GP - Allergic rhinitis Flashcards

1
Q

Compare and contrast common cold and allergic rhinitis

A
  • Acute onset of symptoms within minutes following allergen exposure in allergic rhinitis, but symptoms develop gradually in a common cold
  • No fever in allergic rhinitis, but fever can be present in a common cold
  • Itchy eyes in allergic rhinitis, but rare in a common cold
  • Myalgia, arthralgia are uncommon in allergic rhinitis, but are common in common cold
  • Thin, watery, clear mucus in allergic rhinitis, but thick, green mucus in a common cold
  • Common cold usually takes 1 week to resolve, while allergic rhinitis usually goes away as soon as the patient is no longer exposed to the allergen
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2
Q

What immunoglobulin is responsible for allergic rhinitis?

A

IgE

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3
Q

What are the causes of allergic rhinitis?

A
  • Genetics
  • Environmental
    • House dust mites
    • Animal dander
    • Pollen
    • Occupational - e.g. working with latex gloves, flour, wood dust, lab animals
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4
Q

Give 3 complications of allergic rhinitis

A

Impaired school and work performance

Sleep disturbance

Asthma (often co-exist with allergic rhinitis)

Sinusitis and nasal polyps

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5
Q

What symptoms would a patient with allergic rhinitis present with?

A

Symptoms:

  • Nasal congestion, nasal discharge, sneezing, itchy palate, itchy nose, itchy red eyes with increased tear secretion, cough, post-nasal drip - usually develop within minutes following allergen exposure (pollens, dust mites, animal dander, occupational)
  • Mouth breathing
  • Personal or FHx of atopy - allergic rhinitis (hayfever), asthma, eczema
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6
Q

What signs would a a patient with allergic rhinitis present with?

A

Nasal intonation of voice

Allergic shiners - darkened eye shadows under lower eyelid due to chronic congestion

Horizontal nasal crease across the dorsum of nose (severe rhinitis)

Nasal mucosal swelling + greyish discoloration

Hypertrophic nasal turbinates

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7
Q

Give 3 differential diagnoses of allergic rhinitis

A

Infective rhinitis - cough, fever, lymphadenopathy, purulent nasal discharge

(If nasal discharge is clear, unlikely to be infective)

Autonomic/ irritant rhinitis - symptoms follow a known physical exposure (e.g. changes in temperature or humidity, or with exercise), or chemical irritant exposure (e.g. perfumes, tobacco smoke, odours)

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8
Q

What investigations can you request in GP for a patient with allergic rhinitis?

A

Skin prick test

OR

Measuring the level of serum IgE to allergens e.g. house dust mites, polle, animal dander

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9
Q

What advice would you give to a patient with allergic rhinitis as a GP?

A
  • Advice on allergen avoidance
    • For grass pollen allergy:
      • Avoid walking in open grassy areas, particularly during early morning and early evening
      • Keep windows shut in cars and buildings
    • For dust mite allergy:
      • Wash bedding and furry toys at least once a week at high temperatures
      • Fit blinds that can be wiped clean instead of curtains
      • Avoid use of carpets
    • For animal allergy:
      • Don’t allow animal in the house, if not possible, restrict their presence to bedrooms and kitchen
      • Wash the animal and any surfaces they are in contact with regularly
    • For occupational allergy:
      • Use latex-free gloves, wear protective clothing, or a dust mask
      • Ensure that their workplace is well-ventilated
  • Advice on the use of nasal irrigation with saline
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10
Q

What medications can you give to the patient with allergic rhinitis?

A

For mild-moderate symptom:

  • 1st line - intranasal antihistamine / oral antihistamine e.g. cetirizine (PRN)

For moderate-severe symptoms, or if initial drug treatment is ineffective:

  • Intranasal corticosteroids - to be used during periods of allergen exposure

Advise the person to be reviewed in 2-4 weeks if symptoms persist after initial treatment

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11
Q

When would you refer patients with allergic rhinitis to ENT?

A
  • Red flag features e.g. unilateral symptoms, blood-stained nasal discharge, recurrent nose bleed
  • There is a nasal obstruction and structural abnormality e.g. deviated nasal septum which makes intranasal drug use difficult
  • Persistent symptoms despite optimal management –> referral to allergic specialist
  • Diagnosis is uncertain
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