective rhinitis.
- Nasal polyps.
- Sinusitis.
- Adenoidal hypertrophy.
- Cystic fibrosis.
- Kartagener’s syndrome.
- Foreign body in child
13
Q
What ix would you order for AR?
A
- Clinically diagnosed
- Skin prick test - if causative allergen not clear
- radioallergosorbent test (RAST)/enzyme-linked immunosorbent assay (ELISA)
- if pt is taking antihistamine or has dermatographism
14
Q
When would you consider CT scan?
A
- medical treatment has failed
- diagnosis of chronic rhinosinusitis is suspected
- could not be confirmed on history and examination
- neoplasia is suspected
15
Q
How would you mx AR?
A
- Stepwise approach
- Conservative
- Allergy avoidance
- Topical nasal antihistamines (first line)
- not suited for children <5
- Oral antihistamines
- cetirizine (2-12yo)
- loratadine - pregnant/breastfeeding
- Topical intranasal steroids
- First line for pregnant/breastfeeding
- Mometasone, fluticasone
- Oral steroid
- Prednisolone (5-10 days)
- 20-40 mg per day in adults
- 10mg per day in children
