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Pulmonology > SM 184 Allergic Rhinitis > Flashcards

SM 184 Allergic Rhinitis Flashcards

1
Q

What is Rhinitis?

A

Inflammation of the mucous membranes of the nose +/- the eyes, throat, sinuses

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2
Q

What causes the development of antibodies in Allergic Rhinitis?

A

A genetically susceptible individual is exposed to an antigen, which gets taken up by an APC that interacts with Th2 and B cells to form IgE antibodies

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3
Q

What cause the release of allergic mediators in Allergic Rhinitis?

A

Re-exposure to an antigen after sensitization results in cross linking of IgE antibodies on the surface of mast cells, releasing preformed (histamine, tryptase) and rapidly made (PAF, Leukotrienes, prostaglandins) mediators

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4
Q

What preformed mediators are relevant in Allergic Rhinitis?

A

Preformed mediators released by Mast Cells include Histamine and Tryptase

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5
Q

What rapidly made mediators are relevant in Allergic Rhinitis?

A

PAF, Leukotrienes, and Prostaglandins

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6
Q

What are the late phase mediators in Allergic Rhinitis?

A

Cytokines and Chemokines

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7
Q

What are the two phases of the response in Allergic Rhinitis?

A

The two phases in Allergic Rhinitis are Early Phase (sneezing and itchy eyes) as well as a Late Phase (inflammation and congestion)

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8
Q

What is primarily used to diagnose Allergic Rhinitis?

A

Dx relies on History

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9
Q

What considerations should be used in the history of Allergic Rhinitis?

A

Symptoms, time of year, and location

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10
Q

What features are seen on physical exam in Allergic Rhinitis?

A

Bilateral nasal polyps, nasal septal perforation

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11
Q

What do bilateral nasal polyps suggest?

A

CF, Sinusitis

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12
Q

What do monoliteral nasal polyps suggest?

A

Cancer

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13
Q

What does nasal septal perforation suggest?

A

Trauma, cocaine use

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14
Q

How can Allergic Rhinitis be tested for?

A

Skin Testing > Blood IgE Testing

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15
Q

What is the best treatment for Allergic Rhinitis?

A

Avoidance measures, to decrease exposures

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16
Q

What medications treat Allergic Rhinitis?

A

Nasal steroids, nasal/oral antihistamines, leukotriene inhibitors and mast cell stabilizers

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17
Q

What is an example of a mast cell stabilizer?

A

Cromolyn

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18
Q

What is an example of a leukotriene inhibitor?

A

Montelukast

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19
Q

Can immunotherapy treat Allergic Rhinitis?

A

Yes, especially allergy shots, which significantly decrease symptoms in aeroallergens

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20
Q

How does Allergic Rhinitis affect other respiratory diseases?

A

Allergic Rhinitis can worsen sinusitis, asthma, and sleep apnea

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21
Q

How does a person with Rhinitis present?

A

Red eyes, sneezing/congestion/runny nose, itchy or sore throat with a post-nasal drip

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22
Q

What are some of the costs of Allergic Rhinitis?

A

Px miss work, lose productivity, and worsens quality of life

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23
Q

How do Tcells activate Bcells?

A

MHCII presentation + IL-4 + IL-13

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24
Q

Describe sensitization in Allergic Rhinitis?

A

Interaction between APC’s like Tcells and Bcells that results in the production of antigen-specific IgE

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25
Q

Describe reexposure in Allergic Rhinitis?

A

Preformed IgE on mast cells binds an antigen and cross-links, leading to immediate histamine and tryptase release

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26
Q

What symptoms do the preformed mediators cause?

A

Since the preformed mediators are released early in Allergic Rhinitis, they cause sneezing and itching

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27
Q

What type of mediator are Leukotrienes in Allergic Rhinitis and what symptom do they cause?

A

Leukotrienes are quickly made (not preformed) mediators in Allergic Rhinitis that mediate increased mucous production

28
Q

What type of mediator are Prostaglandins in Allergic Rhinitis and what symptom do they cause?

A

Prostaglandins are quickly made (not preformed) mediators in Allergic Rhinitis that mediate vasodilation

29
Q

What type of mediator is PAF in Allergic Rhinitis and what does it cause?

A

PAF is a quickly made (not preformed) mediator in Allergic Rhinitis that mediates Eosinophil chemotaxis

30
Q

What are the late phase mediators in Allergic Rhinitis?

A

Cytokines and Chemokines

31
Q

What do Cytokines and Chemokines cause in Allergic Rhinitis?

A

Cytokines and Chemokines are late phase mediators and therefore cause nasal congestion and rhinorrhea, as well as exhaustion

32
Q

What causes sneezing and itching in Allergic Rhinitis?

A

Neural stimulation causes sneezing/itching

33
Q

What causes congestion in Allergic Rhinitis?

A

Vasodilation causes congestion

34
Q

What should taking a history for Allergic Rhinits focus on?

A

Pattern/location where symptoms occur, chronicity (seasonal or year round) and occupational considerations

35
Q

What symptoms are associated with Allergic Rhinitis?

A

Congestion, rhinorrhea, post-nasal drip

36
Q

What might be found in physical exam for Allergic Rhinitis?

A

Nasal crease (constantly rubbing nose), edematous nasal mucosa

37
Q

What does a pale nasal mucosa indicate?

A

Allergic Rhinitis

38
Q

What does an erythematous nasal mucosa indicate?

A

Infectious etiology

39
Q

What does a beefy, red, swollen nasal mucosa indicate?

A

Rhinitis medicamentosa

40
Q

What causes Rhinitis Medicamentosa and how does it show up on physical exam?

A

Overuse of nasal decongestants leads to rhinitis medicamentosa, which shows up as a beefy, red swollen nose

41
Q

What does the color of secretions indicate in Allergic Rhinitis?

A 
Clear = viral or allergic rhinitis 
Colorful = infectious
42
Q

What are nasal polyps?

A

Pearl-like outgrowths in the nasal cavity

43
Q

What are the main causes of Rhinitis?

A

Allergic, non-allergic, mixed, pregnancy and connective tissue related

44
Q

What is the most common type of Rhinitis?

A

Mixed (allergic + non-allergic) Rhinitis is the most common type of Rhinitis

45
Q

What can cause non-allergic Rhinitis?

A

Rhinitis medicamentosa and vasomotor rhinitis

46
Q

What symptom is unique to Allergic Rhinitis?

A

Nasal itch is unique to Allergic Rhinitis

47
Q

What are risk factors for Allergic Rhinitis?

A

Family History of Atopy, high IgE levels, high SES

48
Q

How does Non-Allergic Rhinitis differentiate itself rom Allergic Rhinitis?

A

Non-allergic Rhinitis is older onset, does not involve itching, and occurs year round

49
Q

What can trigger non-allergic rhinitis?

A

Strong smells, smoke, alcohol, food triggers

50
Q

What are common allergens in Chicago?

A

Tree, Grass, Ragweed

51
Q

How has climate change impacted Allergic Rhinitis?

A

Increasing temperature and CO2 have increased production of Collagen

52
Q

What are common indoor allergens?

A

Dust, cats/dogs, cockroaches

53
Q

Why is IgE testing less efficacious that skin testing in Allergic Rhinitis?

A

Skin testing has a lower sensitivity

54
Q

How can pet dander be avoided?

A

Don’t have a pet cat/dog

55
Q

How can dust mites be avoided?

A

Wash sheets in hot water

56
Q

Why are injectable steroids not used in Allergic Rhinitis?

A

Discouraged due to potential for long-term side effects

57
Q

What is the first line for Allergic Rhinitis and how does it work?

A

Intranasal steroids are the first line for Allergic Rhinitis, because they block both early and late phase mediators of inflammation

58
Q

Are early or late phase inflammatory agents affected by Intranasal steroids?

A

Both are controlled by Intranasal steroids

59
Q

What are side effects of intranasal steroids?

A

Increase ocular pressure and cataract formation

60
Q

How do first generation oral antihistamines treat Allergic Rhinitis?

A

First generation oral antihistamines cross the BBB and bind H1R

61
Q

What do first generation oral antihistamines target?

A

Central H1 receptors

62
Q

What are the drawbacks of first general oral antihistamines?

A

First generation oral antihistamines lack specificity and may bind to other receptors (cholinergic, alpha, etc.) and cause side effects

63
Q

What are benefits of intranasal antihistamines?

A

Azelastine causes higher tissue levels in the nose that relieve congestion

64
Q

How do Leukotriene Receptor Antagonists compare in treating Allergic Rhinitis?

A

They are less effective than oral antihistamines

65
Q

What is Cromolyn used for?

A

Cromolyn is used for prevention of Ashma

66
Q

What is the point of immunotherapy in Allergic Rhinitis?

A

May prevent development of Asthma

67
Q

What is Samter’s triad and how does it relate to Nasal Polyps?

A

Samter’s triad is Asthma, Aspirin sensitivity, and nasal polyps; a patient presenting with Asthma may be sensitive or allergic to Asthma

Pulmonology (22 decks)

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