Allergic Rhinitis

Question 1

State the type of rhinitis:

Disease caused by an IgE mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens. Symptoms include: Rhinorrhea, nasal congestion, nasal itching, and sneezing

Answer 1

Allergic rhinitis

Question 2

State the type of rhinitis:

Disease caused by an IgE mediated inflammatory response to seasonal aeroallergens. Length of exposure is dependent on geographic location and climatic conditions

Answer 2

Seasonal Allergic rhinitis

Question 3

State the type of rhinitis:

Disease caused by an IgE mediated inflammatory response to year-round environmental aeroallergens. Including dust mites, mould, animal allergens or occupational allergens

Answer 3

perennial allergic rhinitis

Question 4

State the type of rhinitis:

Disease caused by an IgE mediated inflammatory response and characterized by persistent symptoms >4days per week and >4 weeks per year

Answer 4

persistent allergic rhinitis

Question 5

State the type of rhinitis:

Disease caused by an IgE mediated inflammatory response that can occur if an individual is in contact with an exposure that is not normally a part of the individual’s environment (ex. cat at friend’s house)

Answer 5

episodic allergic rhinitis

Question 6

Symptoms of allergic rhinitis

Answer 6

sneezing, nasal congestion, nasal itching, rhinorrhea, eye redness can also be present

Question 7

What is allergic rhinitis caused by?

Answer 7

IgE - mediated reactions to inhaled allergens

Question 8

what two conditions is allergic rhinitis linked to?

Answer 8

asthma and conjunctivitis

Question 9

What three conditions coexist in individuals due to shared genetic conditions?

Answer 9

allergic rhinitis, asthma, atopic dermatitis

Question 10

How long are symptoms for intermittent allergic rhinitis?

Answer 10

< 4 days/week or <4 consecutive weeks

Question 11

How long are symptoms for persistent allergic rhinitis?

Answer 11

> 4 days/week or >4 consecutive weeks

Question 12

A patient is having some symptoms of allergic rhinitis but has normal sleep, no impairment of daily activities, sports, and leisure. Normal work days. Is this considered mild or moderate-severe rhinitis?

Answer 12

mild allergic rhinitis

Question 13

what classification of allergic rhinitis consists of abnormal sleep, impairment of daily activities, sport, leisure, and problems at work and school.

Answer 13

moderate-severe allergic rhinitis

Question 14

What is the term called when the body produced IgE antibodies due to genetic and/or environmental factors?

Answer 14

Atopy

Question 15

T or F: allergic rhinitis is considered a localized disorder

Answer 15

False: part of the respiratory tract now

Question 16

What cells take up the allergens in the nasal mucosa during allergic rhinitis?

a) mast cells
b) basal cells
c) dendritic cells
d) epithelial cells

Answer 16

c) dendritic cells

Question 17

List some risk factors associated with allergic rhinitis?

Answer 17

concomitant asthma 
family history of atopy 
ethnic origin other than white european 
antibiotic use 
maternal and paternal smoking 
early introduction of food or formula 
no older siblings 
allergen exposure 
pollutants 
higher socio economic class 
heavy alcohol consumption

Question 18

What types of medication cause symptoms of allergic rhinitis?

Answer 18

beta-blockers, 
ASA, NSAIDS, 
ACE inhibitors
hormone therapy 
cocaine

Question 19

What are some visible signs of allergic rhinitis in kids?

Answer 19

mouth breathing
rubbing at nose
sniffling or throat clearing
dark circles under eyes bc of nasal congestion

Question 20

T or F: allergic rhinitis is easily diagnosed in primary care

Answer 20

False: often undetected in primary care

Question 21

What test is used to identify specific allergic triggers of rhinitis

Answer 21

Skin prick testing

Question 22

Which specific drug does not appear to reduce skin test reactivity?

Answer 22

Montelukast

Question 23

List 3 general factors that can affect the quality of the allergen extract

Answer 23

Age, seasonal variations, drugs

Question 24

List 4 classes of therapeutic options

Answer 24

1. education
2. allergen avoidance
3. pharmacotherapy
4. allergen immunotherapy

Question 25

``` List the general steps a patient usually takes when having rhinitis or asthma symptoms 1. 2. 3. 4. 5. ```

Answer 25

1. self-care 2. pharmacist 3. general practitioner 4. specialist 5. Emergency Care

Question 26

Group the order of medications in order when a patient has allergies (leukotriene receptor antagonists, combination intranasal corticosteroid/ antihistamine spray, allergen avoidance oral antihistamines intranasal corticosteroids allergen immunotherapy

Answer 26

1. allergen avoidance 2. oral antihistamines 3. intranasal corticosteroids 4. combo intranasal corticosteroid and antihistamine spray 5. leukotriene reeptor antagonists 6. allergen immunotherapy

Question 27

Tips for allergen avoidance

Answer 27

keep window closed using screen filters using an air conditioner limit time outdoors

Question 28

oral antihistamines _________ action of histamine by acting as neutral receptor _________ of histamine H1 receptor

Answer 28

oral antihistamines BLOCK action of histamine by acting as neutral receptor ANTAGONIST of the histamine H1 receptor. They do not prevent release of histamine

Question 29

List 2 non-sedating 2nd antihistamines

Answer 29

1. fexofenadine | 2. bilastine

Question 30

Pros of oral antihistamines? | Cons of oral antihistamines?r

Answer 30

Pros: once-daily administration, rapid/effective action, low cost Cons: less effective than intranasal corticosteroids, some sedation experienced, limited penetration of the BBB

Question 31

Which receptor do oral and intranasal antihistamines target?

Answer 31

H1 receptor

Question 32

Pros and cons of intranasal antihistamines?

Answer 32

Pros: rapid onset of action, first or second line of action Cons: bitter taste, epistaxis, headache, somnolence, nasal burning Intranasal > oral antihistamine for nasal congestion

Question 33

How long does it take to reach the peak effect when taking intranasal corticosteroids?

Answer 33

several hours to days

Question 34

What symptoms do intranasal corticosteroids improve?

Answer 34

sneezing, itching, rhinorrhea, congestion

Question 35

Which intranasal corticosteroid can improve allergic eye symptoms?

Answer 35

fluticasone furoate

Question 36

What are some adverse effects of intranasal corticosteroids

Answer 36

nasal dryness, burning, stinging, blood-tinged secretions, and epistaxis

Question 37

What should a patient be monitoring for when taking intranasal corticosteroid?

Answer 37

intraocular pressure, glaucoma, cataracts

Question 38

What are some ADRs of the combo spray dymista?

Answer 38

bitter taste, epistaxis, somnolence, headache

Question 39

How long should you use an intranasal corticosteroid/intranasal oxymetazoline combination?

Answer 39

less than 3 days (short term) bc pt can develop rhinitis medicmentosa

Question 40

What cells produce leukotrienes?

Answer 40

mast cells, eosinophils, basophils, macrophages, and monocytes

Question 41

When should leukotriene receptor antagonists be used?

Answer 41

only be used if antihistamines, intranasal corticosteroids, or combo are not tolerated

Question 42

ADR of using leukotriene receptor antagonists

Answer 42

Upper respiratory tract infection and headache

Question 43

What are some cons to taking intranasal cromolyn?

Answer 43

slow onset of action (4-7 days) 1 spray in each nostril 6 times daily slight irritation of the mucosa

Question 44

Should oral/intranasal decongestants be avoided in pregnancy?

Answer 44

yes

Question 45

Role of anticholinergics?

Answer 45

block cholinergic receptors to decrease watery nasal secretions

Question 46

What are some side effects of ipratropium nasal spray? (Atrovent)

Answer 46

nasal and oral dryness, irritation and burning