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Pulm by Minnie: AH Update > SM 184a - Allergic Rhinitis > Flashcards

SM 184a - Allergic Rhinitis Flashcards

1
Q

Which medications for allergic rhinitis cross the blood-brain barrier?

What is the effect?

A

1st generation pral antihistamines

-> sedation, increased risk of dementia

2nd generation oral antihistamines do not cross the BBB

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2
Q

Allergic rhinitis affects _____ to ______ of adults worldwide

A

Allergic rhinitis affects 10%** to **30% of adults worldwide

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3
Q

What is the first line of defense against allergic rhinitis?

A

Avoidance

(But nasal steroids are the best medications)

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4
Q

What is the definition of rhinitis?

A

Inflammation of the mucous membranes mostly in the nose but can be in the eyes, throat, sinuses and ears giving rise to symptoms of nasal congestion, rhinorrhea, sneezing and pruritus (itching)

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5
Q

What are the quickly made mediators of allergic rhinitis?

A
  • Leukotrienes
    • LTC4, LTD4
    • Inrease mucous production
  • Prostaglandins D2
    • Vasodilation
  • Platelet activating factor
    • Eosinophil chemotaxis and cell migration
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6
Q

What are the risk factors for allergic rhinitis?

A
  • Family history of atopy/allergies
  • IgE > 100 IU/mL begore age 6
  • Higher socioeconomic status
  • Aeroallergen sensitization (positive allergy skin prick test)
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7
Q

In allergic rhinitis, nasal mucosa and secretions are usually in color

A

In allergic rhinitis, nasal mucosa and secretions are usually clear in color

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8
Q

What is the DDx for nasal polyps/masses?

A
  • Bilateral
    • Samter’s Triad
      • Asthma, aspirin sensitivity, nasal polyps
    • Cystic fibrosis
    • Allergic fungal sinusitis
  • Unilateral
    • Nasopharyngeal cancer
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9
Q

In Chicago, what are the peak allergy seasons for…

Trees:

Grass:

Ragweed:

A

Trees: March-April

Grass: May-July

Ragweed: Mid August-September

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10
Q

What are the early phase symptoms of allergic rhinitis?

A

Sneezing

Itching

Rhinorrhea and congestion

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11
Q

_____ of children worldwide have allergic rhinitis

A

40% of children worldwide have allergic rhinitis

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12
Q

What are the major categories of treatment of allergic rhinitis?

A

Avoidance

Medications

Immunotherapy

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13
Q

Describe the process of allergic sensitization

A
  • Antigen presenting cells bind to a foreign antigen
  • The APC presents the antigen to T cells
  • Activated T cells induce B cells to differentiate into plasma cells that release IgE specific for the antigen
  • Reexposure
    • ​Pre-formed IgE on mast cells come in contact wtih the antigen again
    • Inflammatory cascade occurs
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14
Q

Describe the inflammatory cascade that occurs upon re-exposure to an allergen

A
  • ​Pre-formed IgE on mast cells come in contact wtih the antigen again
  • Inflammatory cascade occurs
    • Immediate
      • Pre-formed and quickly made mediators are released
    • 4-8 hours
      • Late phase mediators are released
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15
Q

What are the pre-formed mediators?

When are they released?

A
  • Histamine
  • Tryptase
  • Chymase
  • Kinins
  • Heparin

They are released immediately upon IgE crosslinking on mast cells

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16
Q

What is the preferred test to determine what somebody is allergic to?

A

Skin testing

More sensitive and specific than IgE testing

17
Q

What medication causes beefy, red-hot turbinates bilaterally?

A

Overuse of topical nasal decongestants

(Should not be used for more than 3 consecutive days)

18
Q

Describe immunotherapy for allergic rhinitis.

How is it delivered?

How long does it take?

A

Immunotherapy can be used to treat allergic rhinitis to specific, clinically relevant aeroallergens

  • Subcutaneous allergy shots
    • Building phase
    • Maintenence phase (3-5 years)
    • May prevent the development of sensitization to new aeroallergens
    • May decrease the risk of developing asthma
  • Sublingual tablets available for grass, ragwee, dust mites
19
Q

What is the best medication for the treatment of allergic rhinitis?

Why?

A

Intranasal steroids

(especially good for moderate to severe seasonal allergies)

  • Block both the early and late phase mediators of inflammation
    • Work best if used consistently
  • May also help ocular symptoms
20
Q

Leukotriene Receptor Antagonists are most helpful for which patients with allergic rhinitis?

A

Patients with…

  • Aspirin sensitivity
  • Exercise-induced asthma
21
Q

Why is skin testing preferred over IgE testing?

A
  • Skin testing is more sensitive and more specific
  • IgE testing cross-reacts with other epitopes and glycoproteins of aeroallergens
  • Too much IgE can alter results
22
Q

What conditions are worsened by allergic rhinitis?

A

Sinusitis

Asthma

Eustachian tube dysfunction

Obstructive sleep apnea

23
Q

Which nasal symptom is specific to allergic rhinitis?

A

Nasal itch

(not present in non-allergic rhinitis)

24
Q

What are some of the characteristics of non-allergic rhinitis?

A
  • Older age of onset
  • Usually less itching/sneezing
  • Year-round
  • Triggers
    • Strong smells, smoke, change in temperature and barometric pressure, alcohol, gustatory
25
Q

What are the late phase mediators of allergic rhinitis? What is their effect?

A
  • Cytokines
    • Inflammatory: IL-1, IL-6, TNF-alspha
    • Promote IgE: IL-4, IL-13
    • Promote eosinophils: IL-3, IL-5, GM-CSF
  • Chemokines
    • RANTES
    • Exotaxin

Cause more nasal congestionn and rhinorrhea

Lead to more fatigue and exhaustion

26
Q

What are some major causes of nasal septal perforation?

A
  • Previous surgery
  • Trauma
  • Cocaine use
  • Connective tissue disease

Pulm by Minnie: AH Update (34 decks)

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