Chaper 24 - Rhinitis

Question 1

Types of rhinitis

Answer 1

NAR, gustatory, hormone-induced, atrophic, CSF leak, drugs

AR, infectious, NAR w eosinophilia, polyps, systemic dz

Question 2

Describe Non-Allergic rhinitis with eosinophilia

Answer 2

Perennial

Levels of eosinophils like allergic rhinitis, but no IgE blood test positivity or skin pricking positivity

Question 3

Pathogenesis of rhinitis medicamentosa, treatment

Answer 3

Downregulation and desensitization of a-adrenergic receptors

Wean
Steroids
IT reduction

Question 4

Rhinitis of pregnancy

Answer 4

20-30%
Hormonal, mechanism undetermined
Resolves within 2 wk delivery

Question 5

Can rhinitis be associated with hypo or hyperthyroidism?

Answer 5

Hypothyroid can cause chronic rhinitis

Question 6

Atrophic Rhinitis

Answer 6

Dry/cong, crust, purulent discharge, halitosis, more common in warm areas

Secondary: from surgery, trauma, gloma. Older PT.

Question 7

Occupational rhinitis causes

Answer 7

Irritant: perfume, paint, dust, smoke

Corrosive: chlorine, sulfur dioxide, ammonia

Immumogenic: IgE Response. Animal dander, grains.
Have Pt keep diary of timing!

Question 8

Gustatory rhinitis

Answer 8

Spicy, hot foods
Elderly

PNS activation

Question 9

Drugs causing rhinitis

Answer 9

ACEi
BBlock
Amiloride
Hydralazine 
Psychotropic
PDE-5

Question 10

Cause of allergic shiners

Answer 10

Swell, congest small vessels beneath skin

Question 11

Appearance of allergic turbinates

Answer 11

Pale, boggy

Question 12

Intermittent vs Persistent allergic rhinitis

Mild vs Mod/Sev

Answer 12

Int: <4 d/wk, <4 wk
Persist: 4+

Mild: no interfere with school/work

Mod/Sev: at least one: sleep trouble, impair daily activities, leisure, sport, impair school/work, troublesome Sx

Question 13

Pathophysiology All Rhin

Answer 13

Allergens phagocytized
Pres to CD4 via MHC II
CD4 -> TH2 -> IL-4, 5, 13 (IgE, eosinophils)
Early: minutes. Mast cells/basophils -> histamine, PD2, Leuko C4/B4, MBP, Plt Act Fact. Pruritis, sneeze, cong/rhin

Late: peak 6 hours after. Nasal congestion. Eosin, Neutro, Mono, Baso

Question 14

Peak seasons for tree, grass, weed

Answer 14

Tree: Spring
Grass: Spring/Summer
Weeds: Summer/Fall

Question 15

Perennial allergens (examples)

Answer 15

animal dander, dust mites, cockroaches, molds

Question 16

Do steroids work for noninflammatory rhinitis?

Answer 16

Yes

Question 17

AEs of oral decongestants

Answer 17

Avoid in HTN patients!

Tachycardia, INC BP
Tremor, insomnia, dizziness, irritability

Question 18

Side effects of intranasal steroids

Answer 18

dry, bleed, irritation/stinging, rare septal perf

May increase IOP

Question 19

How allergy IT works

Answer 19

Initial IgE increase, then slow decrease
Then increase in allergy-specific IgG
Shift from TH2 –> TH1
Induction of T regulatory cells

Question 20

Which drugs treat rhinorrhea

Answer 20

nasal steroids, oral/nasal anti-hist, antileukotriene, nasal anticholinergic, chromone (mast stabilizer)

Question 21

Which drugs treat nasal itch

Answer 21

Nasal steroids, antihistamines

Possibly chromone, antileuko

Question 22

Which drugs treat sneezing?

Answer 22

Nasal steroids, antihistamines, antileukotrienes, maybe chromones

Question 23

Which drugs treat congestion?

Answer 23

Nasal steroids, INTRANASAL ANTIHIST only, decongestants

Maybe chromones, antileuko

Question 24

Which drugs treat ocular Sx of allergies?

Answer 24

Antihistamines

Possibly anti-leukotriene, nasal steroids