Allergic Rhinitis Lecture Flashcards
How may adults and children have allergic rhinitis?
20% and 40%
Define intermittent allergic rhinitis
“Hay fever”
Symptoms occur during certain period of the year
Usally predictable time/events
4 days per week or less than 4 weeks
Define persitent allergic rhinitis
“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
Define mild rhinitis
Symptoms do not impair sleep or daily activities
No troublesome symptoms
Define moderate-to-severe rhinitis
Impairment of sleep
Impairment of daily activity
Troublesome symptoms
Triggered by?
Aeroallergens
Outdoors: pollen, mold spores
Indoor: dust mites, cockroaches, mold spores, cigs,smoke, etc
Occupational: latex, resins, chemicals, dust
Histamine causes?
itching, pain, vasodilation, sneezing
Kinins, PGs, and leukotrienes cause?
Nasal blockage, glandular secretion
Define sensitization phase
allergen exposure stimulates immune system stimulation –> no symptoms
Define early phase
Further allergen exposure causes fast release of pre-formed mast cell mediators –> itching, sneezing within minutes
Define cellular recruitment phase
Mast cells infiltrate the mucosa and set up shop
Define late phase
Several hours after exposure
Mucus hypersecretion from congestion and submucosal gland hypertrophy
– continued exposure, tissue has lower threshold to allergy (hypersensitivity)
Clinical presentation
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
Nonallergic rhinitis?
Unilateral sumptoms Constant during the day Little sneezing Rarely conjunctivitis Causes: nasal polyps, pregnancy, puberty, enlarged tonsils, meds
Exclusion criteria for self-treatment?
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
Three part treatment?
Allergen avoidance
Pharmacotherapy
Immunotherapy
Indoor allergen avoidance?
Conrol humidity
Wash household items
HEPA filter
Pet dander
Outdoor allergen avoidance
Avoid increased exposure
Check the air quality index
Pharmacotherapy treatments?
Antihistamines
Decogestants
Nasal Sprays
First generation antihistamines examples?
Chlorpheniramine
Dexbrompheniramine
Diphenhydramine
Doxylamine
First generation antihistamine pros?
Effective to treat allergic rhinitis
Fast acting
Inexpensive
First generation antihistamine cons?
Sedating
Short duration of action
Anticholinergic side effect
First generation antihistamine cautions?
Potential for overdose –> excessive histamine and cholinergic receptor blockade
CNS symptoms: psychosis, hallucinations, tremors, agitation, lethargy
Cardiac dysrhthmias, alteration in GI
Second generation antihistamine examples?
Clartitin (loratadine) - least sedating
Zyrtex (cetirizine) - most sedating
Allegra (fexofenadine)
Second generation antihistamine pro?
Highly protein bound: do not readily cross the BBB –> less sedating
Less sedating antihistamines have longer?
Action but are more expensive
Overdoses cause?
Headache, somnolence, tachycardia
Decongestants?
Reduce nasal congestion
Often in combo with antihistamine
Topical (nasal and ophthalmic) vs systemic
Cromolyn sodium?
Intranasal anti-inflammatory
Benefits in 3-7 days peak at 2-4 weeks
Okay for pregnant and lactating women
Saline, propylene and polyethylene glycol?
Nasal wetting sprays
May reduce allergic rhinitis symptoms by decreasing irritation and dryness
Special regulation in children?
Loratadine
Cromolyn sodium is approved for children over 5
Avoid first generation antihistamines due to paradoxical reaction potential
Special regulation in elderly?
Loradatine and cromolyn
Avoid first generation antihistamines due to anticholinergic side effects (potential for excitation, confusion, hypotension –> falls)
