Allergic Rhinitis and Cough

Question 1

ANS sympathetic activation

Answer 1

constricts arterioles
reduces mucosal thickness
widens airway allowing more air to enter

Question 2

ANS parasympathetic activation

Answer 2

dilates arterioles
increases mucosal thickness
increases stuffiness and runny nose

Question 3

Immune Defense

Answer 3

first line

cleans and conditions inhaled air

lined with mast cells (release histamine)

Question 4

Antigen Antibody Response

Answer 4

allergen interacts with IgE + mast cells

release of mediators –> vasodilation, increased vascular permeability, production of nasal secretions

sensory nerve stimulation = itching

vagal stimulation = sneezing

Question 5

Mast Cell Mediators

Answer 5

histamine
eosinophil chemotactic factor
leukotienes

Question 6

Histamine

Answer 6

stimulates irritant receptors

pruritus

vascular permeability

mucosal permeability

smooth muscle contraction

Question 7

Eosinophil Chemotactic Factor

Answer 7

influx of inflammatory cells

Question 8

Leukotrienes

Answer 8

smooth muscle contraction

vascular permeability

mucus secretion

chemotaxis

neutrophil chemotaxis

Question 9

Late Phase Reaction

Answer 9

4-8 hrs after initial exposure

caused by cytokines

persistent chronic symptoms

hyper responsive, inflamed mucosa

Question 10

Seasonal Rhinitis Guidelines

Answer 10

1. monotherapy with an intranasal corticosteroid (ages 12+)
2. intranasal corticosteroid > leukotriene receptor antagonist (ages 15+)
3. intranasal corticosteroid + intranasal antihistamine for initial treatment of mod-sev cases (ages 12+)(weak)

Question 11

Nasal Steroids

Answer 11

Benefits include symptom control, improved quality of life, better sleep, cost-saving if used as monotherapy, targeted local effect.

Patient preference will play a large role.

Question 12

Oral Antihistamines

Answer 12

Second generation (nonsedating) agents should be used in patients with primary complaints of sneezing and itching.

Relief of eye symptoms, OTC status and the availability of lower cost generics may be advantages.

Question 13

Intranasal Antihistamines

Answer 13

Evidence is strong but studies were of short duration. May consider these agents as optional.

Question 14

Immunotherapy

Answer 14

Recommended in patients who have inadequate response to with pharmacologic therapy with or without environmental controls