Allergic Rhinitis Lecture Flashcards by Beth Cocker

How may adults and children have allergic rhinitis?

20% and 40%

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Define intermittent allergic rhinitis

“Hay fever”
Symptoms occur during certain period of the year
Usally predictable time/events
4 days per week or less than 4 weeks

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Define persitent allergic rhinitis

“Perennial allergies”
Symptoms occur throughout the year
May wax and wane throughout the year
More than 4 times a week and more than 4 weeks

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Define mild rhinitis

Symptoms do not impair sleep or daily activities

No troublesome symptoms

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Define moderate-to-severe rhinitis

Impairment of sleep
Impairment of daily activity
Troublesome symptoms

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Triggered by?

Aeroallergens
Outdoors: pollen, mold spores
Indoor: dust mites, cockroaches, mold spores, cigs,smoke, etc
Occupational: latex, resins, chemicals, dust

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Histamine causes?

itching, pain, vasodilation, sneezing

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Kinins, PGs, and leukotrienes cause?

Nasal blockage, glandular secretion

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Define sensitization phase

allergen exposure stimulates immune system stimulation –> no symptoms

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Define early phase

Further allergen exposure causes fast release of pre-formed mast cell mediators –> itching, sneezing within minutes

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Define cellular recruitment phase

Mast cells infiltrate the mucosa and set up shop

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Define late phase

Several hours after exposure
Mucus hypersecretion from congestion and submucosal gland hypertrophy
– continued exposure, tissue has lower threshold to allergy (hypersensitivity)

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Clinical presentation

Bilateral worse in the AM
Frequent sneezing
Pruritis
Conjunctivitis
Allergic shiner: suborbital edema causes dark circles
Allergic salute or crease from salute
Open mouth breathing
Nasal voice
Engorged nasal mucosa

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Nonallergic rhinitis?

Unilateral sumptoms
Constant during the day
Little sneezing
Rarely conjunctivitis
Causes: nasal polyps, pregnancy, puberty, enlarged tonsils, meds

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Exclusion criteria for self-treatment?

Under 12
Pregnant
Symptoms of nonallergic rhinitis, otitis media, sinusitis, bronchisits, undiagnosed asthma, COPD, lower respiratory tract infection
Persistant: 2-4 weeks
Side effects of treatment

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Three part treatment?

Allergen avoidance
Pharmacotherapy
Immunotherapy

Indoor allergen avoidance?

Conrol humidity
Wash household items
HEPA filter
Pet dander

Outdoor allergen avoidance

Avoid increased exposure

Check the air quality index

Pharmacotherapy treatments?

Antihistamines
Decogestants
Nasal Sprays

First generation antihistamines examples?

Chlorpheniramine
Dexbrompheniramine
Diphenhydramine
Doxylamine

First generation antihistamine pros?

Effective to treat allergic rhinitis
Fast acting
Inexpensive

First generation antihistamine cons?

Sedating
Short duration of action
Anticholinergic side effect

First generation antihistamine cautions?

Potential for overdose –> excessive histamine and cholinergic receptor blockade
CNS symptoms: psychosis, hallucinations, tremors, agitation, lethargy
Cardiac dysrhthmias, alteration in GI

Second generation antihistamine examples?

Clartitin (loratadine) - least sedating
Zyrtex (cetirizine) - most sedating
Allegra (fexofenadine)

Second generation antihistamine pro?

Highly protein bound: do not readily cross the BBB --> less sedating

Less sedating antihistamines have longer?

Action but are more expensive

Overdoses cause?

Headache, somnolence, tachycardia

Decongestants?

Reduce nasal congestion Often in combo with antihistamine Topical (nasal and ophthalmic) vs systemic

Cromolyn sodium?

Intranasal anti-inflammatory Benefits in 3-7 days peak at 2-4 weeks Okay for pregnant and lactating women

Saline, propylene and polyethylene glycol?

Nasal wetting sprays | May reduce allergic rhinitis symptoms by decreasing irritation and dryness

Special regulation in children?

Loratadine Cromolyn sodium is approved for children over 5 Avoid first generation antihistamines due to paradoxical reaction potential

Special regulation in elderly?

Loradatine and cromolyn Avoid first generation antihistamines due to anticholinergic side effects (potential for excitation, confusion, hypotension --> falls)