Allergic Rhinitis Flashcards
When does allergic rhinitis develop?
usually after 2nd year of life; it is prevalent in children and adults
types of allergic rhinitis
- seasonal (hay fever)
- perennial
- intermittent (sxs 4 days a week or less OR lasts 4 weeks or less)
- persistent (sxs more than 4 days a week or more OR lasts greater than 4 weeks)
- mild (sxs do not interfere with daily activities)
- moderate-severe (impairment of sleep, daily activities, or bad symptoms)
risk factors of allergic rhinitis
family hx of allergic disorders (atopy), filaggrin gene mutation, elevated serum IgE under 6 years of age, higher socioeconomic class, eczema, positive reaction to allergy skin tests, children eating three or more fast food meals per week
allergic rhinitis mediated response
IgE; involves release of mast cell mediators
4 phases
sensitization, early phase, cellular recruitment, late phase
AR symptoms and findings
bilateral symptoms, worse when awakening and at night, frequent or paroxysmal sneezing, anterior watery rhinorrhea, pruritis of eyes/nose, conjunctivitis, allergic shiners, wrinkles below lower eyelids, allergic crease, allergic salute, allergic gape
AR causes and triggers
pollen, mold. pollutants, dust mites, cockroaches, smoke, pet dander, wool dust, latex, resins, biologic enzymes, organic dusts, chemicals
non-AR symptoms and findings
unilateral symptoms, constant day and night, little or no sneezing, posterior watery or thick rhinorrhea, nasal obstruction, anosmia, epistaxis, nasal polyps, enlarged tonsils, nasal septal deviation
non-AR causes and triggers
puberty, pregnancy, thyroid, septal deviation, cocaine, BB, ACEI, chlorpromazine, clonidine, NSAIDS, aspirin, overuse of topical decongestants, systemic inflammatory, lesions/polyps, facial or head trauma
symptoms of AR
itching nose, palate, sneezing, watery rhinorrhea, postnasal drip, nasal congestion
complications of AR
- acute: sinusitis, otitis media with effusion
- chronic: nasal polyps, seep apnea, sinusitis, hyposmia
treatment approach
- allergen avoidance
- pharmacotherapy
- immunotherapy
goals of treatment
- reduce symptoms
- improve functional status and sense of well-being
- individualize to provide optimal symptomatic relief/control
exclusions to self-care
- undiagnosed
- children under 12 and pregnant/lactating women
- signs and symptoms of non-AR
- signs and symptoms of infection
- signs and symptoms of undiagnosed or uncontrolled asthma or other lower respiratory disorders
- unacceptable/severe treatment SE
non-pharmacologic management
- allergen avoidance
- lower household humidity
- limit exposure to pets
- vacuum frequently (avoid carpeting and upholstered furniture)
- HEPA filters
- saline nasal spray
- Neti pot
for initial treatment of seasonal AR in persons aged 12 years or older
routinely prescribe monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine
for initial treatment of seasonal AR in persons aged 15 years or older
recommend an intranasal corticosteroid over a leukotriene receptor antagonist
for treatment of moderate to severe seasonal AR in persons aged 12 or older
the clinician may recommend the combo of an intranasal corticosteroid and an intranasal antihistamine for initial treatment
triamcinolone
Nasacort allergy 24 hr and children’s Nasacort allergy
2 years and older
examples of intranasal glucocorticoids
- triamcinolone
- fluticasone propionate
- budesonide
- fluticasone furoate
fluticasone propionate
Flonase allergy relief and children’s Flonase allergy relief
4 years and older
fluticasone furoate
Flonase sensimist allergy relief
2 years and older
