ENT- Allergic Rhinitis, Chronic Nonallergic Rhinitis/Vasomotor Rhinitis Flashcards
Allergic Rhinitis- Epidemiology
–Affects 10-30% of children and adults in U.S.
–Prevalence is increasing – environmental changes
Allergic Rhinitis- Risk factors
- Family history atopy (atopic triad)
- Male sex
- Birth during pollen season
- First born
- Early use of antibiotics
- Maternal smoking in first year of life
- Indoor allergen exposure
- Serum IgE > 100 IU/mL before age 6
- Presence of allergen-specific IgE
Etiology of Allergic Rhinitis
–Exposure to an airborne allergen in a predisposed person
–Activation of B-cell (humoral) and T-cell (cytotoxic) immune system responses
–Allergen-specific IgE responses cause release of inflammatory mediators
Allergic Rhinitis- Pathophysiology
–Abnormal immune response to an environmental protein
How do you classify allergic rhinitis
Intermittent vs. persistent and severity
Also whether it is seasonal or perennial (year round)
Intermittent Allergic Rhinitis vs. persistent
intermittent: <4 days/week or less than 4 weeks
Persistent: >4 days/week and more than 4 weeks
What criteria should be met to classify allergic rhinitis as moderate to severe?
Pt must have 1 or more of the following:
- Sleep disturbance
- impaired school/work performance
- Impaired daily activities, leisure, and/or sport activities
- Troublesome symptoms
**If patient has none of these symptoms then the allergic rhinitis would be classified as mild
Allergic Rhinitis- Concomitant disorders
- Allergic conjunctivitis
- Sinusitis
- Asthma
- Atopic dermatitis
- Eustachian tube dysfunction- Serous & acute OM
What are clinical manifestations of allergic rhinitis?
- Sneezing
- Rhinorrhea
- Nasal obstruction/congestion
- Nasal itching (also palate & inner ear)
- Postnasal drip (can cause sore throat and trigger cough)
- Cough
- Irritability
- Fatigue
- Eye itching, tearing, burning
What are physical clinical manifestations of allergic rhinitis?
- Infraorbital edema/darkening “allergic shiners”
- Transverse nasal crease “allergic salute”
- Nasal mucosa pale bluish color or pallor & turbinate edema
- Clear rhinorrhea (nose or posterior pharynx)
- Hyperplastic lymphoid tissue in posterior pharynx “cobblestoning”
- TM retraction or serous fluid behind TM
How is Allergic Rhinitis diagnosed?
*Based on clinical diagnosis- dont need any further diagnostic studies
- labs are usually normal
- Allergy skin testing
Serum IgE
Allergic Rhinitis- Information regarding allergy skin testing
–Prick skin test – most commonly used
–Intradermal skin test – higher sensitivity
–Remember to discontinue medications
Medication options for allergic rhinitis
- Glucocorticoid nasal spray
- Oral antihistimines
- +/- decongestant if needed
- Antihistimine nasal sprays
- Combo glucocorticoid and antihistimine nasal spray
- Mast cell stabilizer
- Leukotriene receptor antagonist
- Ipratropium bromide nasal (Atrovent)
- Nasal decongestant sprays (Afrin)
What are 1st, 2nd and 3rd generation oral antihistimine options used to treat allergic rhinitis?
•1st generation:
–Diphenhydramine (Benadryl)
–Chlorpheniramine (Chlor-Trimeton)
–Hydroxyzine (Vistaril)
•2nd/3rd generation
–Loratidine (Claritin)
–Cetirizine (Zyrtec)
–Fexofenadine (Allegra)
–Desloratadine (Clarinex)
–Levocetirizine (Xyzal)
*2nd/3rd generation often preferred over 1st line due to less side effects
What antihistimine nasal spray options are recommended to help treat allergic rhinitis?
- Azelastine (Astepro)
- Olopatadine (Patanase)
**antihistamine nasal sprays are typically recommended if the patient primarily has nasal symptoms
