Minor Ailments : Hayfever Flashcards
What is allergic rhinitis?
An IgE mediated allergy inside the nose - otherwise known as hay fever!
What are the complications of hay fever?
- possible development of nasal polyps, sinusitis and asthma 👃
- impaired school and work performance 🏫
- disturbed sleep 😴
- reduced concentration 💻
What are the symptoms of hay fever/ allergic rhinitis?
- 👃 runny nose
- ❌ anosmia
- 🤧sneezing
- 🛑 nasal congestion
- 😭 itchy and watery eyes
- 😩 scratchiness at back of throat
What are some non - pharmacological ways we can use to manage hay fever??
- 📊 px should monitor pollen counts and go out when they are low - ie avoid early morning and early evening times
- 🪟 🚪 shut the windows and doors in the early evening and mornings , when the pollen counts is high
- avoid walking in very grassy and flowery areas - essp in morning and early evening
- 👓 can wear wrap around glasses if you need to go outside to prevent pollen from entering the eyes
- 👕 avoid doing the washing outside when they pollen count is high
- 🚿 shower and wash hair after exposure
What is the typical first line regimen for managing hay fever?
- intranasal corticosteroid AND an intranasal or oral antihistamine , alone or in combination
If a patient has more nasal symptoms of hay fever, ie anosmia, congestion, runny nose, which medication would you recommend?
- intranasal corticosteroid (if an adult) ie beclometasone
- however note that they take a few days for the effect to take place
For general symptoms of hay fever, which medication would you recommend
A 2nd generation antihistamine - ie loratadine, or fexofenadine, cetrizine
For ocular symptoms 👁️ of hay fever, ie itchy and watering eyes which medication would you recommend ?
Sodium cromoglicate - mast cell stabiliser
Use QDS
Explain briefly how hayfever is mediated - ie the pathophysiology?
IgE mediated response to an allergen such as pollen, dust, mites, pet hairs etc.
Basically, the allergen enters the body and is exposed to b - plasma cells which produce IgE antibodies specific to that antigen.
The IgE mediated antibodies will the bind to IgE receptors on basophil and mast cells which contain histamine
Upon re exposure of the allergen, it binds to the IgE antibodies, triggering the degranulation of the mast and basophils resulting in the release of histamine which mediates the allergic response
Describe some of the effects of histamine in the body in relation to allergic rhinitis
- rhinorrhea (runny nose)
- sneezing
- stridor
- angiodema (hence nasal congestion)
Rmb histamine has vasodilatory action!
Which drug can we use for nasal congestion in hay fever?
How does it work and what are its limitations?
Phenylephrine - ie Sudafed - it is a local vasoconstrictor
- It works by constricting the blood vessels in the nose to prevent the fluid from draining into the surrounding tissues lining the nasal passages
- hence it works as a nasal decongestant
📅 px must not use it past 7 days = rebound congestion where the stuffy nose, sneezing and runny nose comes back with continued sue of the decongestant - tell px hw important it is it to only use it for 5 - 7 days and come back if symptoms havnt subsided after that do not keep using
- also tell pc if they have remaining sprays and dont want to keep the botttle to bring it back for disposal in the pharmacy
Name some intranasal corticosteroids used to treat hayfever?
- beclometasone, Fluticasone , budesonide, mometasone,
- brand name - beconase
Px counselling for using intranasal corticosteroids for hay fever?
- 🕰️ take several days to take effect, and need to be used regularly to have a good effect
- general side effects include nasal irritation at first 😩 , altered smell and taste 👃 👅 epistaxis 🩸, headache 🤕 , throat irritation
⚠️ avoid sniffing the spray after applying it to nose - systemic side effect risk - ie fatigue, anxiety, fluid retention, Cushing, headac, hirsutism, hypertension, nausea, weight increase
Name 3 1st generation antihistamines?
- chlorphenamine
- diphenhydramine
- promethazine
Why are the 1st generation antihistamines not commonly used or advised anymore?
- 🧠 they can cross the BBB leading to CNS side effects ie drowsiness and sedation
- 🥵 they also had more antimuscarinic side effects such as constipation 💩 , urinary retention 😩 , dry mouth 👄 , blurred vision 🤓 , GI disturbances 🤢
Name some of the 2nd generation antihistamines?
Loratadine, fexofenadine, cetirizine, acrivastine, mizolastine
What is the benefit of using 2nd generation antihistamines
:) 😊 they are non sedating (nb they are less sedating) - they do however cross the BBB but to a slight extent - not rlly enough to have major cognitive effect
Which type of antihistamines and give some examples, would you prescribe or advise for an older patient and why?
The newer non sedating antihistamine
- ie loratadine, cetirizine, fexofenadine
- they are less sedating and have less implications on elderly Px condition and motility
Which antihistamines also have a use in nausea and vomiting?🤮
- ☕️ cinnarizine
- 🚲 cyclising
- 🤨 promethazine
Give an example of an intranasal antihistamine?
Azelastine - the others are oral
General side effects of the non sedating, 2nd generation antihistamines?
- 🤕 headache
- 👄 dry mouth 🏜️
- 🤢 fee t sick
- 😴 drowsiness this is less common but is still possible bc the do cross the BBB but to a slight extent
Which antihistamine will a px need a Rx for?
Intranasal ones -ie azelastine
👃 Counselling points for correct nasal spray administration technique?
- shake the container well and look down
- using the right hand for the left nostril, put the nozzle inside the nose, aiming for the outside wall.
- squeeze once or twice in different directions whilst breathing in gently
- DO NOT SNIFF 🤧
- change hands, and spray in the other nostril
