Allergic Rhinitis Intro

Question 1

describe the physiology of nasal mucosa

Answer 1

the nasal mucosa is rich in vascular tissue and controlled by the autonomic nervous system (both the sympathetic and parasympathetic)
line with mast cells that both contain and release histamine

Question 2

sympathetic action on the nasal mucosa

Answer 2

sympathetics constricts arterioles, Reducing the mucosa thickness and widens the airway allowing for more air to enter

Question 3

parasympathetic action on the nasal mucosa

Answer 3

increases mucosal thickness and increases stuffiness, runny nose is also experienced

Question 4

what is the first line of immune defense in the nose?

Answer 4

the nasal muscle will cleans and conditions the inhaled air

Question 5

how long does the antigen-antibody response take to initiate

Answer 5

seconds to minutes

Question 6

how is the. antigen antibody response initiated

Answer 6

allergen interacts with IgE molecules bound to mast cells causing an immediate reaction and release of mediators

Question 7

during the antigen antibody response mediators like histamine are released resulting in what?

Answer 7

vasodilation, increased vascular permeability and production of nasal secretions

Question 8

how is itching produced in the antigen-antibody response of allergic rhinitis?

Answer 8

senstory nerve stimulation

Question 9

how is sneezing produced in the antigen-antibody response of allergic rhinitis?

Answer 9

vagal stimulation pathways

Question 10

describe the effect of the mediator histamine

Answer 10

stimulate irritant receptors, pruitis, vasular permeability, muscosal permeability and smooth muscle contraction

Question 11

which mediator produces smooth muscle contraction, vascular permeability, mucus secretion, chemotaxis and neutrophil chemotaxis?

Answer 11

Leukotrienes

Question 12

describe the effect of eosinophil chemotactic factor

Answer 12

influx of inflammatory cells

Question 13

late phase reaction

• time after initial exposure
• is caused by?
• acute or chronic symptoms
• describe the effect on mucosa

Answer 13

4 to 8 hours after initial exposure
caused by cytokines primarily released by mast cells
persistent chronic symptoms
inflamed mucosa become hyper responsive

Question 14

what are the results of a inflamed hyper responsive mucosa?

Answer 14

the mucosa reacts to nonspecific triggers

and has reactions to lower amount of the same antigen

Question 15

why does clinical controversy exist in the treatment of allergic rhinitis?

Answer 15

avoidance steps are logical, but there is little existing evidence that environmental control measures provide clinical benefit, controls trails need to be performed

Question 16

describe environmental controls to prevent allergic rhinitis

Answer 16

theses are steps that patients may take to promote prevention of allergic rhinitis, such as not smoking around patients, keeping the pet out of the patients bedroom, and encasing mattresses and pillows, however there is little research that shows the absolute benefit of these measure

Question 17

Joint Task Force (AAAAI) recommended guideline (basic three steps)?

Answer 17

1. intranasal corticosteroid mono-therapy rather than oral antihistamine in 12+ y.o. patients (strong recommendation)
2. if person is over age 15 use a intranasal corticosteroid over leukotriene
3. consider combination with an intranasal antihistamine for treatment of moderate to severe seasonal allergic rhinitis in those 12+ y.o. (weak recommendation)

Question 18

Joint Task Force (AAAAI) recommended initial therapy?

Answer 18

clinical judgement and patient values should be used in selecting until therapy

Question 19

level of evidence grade – environmental factors

Answer 19

B

Question 20

level of evidence grade – Nasal steroids

Answer 20

A

Question 21

level of evidence grade –Oral antihistamines

Answer 21

A

Question 22

level of evidence grade –Intranasal antihistamines

Answer 22

A

Question 23

level of evidence grade – Oral leukotriene receptor antagonist

Answer 23

D

Question 24

level of evidence grade –Combination therapy

Answer 24

Variable

Question 25

level of evidence grade – Immunotherapy

Answer 25

A

Question 26

Symptoms controlled – antihistamines systemic

Answer 26

sneezing, rhinorrhea, itching, conjunctivitis

Question 27

Symptoms controlled – antihistamines ophthalmic

Answer 27

conjunctivitis

Question 28

Symptoms controlled – antihistamines intranasal

Answer 28

sneezing, rhinorrhea, nasal pruritus

Question 29

Symptoms controlled – decongestants systemic

Answer 29

nasal congestion

Question 30

Symptoms controlled – decongestants topical

Answer 30

nasal congestion

Question 31

Symptoms controlled – intranasal corticosteroids

Answer 31

sneezing, rhinorrhea, itching, nasal congestion

Question 32

Symptoms controlled – mast cell stabilizers

Answer 32

prevents symptoms

Question 33

Symptoms controlled – intranasal anticholinergics

Answer 33

rhinorrhea

Question 34

Symptoms controlled – leukotriene receptor antagonist

Answer 34

when combined with antihistamines more effective than antihistamines alone