Allergic Rhinitis & Common Cold Flashcards
Atopy Triad (Rule of 3)
Atopic Dermatitis
Allergic Rhinitis
Asthma
NSAID Caution (Rule of 3)
Aspirin Allergy
Nasal Polyps
Asthma
Zinc and the common cold
Helps with tissue repair
SE: Causes a decrease in appetite due to change in taste + anosmia (inability to smell)
Vitamin C and the common cold
Prophylaxis has only been show to be semi-efficacious
Nasal Steroids and the common cold
Not as effective against a virus versus allergic rhinitis
- Cause mild vasoconstriction and anti-inflammatory effects
Decongestants and the common cold
Nasal: Use for 3 days then throw away (Virus = transmittable)
Antihistamines and the common cold
More helpful for sleep induction than symptoms relief from the rhinovirus
Nasal Irrigation Considerations for Patients
USE CLEAN WATER
Do NOT use in kids < 4 y.o.
- Can use a nasal aspirator
SACAOS: What is this?
Step Approach to Sinus Issues S = Sinus Rinse A = Antihistamines/Decongestants C = Corticosteroid sprays A = Antibiotics O = Oral corticosteroids S = Surgery
Define Sinusitis and Rhinitis
Sinusitis: Inflammation of the lining of the sinuses
- PAINFUL for patients
Rhinitis: Inflammation of the lining of the nasal passages
When should you refer a patient with rhinosinusitis to a SPECIALIST?
1) Recurrent episodes: 2 to 4 episodes with at least 8 weeks between the episodes
2) Symptoms after 2 courses of antibiotics
3) Comorbid immunodeficiency
What is allergic rhinitis?
Exposure to an allergen elicits nasal symptoms and inflammation of the lining of the nasal passages
Who is at risk for developing allergic rhinitis?
Family history
Atopy
Clean-freaks
Patient comes to your pharmacy and asks what she can do to get rid of her runny nose and watery eyes that continually bother her at least 4 times a week for months at a time. It has been affecting her sleeping habits and she has been falling asleep at work randomly.
Classify her allergic rhinitis severity.
Moderate-Severe: Pt may have impairment of sleep, daily life or troublesome symptoms
- Occur > 4 days per week AND > 4 weeks
Jack’s mom brings him into the clinic and asks for a recommendation to help her son’s runny nose and itchy eyes. She reveals that he is 12 years old and that the family recently visited a horseback riding ranch for vacation 5 days ago.
Classify his allergic rhinitis severity.
Mild: Symptoms do not impair sleep or daily life
- Occur ≤ 4 days per week OR ≤ 4 weeks
- Probably due to allergen exposure at the ranch
What happens in the early phase of the allergic response?
IgE binds to mast cells = rapid release of allergic mediates
Then Leukocytes and eosinophils migrate to the nasal mucosa
What happens in the last phase of the allergic response?
Cytokines have caused huge infiltration and inflammation + mucus hypersecretion
List the symptoms of Allergic Rhinitis
Sneezing
Watery runny nose
Itching eyes, nose, palate - “Allergic salute” Congestion: Varies, usually not severe, can lead to mouth breathing
Conjunctivitis
Allergic shiners = “black eyes”
Allergic crease = on nose from rubbing upward
How do you treat allergic rhinitis?
#1 Avoid the Allergen #2 Prophylax whenever possible #3 Daily therapy - must be started 10 to 14 days b4 allergy season #3 Incidental - Take drug 1 to 2 hrs before exposure
What is the #1 choice for allergic rhinitis?
Nasal steroids; No product has been proven superior to the others
Nasal Steroids Benefits (4)
1) Vasoconstriction - mild
2) Reduced edema and infiltrates
3) Mast cell stabilization - mild
4) Reduced inflammation
Concerns with Nasal Steroid Use
- Growth suppression in children
- Epistaxis (Nose bleeds)
- Drug interactions
- Fluticasone inhibits CYP3A4 - Takes 3 to 4 days for improvement to appear!
What is the role of antihistamines in allergic rhinitis treatment?
2nd line therapy
Benefits: Bind at H1 receptor to block histamine
- 2nd gens may have anti-inflammatory effects
Which antihistamines is recommended for skin allergies?
Tavist (clemastine)
List the 1st generation antihistamines from this lecture
chlorpheniramine
clemastine
diphenhydramine
doxylamine
List the 2nd generation antihistamines from this lecture
Piperzine = Ceterizine, levocetirizine Piperidine = loratadine, fexofenadine, desloratadine
What are the concerns with antihistamine use?
1st Generations:
May cause sedation (or stimulation in young kiddos)
Anticholinergic
Photosensitizing
Do not use:
Newborns/Infants, Lactation, BPH, MAOI use, Urinary retention issues, Asthma attack or Narrow Angle glaucoma
How do you over come tolerance of antihistamines?
Switch classes: Piperzine to Piperidine and vice versa
List DDIs with antihistamines
Fexofenadine = avoid fruit juices due to compete for CYP receptors for uptake
Loratadine = ketoconazole, cimetidine, erthromycin
Chlorpheniramine = phenytoi
What are azelastine and olapatdine?
Nasal antihistamines
What are the benefits of decongestant use?
Constriction of blood vessels
Decreased mucosal edema
- Airways open up!
What are concerns with decongestant use?
MAOI use because these drugs require MAO for metabolism
Elevated BP due to vasoconstriction
Tachycardia
Stimulant use = anxiety, tremor, insomnia, restlessness and nausea
What is rebound congestion?
Problem that occurs with longer term use of decongestants
- Avoid this by using for 3 days then stopping use for 3 days before continuing the same cycle
Cromolyn nasal Spray
Mast cell stabilization
- May cause nasal irritation
Not widely recommended
Ipratropium nasal spray
Antisecretory but NOT a vasconstrictor
