Allergic rhinitits

Question 1

AR classification

Answer 1

Traditional
-seasonal from outdoor
-Perennial from indoor
Duration
-intermittent <4d/w
-Persistent >4d/w or Sx for >4w
Severity
-mild
-moderate/severe only when daily life or sleep if affected

Question 2

AR symptoms

Answer 2

-Dennie Morgan lines around eyes
-nasal crease
-allergic shiner from rubbing
-mouth breathing
-lots of clear discharge

Question 3

AR Red flags

Answer 3

Can’t identify allergen after 2w, unilateral Sx, fever, purulent discharge, nosebleed, <2yo with moderate or severe Sx, ineffective after 1-2w

Question 4

AR treatment progression

Answer 4

1. Avoidance (common in all levels)
2. Oral/spray antihistamine
3. spray corticosteroid
4. corticosteroid and nasal antihistamine

Question 5

Use of nasal corticosteroid

Answer 5

Can use saline to open up nose, aim away from septum to prevent thinning, may take 2-4w for effects

Question 6

AR pregnancy

Answer 6

Beclomethasone, budesonide, fluticasone are safe, Anti H1 are safe, Avoid all decongestants in 1st trimester

Question 7

AR Breastfeeding

Answer 7

Beclomethasone, budesonide, fluticasone are safe, Anti H1 are safe, avoid pseudoephedrine, use topical decongestants

Question 8

AR kids

Answer 8

No decongestants for <6yo
Use 2nd gen anti H1
>2yo use budesonide or mometasone