Allergic Rhinitis and Cough Flashcards

1
Q

ANS sympathetic activation

A

constricts arterioles
reduces mucosal thickness
widens airway allowing more air to enter

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2
Q

ANS parasympathetic activation

A

dilates arterioles
increases mucosal thickness
increases stuffiness and runny nose

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3
Q

Immune Defense

A

first line

cleans and conditions inhaled air

lined with mast cells (release histamine)

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4
Q

Antigen Antibody Response

A

allergen interacts with IgE + mast cells

release of mediators –> vasodilation, increased vascular permeability, production of nasal secretions

sensory nerve stimulation = itching

vagal stimulation = sneezing

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5
Q

Mast Cell Mediators

A

histamine
eosinophil chemotactic factor
leukotienes

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6
Q

Histamine

A

stimulates irritant receptors

pruritus

vascular permeability

mucosal permeability

smooth muscle contraction

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7
Q

Eosinophil Chemotactic Factor

A

influx of inflammatory cells

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8
Q

Leukotrienes

A

smooth muscle contraction

vascular permeability

mucus secretion

chemotaxis

neutrophil chemotaxis

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9
Q

Late Phase Reaction

A

4-8 hrs after initial exposure

caused by cytokines

persistent chronic symptoms

hyper responsive, inflamed mucosa

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10
Q

Seasonal Rhinitis Guidelines

A
  1. monotherapy with an intranasal corticosteroid (ages 12+)
  2. intranasal corticosteroid > leukotriene receptor antagonist (ages 15+)
  3. intranasal corticosteroid + intranasal antihistamine for initial treatment of mod-sev cases (ages 12+)(weak)
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11
Q

Nasal Steroids

A

Benefits include symptom control, improved quality of life, better sleep, cost-saving if used as monotherapy, targeted local effect.

Patient preference will play a large role.

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12
Q

Oral Antihistamines

A

Second generation (nonsedating) agents should be used in patients with primary complaints of sneezing and itching.

Relief of eye symptoms, OTC status and the availability of lower cost generics may be advantages.

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13
Q

Intranasal Antihistamines

A

Evidence is strong but studies were of short duration. May consider these agents as optional.

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14
Q

Immunotherapy

A

Recommended in patients who have inadequate response to with pharmacologic therapy with or without environmental controls

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