Allergic rhinitis (hay fever) Flashcards
What is allergic rhinitis?
Hay fever
occurs after an inflammation response releasing histamine due to allergens being deposited on the nasal mucosa.
In allergic rhinitis, list some common allergens
When is allergic rhinitis worse?
Grass pollen, tree pollen, fungal mold spores
Worse when pollen count is high. Peak at May-July, but symptoms may start in April, when tree pollen appears
Define perennial allergic rhinitis
year-round symptoms due to house dust mite, animal dander and feathers
Time scale for intermittent allergic rhinitis
<4 days/7 or <4 weeks
Time scale for persistent allergic rhinitis
> 4 days/7 and >4 weeks
Describe mild allergic rhinitis effect on life
normal sleep, normal daily activities including sports, leisure, work/school, symptoms not troublesome
Describe moderate allergic rhinitis effect on life
abnormal sleep
impairment of daily activities including sports, leisure.
Problems at work/school
Troublesome symptoms
Treatment timescale of allergic rhinitis
with treatment should resolve within 5 days
Symptoms of allergic rhinitis
- Rhinorrhoea
- nasal congestion
- nasal itching
- irritation of roof of mouth
- itchy and watery eyes, tear duct congestion
- sneezing
Define rhinorrhoea in hay fever
runny nose, thin discharge, clear, watery, but can change to thick, purulent suggesting infection, but no need for antibiotics - treat hay fever as normal
Cause of nasal congestion in hay fever and signs it is severe
Examples of secondary inflammation
Nasal congestion is due to inflammatory response causing vasodilatation of nasal blood vessels.
Severe=headaches and earache.
Secondary inflammation= otitis media, sinusitis
what causes the eye symptoms in hay fever?
direct inflammation in the eye due to pollen
Describe the pattern of sneezing in allergic rhinitis
sneezing is more severe in the morning and evening when pollen rises and settles
Gets better with rain.
If the cause is fungal mould spores, however, then it is worse in damp weather, present in September
referral criteria for allergic rhinitis
- failed medication
- wheezing/shortness of breath (asthma - sometimes only during summer=seasonal asthma)
- tightness of chest
- painful ear
- painful sinuses
- painful conjunctivitis
- failed medication
Lifestyle advice for hay fever/allergic rhinitis
sleep with windows closed
avoid being outside when pollen count is high (mid morning/early evening)
get someone else to cut the lawn/grass
avoid stroking animals
drive the car with windows and vents closed
Vacuum regularly
List drugs that treat allergic rhinitis
Antihistamines:
- cetirizine
- chlorphenamine
- loratidine
Steroid:
-beclomethasone
Mast cell stabiliser:
-sodium cromoglicate
Benadryl one day relief
active ingredient
symptoms
cetirizine
Hay fever, sneezing, rhinorrhoea
Benadryl one day relief
directions side effects
patient populations
one daily
Headache, malaise (discomfort)
Only suitable for >12 years
Fine to use in pregnancy and breastfeeding
Piriton allergy tablets
active ingredient
symptoms
Chlorphenamine
Hay fever, urticaria (allergic rash), chickenpox itch, insect bites, food allergies
Piriton allergy tablets
side effects
drowsiness dry mouth blurred vision constipation urinary retention sedating effect aids sleep
Piriton allergy tablets
patient populations
> 6yrs only
suitable in pregnancy and breastfeeding
Clarityn rapide allergy tablets
active ingredient
symptoms
Loratidine
Symptomatic treatment of allergic rhinitis and chronic urticaria (allergy rash)
Clarityn rapide allergy tablets
patient populations
> 2years only
Not suitable for breastfeeding or in pregnancy
Beconase Hay fever nasal spray
active ingredient
symptoms
Beclomethasone
reduces inflammation
Beconase hay fever nasal spray
side effects
Warnings
counselling
Rare: dryness and irritation of nose and throat, nosebleeds
NOT to be used in glaucoma
Only for use in >18 years for up to 3 months
Not suitable in pregnancy or breastfeeding
Counselling:
Takes several days to see effect
regular use needed
Murine hay fever relief eye drops
active ingredient
symptoms
sodium cromoglicate
red, itchy, watery eyes
Both seasonal and perennial allergic conjunctivitis
Murine hay fever relief eye drops
warnings, side effects
patient populations
counselling
May feel mild transient burning/stinging sensation after administration
>6yrs only
Suitable in pregnancy and breastfeeding
Can use mast cell stabiliser for prophylaxis. In recurrent season allergies, use 4 weeks before the start of allergy season
remove contact lenses before applying?
