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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
Describe reexposure in Allergic Rhinitis?
Preformed IgE on mast cells binds an antigen and cross-links, leading to immediate histamine and tryptase release
26
What symptoms do the preformed mediators cause?
Since the preformed mediators are released early in Allergic Rhinitis, they cause sneezing and itching
27
What type of mediator are Leukotrienes in Allergic Rhinitis and what symptom do they cause?
Leukotrienes are quickly made (not preformed) mediators in Allergic Rhinitis that mediate increased mucous production
28
What type of mediator are Prostaglandins in Allergic Rhinitis and what symptom do they cause?
Prostaglandins are quickly made (not preformed) mediators in Allergic Rhinitis that mediate vasodilation
29
What type of mediator is PAF in Allergic Rhinitis and what does it cause?
PAF is a quickly made (not preformed) mediator in Allergic Rhinitis that mediates Eosinophil chemotaxis
30
What are the late phase mediators in Allergic Rhinitis?
Cytokines and Chemokines
31
What do Cytokines and Chemokines cause in Allergic Rhinitis?
Cytokines and Chemokines are late phase mediators and therefore cause nasal congestion and rhinorrhea, as well as exhaustion
32
What causes sneezing and itching in Allergic Rhinitis?
Neural stimulation causes sneezing/itching
33
What causes congestion in Allergic Rhinitis?
Vasodilation causes congestion
34
What should taking a history for Allergic Rhinits focus on?
Pattern/location where symptoms occur, chronicity (seasonal or year round) and occupational considerations
35
What symptoms are associated with Allergic Rhinitis?
Congestion, rhinorrhea, post-nasal drip
36
What might be found in physical exam for Allergic Rhinitis?
Nasal crease (constantly rubbing nose), edematous nasal mucosa
37
What does a pale nasal mucosa indicate?
Allergic Rhinitis
38
What does an erythematous nasal mucosa indicate?
Infectious etiology
39
What does a beefy, red, swollen nasal mucosa indicate?
Rhinitis medicamentosa
40
What causes Rhinitis Medicamentosa and how does it show up on physical exam?
Overuse of nasal decongestants leads to rhinitis medicamentosa, which shows up as a beefy, red swollen nose
41
What does the color of secretions indicate in Allergic Rhinitis?
``` Clear = viral or allergic rhinitis Colorful = infectious ```
42
What are nasal polyps?
Pearl-like outgrowths in the nasal cavity
43
What are the main causes of Rhinitis?
Allergic, non-allergic, mixed, pregnancy and connective tissue related
44
What is the most common type of Rhinitis?
Mixed (allergic + non-allergic) Rhinitis is the most common type of Rhinitis
45
What can cause non-allergic Rhinitis?
Rhinitis medicamentosa and vasomotor rhinitis
46
What symptom is unique to Allergic Rhinitis?
Nasal itch is unique to Allergic Rhinitis
47
What are risk factors for Allergic Rhinitis?
Family History of Atopy, high IgE levels, high SES
48
How does Non-Allergic Rhinitis differentiate itself rom Allergic Rhinitis?
Non-allergic Rhinitis is older onset, does not involve itching, and occurs year round
49
What can trigger non-allergic rhinitis?
Strong smells, smoke, alcohol, food triggers
50
What are common allergens in Chicago?
Tree, Grass, Ragweed
51
How has climate change impacted Allergic Rhinitis?
Increasing temperature and CO2 have increased production of Collagen
52
What are common indoor allergens?
Dust, cats/dogs, cockroaches
53
Why is IgE testing less efficacious that skin testing in Allergic Rhinitis?
Skin testing has a lower sensitivity
54
How can pet dander be avoided?
Don't have a pet cat/dog
55
How can dust mites be avoided?
Wash sheets in hot water
56
Why are injectable steroids not used in Allergic Rhinitis?
Discouraged due to potential for long-term side effects
57
What is the first line for Allergic Rhinitis and how does it work?
Intranasal steroids are the first line for Allergic Rhinitis, because they block both early and late phase mediators of inflammation
58
Are early or late phase inflammatory agents affected by Intranasal steroids?
Both are controlled by Intranasal steroids
59
What are side effects of intranasal steroids?
Increase ocular pressure and cataract formation
60
How do first generation oral antihistamines treat Allergic Rhinitis?
First generation oral antihistamines cross the BBB and bind H1R
61
What do first generation oral antihistamines target?
Central H1 receptors
62
What are the drawbacks of first general oral antihistamines?
First generation oral antihistamines lack specificity and may bind to other receptors (cholinergic, alpha, etc.) and cause side effects
63
What are benefits of intranasal antihistamines?
Azelastine causes higher tissue levels in the nose that relieve congestion
64
How do Leukotriene Receptor Antagonists compare in treating Allergic Rhinitis?
They are less effective than oral antihistamines
65
What is Cromolyn used for?
Cromolyn is used for prevention of Ashma
66
What is the point of immunotherapy in Allergic Rhinitis?
May prevent development of Asthma
67
What is Samter's triad and how does it relate to Nasal Polyps?
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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