Allergic Rhino Flashcards
What is considered intermittent allergic rhintis
Affects pt < 4 days/week OR <4 weeks/yr
What is considered persistent allergic rhinitis
Affects pt >4 days/week AND >4 weeks/yr
Non-pharm allergy treatment
- allergen avoidance
- nasal saline irrigations
- adhesive nasal strips
Intranasal corticosteroids used for allergic rhinitis
- Beclothasone
- Budesonide
- Flunisolide
- Fluticasone
- Mometasone
- Triamcinolone
- Ciclesonide
Intranasal antihistamines used for allergic rhinitis
- Azelastine
- Olopatadine
Opthalmic antihistsamies used for allergic rhinitis
- Ketotifen
- Azelastine
- Olopatadine
- Alcaftdadine
- Emedastine
- Epinastine
Systemic antihistsamies used for allergic rhinitis
First gen:
- Chlorpheniramine
- Benadryl
Second gen:
- Cetirizine
- Levocetirizine
- Loratadine
- Desloratadine
- Fexofenadine
MOA of antihistamines (all) in allergic rhiitis
Competitively antag H1 receptors → prevent receptor activation
- intranasal more targeted and can be effective in pts who failed PO
- opthalmic for conjunctiviits
What allergic rhinitis s/s do opthalmic antihistamines treat?
- X
- X
- X
- X
- Ocular s/s
Intranasal antihistamine onset in allergic rhinitis
15-30min
What allergic rhinitis s/s do intranasal antihistamines treat?
- Congestion
- Rhinorrhea
- Sneezing
- Nasal itching
- X
Systemic antihistamine onset in allergic rhinitis
take 1-2 hr prior to anticpated eposure
opthalmic antihistsamines AE
HA
Blurred vision
Burning/stinging of eyes
Discomfort
Bitter taste
Pharyngitis
intranasal antihistsamines AE
Less systemic AE than PO
Bitter taste
Nasal burning
Epistaxis
HA
Somnolence
What allergic rhinitis s/s do systemic antihistamines treat?
- X
- Rhinorrhea
- Sneezing
- Nasal itching
- Ocular s/s
systemic antihistsamines AE
Change in appetitie
GI discomfort
First gen: cross BBB →
- anticholinergic: urinary, retention drying, constipating
- sedating
- slowed GI motility
- narrow-angle glaucoma
Second gen: less likely to cross CNS but some can still be sedating (cetirizine and levocetirizine)
MOA of intranasal corticosteroids in allergic rhiitis
Suppress mediator, cytokine release and neutrophil recruitment → reduce inflammation
Reduce antigen-induced hyperresponsiveness of nasal mucosa
Intranasal corticosteroid onset in allergic rhinitis
onset: hours - days
peak response: 2-3 weeks
ROUTINE USE
What allergic rhinitis s/s do intranasal corticossteroids treat?
- Congestion
- Rhinorrhea
- Sneezing
- Nasal itching
- Ocular s/s
Intranasal corticosteroid AE
- HA
- Dryness
- Burning, stinging → avoid in pts with septum ulcers or recent nasal surgery/trauma
- Blood tinged secretions
- Epistaxis
Growth suppression in children (mixed results, no effet with fluticasone, mometasone, triamcinolone)
Systemic decongestants used for allergic rhinitis
- pseudoephedrine
- phenylephrine
Topical decongestants used for allergic rhinitis
- phenylephrine
- tetrahydrozoline
- naphazoline
- oxymetazolie
MOA of decongestants in allergic rhinitis
Sympathomimetic agents: target adrenergic receptors in the nasal mucosa → vasoconstriction
Reduce swollen nasal mucosa and improve ventilation
Decongestants onset in allergic rhinitis
Topical: fast
System: slower
What allergic rhinitis s/s do decongestants treat
- Congestion
- X
- X
- X
- X
Topical decongestants AE
Prolonged use (>3-5 days) → rebound congestion
- Sneezing
- Burning, stinging
- Drying of nasal mucosa
Systemic decongestants AE
Increase BP (do NOT use with MAOIs)
CNS stimulation
- restlessness
- insomnia
Urinary retention
MOA of cromolyn
mast cell stabilizer
Cromolyn onset in allergic rhintis
Onset: slow, up to several weeks → routine dosing of 1 spr TID/QID (up to Q4H) SCHEDULED
What allergic rhinitis s/s does cromolyn treat
- Congestion
- Rhinorrhea
- Sneezing
- Nasal itching
- X
Cromolyn AE
- sneezing
- nasal irritation
Ipratropium MOA in allergic rhitiis
anticholinergic
Ipratropium onset in allergic rhintiis
<15 min
What allergic rhinitis s/s does ipratropiium treat
- X
- Rhinorrhea
- X
- X
- X
Ipratropium AE
HA
Nosebleeds
Nasal dryness
AVOID IN:
- narrow angle glaucoma
- myasthenia gravis
- BPH
Montelukast MOA
Inhibition of cysteinyl leukotriene receptor
Montelukast onset in allergic rhinitis
slow, may not see full effect until after a month of use
What allergc rhinnitis s/s does montelukast treat?
- Congestion (barely)
- Rhinorrhea (barely)
- Sneezing (barely)
- Nasal itching (barely)
- X
Montelukast AE
- HA
- Fatigue
- GI upset
- Nasal congestion
- Neuropsychiatric events
Omalizumab
xolair
mAb for allergic rhinitis treatment
last last line
allergy shots that induce tolerance
Clincal pearls and treatment notes for allergic rhinitis
- Intranasal corticosteroids better than PO antihistamines for nasal symptoms with little benefit to combining the two
- Montelukast isn’t great → last line unless pt also has asthma
- Intranasal antihistamines faster than intranasal steroids with similar efficiacy
- Short course of systemic corticosteroids is NOT better than intranasal corticoisteroids
What is considered mild allergic rhinits?
No interference with QOL
What is considered moderate to severe allergicrhinits
Interference with QoL
What is considered intermittent allergicrhinits
Affects pt < 4 days/week OR <4 weeks/yr