Allergic Rhinitis Treatment Flashcards
what is allergic rhinitis?
an inflammatory, IgE- mediated disease characterized by nasal congestion, rhinorrhea, sneezing, and/or itching
how common is allergic rhinitis?
most common chronic disease in children
–> allergic triad (atopic dermatitis, allergic rhinitis, asthma)
- but also adults
what are the most common precipitating allergens?
- seasonal
– grasses, trees, weeds, molds - perennial
– molds, house dust - episodic
– animal dander - mixed
what are some signs and symptoms of AR?
- bilateral presentation
- sneezing/ congestion
- rhinorrhea (runny nose)
- nasal creases ( allergic salute)
- allergic conjunctivitis
- fatique, depression, irritability
what percent of people with AR have allergic conjunctivitis?
50-70%
what is non-allergic rhinitis?
CAUSE: exposure to airborne irritants (pollution, chemicals)
PT. POP: adults
Symptoms: chronic rhinorrhea (sneezing is uncommon)
what are intermittent symptoms?
- <4 days/week or <4 weeks at a time
what are persistent symptoms?
- > 4 days/week or > 4 weeks at a time
what are mild symptoms?
- normal
- no troublesome symptoms
what are moderate to severe symptoms?
- abnormal sleep
- difficulties at work/ activities/ school/ sports
- troublesome symptoms
what are some goals of therapy?
- minimize symptoms
- minimize side effects from treatment
- maintain quality of life
what does saline nasal spray do?
- helps to clear passages of pollen
- can be used PRN
when do you refer patients?
- unilateral symptoms and purulent discharge
- dont respond to meds
what are the clinical pearls for antihistamines?
- 1st and 2nd gen
– no difference in efficacy
– risk of SEs vary
– best when taken prior to exposure
what are the clinical pearls for ICS?
- most effective at relieving nasal symptoms
- choice for mod to severe AR
- max benefit is 1-2 weeks
what are the clinical pearls for decongestants?
- pseudoephedrine vs. phenylephrine
– used in combo with other agents
– max relief of nasal congestion
what are the clinical pearls for montelukast?
- limited role in pts. with AR
- RX only- $$$
- less effective than corticosteroids
what are the clinical pearls for intranasal antihistamines/ ocular drops?
- intranasal antihistamines
- azestaline
- olopatadine - ocular drops
- olopatadine
- ketotifen
- azestaline
- ketorolac
what are some clinical pearls for non-allergic rhinitis?
- ipratropium bromide
- 0.03%
– non-AR
- 0.06%
– rhinorrhea with common cold - intranasal corticosteroids
when do you follow up with AR patient?
- symptomatic relief
– others
what meds would you give someone with mild intermittent classification? is there a preferred order?
- OAH +/- decongestant or INA
- no preferred order
what meds would you give someone with mod to severe intermittent classification? is there a preferred order?
- OAH +/- decongestant; or INA; or LTRA; or INCS
- no preferred order
what meds would you give someone with mild persistent classification? is there a preferred order?
- OAH +/- decongestant; or INA; or INCS
- no preferred order
what meds would you give someone with mod to severe persistent classification? is there a preferred order?
- INCS, OAH +/- decongestant or LTRA
- preferred order
- combo therapy if symptoms not controlled with single agent
if you had symptoms controlled but ADRs are problematic what would you give the patient?
switch to alternative agent to minimize ADRs
if you had any AR type with severe congestion what would you give the patient?
consider routine use of antihistamine decongestant combo
if you had any AR type with persistent rhinorrhea what would you give the patient?
consider adding iprotropium NS
if you had severe AR w/o good symptom control what would you give the patient?
consider skin testing and immunotherapy (shots)
if you had AR symptoms not well controlled and pt has mod to severe asthma or atopic dermatitis (rare) what would you give the patient?
consider tx with biologics
what are the disadvantages and advantages of oral antihistamines (only 2nd gen)?
- QD dosing (adv)
- only impacts histamine receptors (disadv)
what are the disadvantages and advantages of intranasal antihistamines?
- excellent for rhinorrhea (adv)
- expensive; risk of drowsiness (disadv)
what are the disadvantages and advantages of intranasal cromolyn?
- safe for pregnancy (adv)
- required TID-QID dosing (disadv)
what are the disadvantages and advantages of ICS?
- QD dosing and most complete symptomatic relief (adv)
- max benefit is 1-2 weeks (disadv)
what are the disadvantages and advantages of montelukast?
- QD dosing (adv)
- rx only; and more expensive than OTC meds (disadv)
what are the disadvantages and advantages of oral or intranasal decongestant?
- superior for relieving congestion (adv)
- use of nasal sprays should be limited to 3 days (disadv)
what are the disadvantages and advantages of immunotherapy?
- specific antigens (adv)
- expensive (disadv)
what are the disadvantages and advantages of biologics?
- very severe symptoms (adv)
- expensive (disadv)
