Allergic Rhinitis Scott Exam 4 Flashcards
What is the most common chronic disease in children?
Allergic rhinitis
What are the most common symptoms of allergic rhinitis?
Nasal congestion, rhinorrhea, sneezing, itching, postnasal drip (which may cause cough), conjunctivitis, fatigue, irritability, nasal crease (children)
What disease states comprise the allergic triad?
Allergic rhinitis, asthma, atopic dermatitis (eczema)
What is the most common allergen in episodic AR?
Pet dander
What are the most common triggers of perennial AR?
Molds and house dust
What are the most common triggers of seasonal AR?
Grasses, trees, weeds, some molds
How do common cold symptoms differ from allergic rhinitis?
Cold – no itching, less often rhinorrhea, more HA
What symptoms would point you towards sinus infection instead of allergic rhinitis?
Colored nasal discharge, fever, chills, cough, length of time
How long should you wait until you evaluate treatment efficacy?
2-4 weeks of continuous use
What should always be considered to help treat allergic rhinitis?
Environmental controls (avoidance, AC, masks)
What is the two general treatments for nasal congestion in AR?
Intranasal corticosteroids and oral decongestants
What are the two general treatments for rhinorrhea, nasal itching, and intermittent sneezing?
Oral or intranasal antihistamines
What is the mainstay for mild chronic (minimal impact QOL) AR symptoms?
PO 2nd generation antihistamine
What are the two general treatments for moderate to severe chronic symptoms?
Intranasal corticosteroids and intranasal antihistamine
True or false: Adding an intranasal corticosteroid to an oral antihistamine may help control AR symptoms.
False – no additional benefit. Just switch!
After step 2 treatments fail for AR, what might be an option if a patient still has moderate to severe symptoms?
Skin testing and aggressive avoidance
If AR treatment is controlling symptoms but has significant side effects, should you try to decrease the dose or switch to a different agent?
Switch to a different agent – lower dose likely not efficaceous.
What are the treatment options for pregnant patients with AR?
Avoidance, intranasal saline, oral antihistamines, nasal cromolyn, intranasal corticosteroids, montelukast. AVOID oral decongestants.
What symptom is not well controlled by oral antihistamines?
Nasal congestion
What medication is most effective in episodic allergic rhinitis?
Intranasal antihistamines
How long before allergen exposure must an antihistamine be taken?
1-2 hours prior to exposure
What second generation antihistamine has some mild sedation?
Cetirizine (Zyrtec)
What patient population is especially affected by anticholinergic effects of antihistamines (dry mouth, urinary retention, constipation)?
Elderly patients
What second generation antihistamine is usually dosed lower than what might be needed?
Loratadine (Claritin)
What AR treatment has the fastest onset of action?
Intranasal antihistamines–helps with ocular symptoms too although some drowsiness, expensive, and BID
What is an important counseling point for intranasal decongestants?
Do not take for longer than 3 days (may use longer if just at night).
What are side effects for topical decongestants? Systemic decongestants?
Topical – burning, stinging, dryness, rebound congestion
Systemic – tachycardia, tremor, insomnia (SR dosage forms)
What patients should use decongestants with caution?
HTN, ischemic heart disease, DM, hyperthyroid
Minimal change HR/BP at doses
What is the maximum amount of sudafed that can be bought per day? Per 30 days?
Daily: 3.6g MAX
30 days: 7.2g MAX
No restrictions when dispensed by prescription
What nasal decongestant is worthless?
Phenylephrine
What are two available brands of intranasal decongestants?
Oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine)
What is one thing to watch out for when dealing with OTC decongestants?
Confusion with names and ingredients – same name different combinations
What is the most effective treatment for nasal symptoms when used consistently?
Corticosteroid nasal sprays (also ocular Sx)
How long must intranasal cortocosteroids be used to reach maximum benefit?
1-2 weeks
What are the two OTC corticosteroid nasal sprays?
Nasacort Allergy 24 (triamcinolone) once daily, not for children
What is the name for the combination intranasal corticosteroid and antihistamine?
Dymista (fluticasone + azelastine)
What are side effects of intranasal corticosteroids?
Nasal irritation/stinging, dryness, sneezing, sore throat, epistaxis, some systemic absorption
What steps should you tell a patient to follow when using an intranasal mist?
Blow nose, remove cap, shake container, prime, squirt mid-inhalation while blocking other nostril, point away from septum, clean nose piece.
What situations may cromolyn be better for?
Seasonal rhinitis, pregnancy.
Dosed 3-4 times daily, slow onset, not very effective severe
What are uses for ipratropium IN?
Decreases rhinorrhea and best for vasomotor (non-allergic) rhinitis. Used 4 times daily.
What patients may especially benefit from montelukast?
Patients with asthma, similar effect to antihistamines.
For children taking montelukast, what counseling points should you give?
The oral granules can be taken PO directly or mixed with a spoonfull of soft food (not liquids or large amnt). Ingest within 15 mins of mixing.
What allergies may make a patient eligible to receive sublingual immunotherapy?
Grass allergies
