Management of rhinitis Flashcards
What is allergic rhinitis?
- It is the inflammation of the inning of the nasal cavity & the paranasal sinuses as they are continuous due to ingested or environmental factors
- IgE-mediated hypersensitivity response to allergen, can be associated with redness and itchiness of the yes
- The hallmark complaint is the nasal obstruction
- Usually, the patient will complain of a 2-month cold, as it can start with a virus that damages the nasal mucosa, causing the presentation of proteins which results in the release of IgE
- The paranasal cavities gives resonance when we talk
What are the complications of allergic rhinitis?
1) They might lead to asthma (in 30-40% of the cases)
2) Wheezing and chest allergy after a while of allergic rhinitis
3) Sinus infection/nasal polyps which can lead to headache
- 80% of asthmatic patients will have allergic rhinitis
What are the causes of rhinitis?
1) Allergy
- Seasonal
- Food-related
- Drug-induced
- Animals
- Dust mites
2) Infectious
- Acute
- Chronic
What are the classifications of allergic rhinitis?
1) Intermittent
- <4-days per week, or < 4-weeks
2) Persistent
- > 4-days, or > 4-weeks
3) Mild
- It doesn’t affect life
4) Moderate-Severe
- One of the following is affected (sleep, daily activities, work, troubled with the symptoms)
- Medication is given in this case
What is meant by seasonal rhinitis?
- AKA intermittent rhinitis (<4-days per week, <4-week)
- It is a type of rhinitis that is caused by exposure to seasonal allergens like pollen
- Common during spring
What is perennial rhinitis?
- AKA persistent rhinitis (>4-days or 4-weeks)
- It is due to the continuous exposure to the allergen (like house dust mite
- Appears mainly in the morning once they wake up
What is mild allergic rhinitis?
It is when the rhinitis symptoms do not cause sleep disturbance, impairment of daily activities, or work & do not cause problematic symptoms
Describe the pathophysiology of allergic rhinitis
- It has four phases
1) Sensitization
2) Subsequent reaction to allergen (early phase, sneezing, ocular symptoms, watery discharge, itching), mediated by histamine
3) Late phase reaction (nasal obstruction & hyperresponsiveness), mediated by PG and Leukotrienes
4) Systematic activation (loss of smell and taste, mediated by eosinophils and neutrophils
- Allergens go to nasal mucosa —> IgE takes allergens to mast cells —> Histamine and other inflammatory mediators released
Why you must not travel when you have allergic rhinitis?
Allergic rhinitis can block the eustachian tube (inner ear), when you fly you are unable to equalize the ear pressure, where you can damage the ear and bleeding might occur
What are the pathological changes that occur in the nasal mucosae and sinuses due to allergic rhinitis?
1) Local mucosal changes
- Edema
- Infiltration with eosinophils and plasma cells
- Watery discharge
- Vascular dilation
- Polyp (edematous swollen mucosae due to too much inflammation)
- Su
2) Involvement of the sinuses
- Thickening
- Polyp in the sinuses
- Fluid effusion
- People with Kartagener’s syndrome have polyps
- Polyps usually occur in the middle meatus
What are the symptoms of rhinitis in children?
1) Cough
2) Sneezing
3) Nasal pruritus
4) Nasal congestion
5) Sore throat
6) Bad breath (halitosis)
7) Change of voice due to congestion (hypernasality)
What are the symptoms of allergic rhinitis?
1) Allergic cobblestoning of the conjunctiva (edema + hyperplasia of the papillae)
2) Allergic shiners (dark circles beneath the eyes)
3) Allergic salute (upward swipe of the fingers along the nose “itching”)
4) Pale edematous of the inferior turbinate (including watery nasal secretions)
5) Adenoid typeface (opened mouth + gaping habitus)
What is occupational rhinitis?
- Rhinitis that occurs as a consequence of allergens inhaled in the workplace which is frequently associated with asthma
- Agents like:
- Flour
- Wood dust
- Washing powder
- Latex
- Paint
- Drugs (pharmaceutical workers)
What is food-induced rhinitis and what is the common food that induces it?
- A rare cause of allergic rhinitis, associated with urticaria, angioedema, GIT symptoms, as food provokes IgE
1) Milk, Egg, Cheese (in children)
2) Nuts, Fish, Shellfish, Citrus fruit (in adults)
What is the primary tool used to test for allergic rhinitis?
Skin test
- Anti-histamines should not be taken before 4-5 days
What are the laboratory tests for allergic rhinitis?
1) Nasal cytology
2) Eosinophil count in nasal secretion
3) Blood IgE levels (RAST “Radioallergosorbent test”)
4) Blood (ELISA, Cap test)
- The normal value of IgE is 150-300 IU in adults
What are the goals of chronic rhinitis therapy?
- Chronic rhinosinusitis cannot be cured in most patients but the symptoms can be managed
1) Control of mucosal inflammation and edema
2) Maintaining adequate sinus ventilation and drainage (prevent any collection of sinus edema)
3) Treatment of infection
4) Reducing the number of acute exacerbations
What are the different treatment approaches for rhinitis?
1) Avoid of allergen
2) Drugs
3) Immunotherapy
4) Surgery
Which type of rhinitis is due to continuous exposure to allergens like house dust mites?
- Persistent rhinitis
Which type of rhinitis is caused by seasonal allergens like pollen?
Seasonal rhinitis (common during spring, when flowers bloom)
This pharma part hw don’t ask about so let’s begin
What is the single most effective treatment of allergic rhinitis?
Nasal spray of glucocorticoids
What are the medications you should administer for rhinitis patients?
1) Antihistamines (H1-Receptor blockers “responsible for vascular permeability”, the first generation has a sedative effect while the second generation does not like alkylamines)
2) Steroids (Oral “short-time only”, topic “long time”)
3) Alpha-receptor agonist (decongestant “for a short time”)
What are some examples of second-generation anti-histamine drugs?
1) Cetirizine
2) Loratadine (most commonly used)
3) Desloratadine
Which H1-receptor antagonist (anti-histamine) can be used as a local anesthetic?
1) Dimenhydrinate
2) Promethazine
Which drug stabilizes the membrane of the mast cell by inhibiting the influx of Ca+?
Cromolyn
How to desensitize a patient from an allergen?
Inject the allergen in an increasing dose subcutaneously
When is surgery indicated?
1) Restoration of the sinus ventilation
2) Debulking of severe polyposis
3) when intensive medical treatment fails
4) Bony erosion of the disease beyond the sinus cavity
5) In patients with both asthma and chronic rhinitis
What are the drugs that can induce rhinitis?
1) NSAID
2) Beta-Blockers
3) ACEI
4) Oral contraceptives
What is meant by rhinitis medicamentosa?
- It is a condition that results from the overuse of medication with local nasal decongestant
- Rhinitis medicamentosa = Long usage of decongestant —> Rebound congestion due to smooth muscle relaxation —> Consistent nasal blockage without decongestant —> Replace with topical steroid in one side
When does hormonal-induced rhinitis occur?
1) Menstruation
2) Pregnancy
3) Untreated hypothyroidism
4) Sexual excitement (honeymoon rhinitis)
