Hogan: Allergic Rhinitis Flashcards
Collection of symptoms from the nose and eyes occurring when the individual inhales an allergen to which he is sensitized. Symptoms may occur both early and late. A hallmark feature is itch or sneeze.
allergic rhinitis
(blank) is a chronic inflammatory disorder of the airways characterized by obstruction of airflow
may be completely or partially (blank) with or without specific therapy.
At any age. In more than half of asthmatics-develops before (blank) years old. But now adult epidemic is being appreciated.
Multiple triggers are possible even in same patient.
(blank) predominate in children, females in adult onset asthma
asthma;
reversed;
3;
males
What cells are involved in the early phase of asthma caused by a specific allergen? What cells are involved in the late phase? In the chronic phase?
mast cells - allergen binds to cross-linked IgE on mast cells –> histamine is released (minutes)
late phase - flux of eosinophils in response to mast cell cytokine signals (4-8 hours)
chronic phase - with repeated exposure, it becomes a cell mediated reaction with lymphocytes
What happens to the airways of patients with asthma?
smooth muscle hypertrophy
basement membrane thickening
decreased lumen
mucus plugging
What are the immediate symptoms of allergic rhinitis?
itch - in nose, mouth, eyes, ears, throat anosmia rhinorrhea sneezing tearing eyes
What are the later symptoms of allergic rhinitis - after the allergen is inhaled?
congestion coughing clogged/popping ears (eustachian tube dysfunction) anosmia sore throat fatigue/sleepiness headache mouth breathing
What are some physical exam findings in asthma patients?
shiners under eyes hang-dog lips (dry from mouth breathing) allergic crease on nose blue/pale nasal mucosa allergic conjunctivitis
What is the differential diagnosis for children with symptoms of allergic rhinitis?
sinusitis
adenoidal hypertrophy
anatomic nasal variations
CF (polyps are CF unless proven otherwise)
immotile cilia
tic cough
non allergic rhinitis (ex: skiing and nose starts running)
What are the complications of allergic rhinitis?
Sinusitis Vernal Conjunctivitis (photophobia) Recurrent otitis media Eustachian tube dysfunction Worsening eczema Worsening asthma Sleep apnea (adenoidal obstruction)
About (blank)% of children have AR by 3 years of age.
44 % of 13 year old children with AR (2 parents with AR)
- *Half had severe persistent symptoms
- *Vast majority had symptoms continuously >2 months/year
6
What is the mean number of allergens that pediatric patients with AR are sensitized to?
about 3 (polysensitized)
**most pts are likely to have symptoms year-round bc they encounter different antigens across the year
How does asthma change seasonally? In which season are there the lowest asthma symptoms? In which season is there an increased risk of uncontrolled asthma with AR? During which season is eczema associated with higher risk of uncontrolled asthma?
summer;
spring;
autumn
What is the unified airway hypothesis?
allergic rhinitis and asthma are linked and should be considered a continuum of the same disease
What happens to the prevalence of pollen allergy as children get older?
it increases
**0% pollen allergy if less than 1 yo
need exposure to the allergen
What happens to asthma during puberty?
sometimes it improves during puberty, & then returns in adulthood
(blank) first symptoms of both AR and asthma occur in 1st yr. of symptoms vs. (blank) had AR first then asthma
1/3;
2/3
What can be used to improve rhinitis and asthma symptoms in pts with both AR and asthma?
nasal steroids
Knowledge of (blank) are very relevant to ascertaining if rhinitis/asthma symptoms are potentially allergic.
local allergens
These are some common allergies in the inner city
cockroach
mice
This is a common allergy in the desert
swamp coolers –> indoor humidity –> mold
