module 3 peds allergic rhinitis, allergy immunotherapy

Question 1

2 phases of allergic rhinitis

Answer 1

immediate: 15-30 minutes after exposure
- mast cell mediator release
late phase: 6-12 hours after exposure
- due toe inflammatory cells

Question 2

allergic rhinitis s/s

Answer 2

rhinorrhea
nasal, palate, and eye pruritus
congestion
sneezing
poor sleep
generalized malaise

Question 3

family hx for allergic rhinitis

Answer 3

atopic dermatitis
allergic rhinitis
asthma

Question 4

intermittent AR

Answer 4

persists for < 4 weeks

Question 5

persistent AR

Answer 5

> 4 weeks

Question 6

mild AR

Answer 6

does not impair
- daily activities
- sleep
- school or work activities
- child not trouble by the symptoms
If one or more of these symptoms
- moderate to severe AR

Question 7

AR < 2 years old

Answer 7

rare

Question 8

AR clinical findings

Answer 8

• reduced patency from bilateral nasal obstruction
• mouth breathing, snoring
• pale to purple, edematous nasal mucous membranes
• clear, thin, watery rhinorrhea
• nasal crease
• itching, rubbing of nose

Question 9

associated manifestations of AR

Answer 9

• high arched palate
• enlarged tonsillar and adenoidal tissue
• repeated sniffing, snorting, coughing
• clearing of throat
• red conjunctiva, tearing, lid and periorbital edema
• cobblestone appearance of pharynx or palpebral conjunctivae
• chronic mouth breathing -> facial changes, dental malocclusions, snoring
• sleep disturbances

Question 10

risk factors for ped AR

Answer 10

+ family hx
first born
male
early use of systemic antibiotics
maternal smoking
exposure to allergens

Question 11

referrals for serologic testing

Answer 11

reserved for children with significant s/s that do not respond to traditional management

Question 12

Rx therapy for AR

Answer 12

Intranasal corticosteroids
oral antihistamines
topical nasal antihistamines
decongestants
nasal cromolyn
leukotriene modifiers

Question 13

Oral antihistamines

Answer 13

H1/H2: cause early and late phase of allergic response
H3/H4: cause pruritus and proinflammatory response
- 2nd gen: effective in relieving s/s of AR

Question 14

Topical nasal antihistamines

Answer 14

Azelastine: >6mo old
Olopatadine: > 6 years old

Question 15

decongestants

Answer 15

help relieve nasal congestion
- no evidence supporting use of oral phenylephrine
- Contraindicated: < 4 years old

Question 16

Topical decongestants

Answer 16

can cause rebound rhinorrhea if used for more than 3-5 days

Question 17

Intranasal corticosteroids

Answer 17

reduce local cytokine and mediator release factors produced by mast cells, basophils, eosinophils, monocytes, and macrophages
-> dec. inflammation and nasal obstruction
> relieve nasal congestion, rhinorrhea, itching, sneezing

Question 18

leukotriene modifiers

Answer 18

montelukast only approved LTRA for use in AR
- > 6mo

Question 19

Allergy immunotherapy includes

Answer 19

subcutaneous immunotherapy
oral immunotherapy
epicutaneous immunotherapy
sublingual immunotherapy

Question 20

oral immunotherapy

Answer 20

• highest rate of allergic side effects
• best results in terms of sustained lack of reaction to food allergens

Question 21

allergy immunotherapy is a tx for

Answer 21

food allergy
severe allergic asthma

Question 22

goal of allergy immunotherapy

Answer 22

induce immune tolerance and cause a change in the immune response to specific antigens
- longer lasting benefits without need for daily meds

Question 23

epicutaneous immunotherapy

Answer 23

small allergen patch on the back or upper arm
- daily changes

Question 24

adverse reactions to allergy immunotherapy

Answer 24

local
- tingling following sublingual
Systemic
- life-threatening, anaphylaxis

Question 25

Allergic rhinitis complications

Answer 25

eustachian tube dysfunction
serous otitis media
malocclusion
high-arched palate