module 3 peds allergic rhinitis, allergy immunotherapy Flashcards
2 phases of allergic rhinitis
immediate: 15-30 minutes after exposure
- mast cell mediator release
late phase: 6-12 hours after exposure
- due toe inflammatory cells
allergic rhinitis s/s
rhinorrhea
nasal, palate, and eye pruritus
congestion
sneezing
poor sleep
generalized malaise
family hx for allergic rhinitis
atopic dermatitis
allergic rhinitis
asthma
intermittent AR
persists for < 4 weeks
persistent AR
> 4 weeks
mild AR
does not impair
- daily activities
- sleep
- school or work activities
- child not trouble by the symptoms
If one or more of these symptoms
- moderate to severe AR
AR < 2 years old
rare
AR clinical findings
- reduced patency from bilateral nasal obstruction
- mouth breathing, snoring
- pale to purple, edematous nasal mucous membranes
- clear, thin, watery rhinorrhea
- nasal crease
- itching, rubbing of nose
associated manifestations of AR
- high arched palate
- enlarged tonsillar and adenoidal tissue
- repeated sniffing, snorting, coughing
- clearing of throat
- red conjunctiva, tearing, lid and periorbital edema
- cobblestone appearance of pharynx or palpebral conjunctivae
- chronic mouth breathing -> facial changes, dental malocclusions, snoring
- sleep disturbances
risk factors for ped AR
+ family hx
first born
male
early use of systemic antibiotics
maternal smoking
exposure to allergens
referrals for serologic testing
reserved for children with significant s/s that do not respond to traditional management
Rx therapy for AR
Intranasal corticosteroids
oral antihistamines
topical nasal antihistamines
decongestants
nasal cromolyn
leukotriene modifiers
Oral antihistamines
H1/H2: cause early and late phase of allergic response
H3/H4: cause pruritus and proinflammatory response
- 2nd gen: effective in relieving s/s of AR
Topical nasal antihistamines
Azelastine: >6mo old
Olopatadine: > 6 years old
decongestants
help relieve nasal congestion
- no evidence supporting use of oral phenylephrine
- Contraindicated: < 4 years old
Topical decongestants
can cause rebound rhinorrhea if used for more than 3-5 days
Intranasal corticosteroids
reduce local cytokine and mediator release factors produced by mast cells, basophils, eosinophils, monocytes, and macrophages
-> dec. inflammation and nasal obstruction
> relieve nasal congestion, rhinorrhea, itching, sneezing
leukotriene modifiers
montelukast only approved LTRA for use in AR
- > 6mo
Allergy immunotherapy includes
subcutaneous immunotherapy
oral immunotherapy
epicutaneous immunotherapy
sublingual immunotherapy
oral immunotherapy
- highest rate of allergic side effects
- best results in terms of sustained lack of reaction to food allergens
allergy immunotherapy is a tx for
food allergy
severe allergic asthma
goal of allergy immunotherapy
induce immune tolerance and cause a change in the immune response to specific antigens
- longer lasting benefits without need for daily meds
epicutaneous immunotherapy
small allergen patch on the back or upper arm
- daily changes
adverse reactions to allergy immunotherapy
local
- tingling following sublingual
Systemic
- life-threatening, anaphylaxis
Allergic rhinitis complications
eustachian tube dysfunction
serous otitis media
malocclusion
high-arched palate
