Rhinitis Flashcards
What are the symptoms of allergic rhinitis (hayfever)?
nasal itch, sneeze, watery rhinorrhoea, nasal congestion, runny nose
what is the causative allergen of AR in April and May-July?
April - tree pollen
MAy-july - grass pollen
When would you refer a pt that has rhinitis?
- wheezing (difficulty breathing)
- when a severe secondary infection (purulent conjunctivitis) affects the eyes
- painful ear
- nasal obstruction that fails to clear
- unilateral discharge (could be due to foreign body)
What are ways to avoid allergen exposure/?
stay indoors, close windows when pollen counts are high, wear ‘wrap on’ sunglasses, hoovering the house and keeping pets away from certain areas of the house
What tx options are available for pts with AR?
- oral antihistamines
- nasal steriods
- oral and topical decongestants
- eye drops
What is the antihistamine of choice?
Loratadine because it causes less sedation
What is the most effective type of tx used for pts with AR?
intranasal corticosteriods
Name some intranasal corticosteriods. Can you use them in children?
beclometasone (beconase) 2 sprays BD, fluticasone (pirinase) 2 sprays OD, triamcinolone 2 sprays OD (NASACORT)
once symptoms are controlled use, the lowest effective dose
use only >18 years
What are the side effects asssociated with beclometasone/fluticasone AND triamcinolone?
- Nasal irritation, bitter taste, headache, nosebleeds
- headache, nosebleeds, dyspepsia, bronchitis flu-like symptoms and cough
In which pts should you avoid using nasal corticosteroids?
avoid in glaucoma
Can decongestants be used?
only for short term relief of nasal congestion as there is risk of rebound congestion and cannot be used for a long period of time
Are mast cell stabilisers useful?
only useful when pt can predict well in advance the onset of symptoms so they can use a week in advance
also sodium cromoglicate and lodoxamide are poorly absorbed and the amount reaching the circulation is very low
safe in pregnancy
Name ocular and nasal mast cell stabilisers, the side effects that occur with it and the age restrictions
ocular: lodoxamide (alomide allergy), >4 years, headache/nausea/dizziness sodium cromoglicate (opitcrom allergy, optrex, murine) >6 years local irritation, blurred vision
Nasal: sodium cromoglicate (Rynacrom 4% nasal spray) >5 years, nasal irritation
What are ocular sympathomimetics? What is the purpose of their use?
combination of sympathomimetic and antihistamine (antazoline/xylometazoline - otrivine antistin)
- reduces redness in the eye
What are the age restrictions/side effects and interactions of otrivine antistin and naphazoline?
Otrivine: >12 years, local irritation, avoid in glaucoma as it increases intraocular pressure , avoid pts taking MAOIs
naphazoline ( murine irritation and redness): >12 years, local irritation, avoid in pts taking MAOIs
