Chronic Rhinitis Flashcards
Allergic rhinitis
What is it?
Allergens?
IgE-mediated inflammation of nasal membranes
Sensitisation to allergens such as dust mites, grass/tree/weed pollens, animal dander or occupational exposures.
Non-allergic rhinitis
Causes
Vasomotor rhinitis
Drugs - ACEi, Beta-blockers, aspirin, alcohol, cocaine
Hormones - pregnancy pill, hypothyroidism
Physical irritants (e.g. temperature or humidity changes)
Presentation triad
Chronic nasal congestion
Rhinorrhoea
Sneezing
Allergic rhinitis:
1 other symptom if allergic
What is it associated with?
When does it start and get better?
Nasal itch
Associated allergic conjunctivitis
Eczema or asthma may be linked
Onset usually in childhood and improves with age
Seasonal
Non-allergic rhinitis:
Onset?
Onset age later
Usually happens all year round
Investigations
Skin prick testing to distinguish between allergic or non-allergic
Management for allergic rhinitis
Avoid triggers
Management - Medical
1st line - 3
Intranasal antihistamines (azelastine)
Intranasal corticosteroids (fluticasone, beclometasone, betamethasone)
Oral non-sedating antihistamines (cetirizine, loratadine, fexofenadine)
Management - Medical
Intranasal
Oral
Saline irrigation
Decongestants (ephedrine, xylometazoline)
Sodium cromoglicate
Ipratropium
Montelukast
Steroids
Complications
Sinusitis
Postnatal drip and chronic cough
Antihistamines:
MOA
Where are H1 receptors found? - 3
H1 receptor blockers
Smooth muscle (bronchoconstriction) Vascular smooth muscle and capillary endothelium (inflammation) CNS (wakefulness)
Antihistamines:
Sedating (first generation) - examples
Use?
Chlorphenamine
Promethazine
Cyclazine
N&V
Pruritis
Antihistamines:
Non-sedating (first generation) - examples
Use?
Cetirizine
Loratadine
Fexofenadine
Allergic symptoms - rhinitis, urticaria, pruritus
Antihistamines:
Side effects
Sedation
Headache
Anticholinergic effects - urinary retention, dry mouth, blurred vision, GI upset
