Allergic Rhinitis Lecture

Question 1

How may adults and children have allergic rhinitis?

Answer 1

20% and 40%

Question 2

Define intermittent allergic rhinitis

Answer 2

“Hay fever”
Symptoms occur during certain period of the year
Usally predictable time/events
4 days per week or less than 4 weeks

Question 3

Define persitent allergic rhinitis

Answer 3

“Perennial allergies”
Symptoms occur throughout the year
May wax and wane throughout the year
More than 4 times a week and more than 4 weeks

Question 4

Define mild rhinitis

Answer 4

Symptoms do not impair sleep or daily activities

No troublesome symptoms

Question 5

Define moderate-to-severe rhinitis

Answer 5

Impairment of sleep
Impairment of daily activity
Troublesome symptoms

Question 6

Triggered by?

Answer 6

Aeroallergens
Outdoors: pollen, mold spores
Indoor: dust mites, cockroaches, mold spores, cigs,smoke, etc
Occupational: latex, resins, chemicals, dust

Question 7

Histamine causes?

Answer 7

itching, pain, vasodilation, sneezing

Question 8

Kinins, PGs, and leukotrienes cause?

Answer 8

Nasal blockage, glandular secretion

Question 9

Define sensitization phase

Answer 9

allergen exposure stimulates immune system stimulation –> no symptoms

Question 10

Define early phase

Answer 10

Further allergen exposure causes fast release of pre-formed mast cell mediators –> itching, sneezing within minutes

Question 11

Define cellular recruitment phase

Answer 11

Mast cells infiltrate the mucosa and set up shop

Question 12

Define late phase

Answer 12

Several hours after exposure
Mucus hypersecretion from congestion and submucosal gland hypertrophy
– continued exposure, tissue has lower threshold to allergy (hypersensitivity)

Question 13

Clinical presentation

Answer 13

Bilateral worse in the AM
Frequent sneezing
Pruritis
Conjunctivitis
Allergic shiner: suborbital edema causes dark circles
Allergic salute or crease from salute
Open mouth breathing
Nasal voice
Engorged nasal mucosa

Question 14

Nonallergic rhinitis?

Answer 14

Unilateral sumptoms
Constant during the day
Little sneezing
Rarely conjunctivitis
Causes: nasal polyps, pregnancy, puberty, enlarged tonsils, meds

Question 15

Exclusion criteria for self-treatment?

Answer 15

Under 12
Pregnant
Symptoms of nonallergic rhinitis, otitis media, sinusitis, bronchisits, undiagnosed asthma, COPD, lower respiratory tract infection
Persistant: 2-4 weeks
Side effects of treatment

Question 16

Three part treatment?

Answer 16

Allergen avoidance
Pharmacotherapy
Immunotherapy

Question 17

Indoor allergen avoidance?

Answer 17

Conrol humidity
Wash household items
HEPA filter
Pet dander

Question 18

Outdoor allergen avoidance

Answer 18

Avoid increased exposure

Check the air quality index

Question 19

Pharmacotherapy treatments?

Answer 19

Antihistamines
Decogestants
Nasal Sprays

Question 20

First generation antihistamines examples?

Answer 20

Chlorpheniramine
Dexbrompheniramine
Diphenhydramine
Doxylamine

Question 21

First generation antihistamine pros?

Answer 21

Effective to treat allergic rhinitis
Fast acting
Inexpensive

Question 22

First generation antihistamine cons?

Answer 22

Sedating
Short duration of action
Anticholinergic side effect

Question 23

First generation antihistamine cautions?

Answer 23

Potential for overdose –> excessive histamine and cholinergic receptor blockade
CNS symptoms: psychosis, hallucinations, tremors, agitation, lethargy
Cardiac dysrhthmias, alteration in GI

Question 24

Second generation antihistamine examples?

Answer 24

Clartitin (loratadine) - least sedating
Zyrtex (cetirizine) - most sedating
Allegra (fexofenadine)

Question 25

Second generation antihistamine pro?

Answer 25

Highly protein bound: do not readily cross the BBB –> less sedating

Question 26

Less sedating antihistamines have longer?

Answer 26

Action but are more expensive

Question 27

Overdoses cause?

Answer 27

Headache, somnolence, tachycardia

Question 28

Decongestants?

Answer 28

Reduce nasal congestion
Often in combo with antihistamine
Topical (nasal and ophthalmic) vs systemic

Question 29

Cromolyn sodium?

Answer 29

Intranasal anti-inflammatory
Benefits in 3-7 days peak at 2-4 weeks
Okay for pregnant and lactating women

Question 30

Saline, propylene and polyethylene glycol?

Answer 30

Nasal wetting sprays

May reduce allergic rhinitis symptoms by decreasing irritation and dryness

Question 31

Special regulation in children?

Answer 31

Loratadine
Cromolyn sodium is approved for children over 5
Avoid first generation antihistamines due to paradoxical reaction potential

Question 32

Special regulation in elderly?

Answer 32

Loradatine and cromolyn
Avoid first generation antihistamines due to anticholinergic side effects (potential for excitation, confusion, hypotension –> falls)