Rhinitis/CRS

Question 1

Prognostic factors for CRSsNP

Answer 1

higher eos count
presence of biofilms
Smoking
Atopy
Disrupted mucociliary transport system
immunodeficiencies

Question 2

Tx of CRSsNP

Answer 2

1) Abx if suspect infection - Amox-Clav; given for several weeks. ideally want cx.
2) INCS - pulmicort rinses may be more effective (area of distribution)
3) Nasal rinses
4) Oral steroids (short term) if severe/refractory sx

Question 3

Name all the intranasal steroid sprays

Answer 3

1. Beclomethasone - Beconase
2. Fluticasone proprionate - Flonase
3. Fluticasone furoate - Avamys, Veramyst
4. Ciclesonide - Omnaris
5. Mometasone - Nasonex
6. Budesonide - Rhinocort
7. Triamcinolone - Nasacort

Dymista = fluticasone proprionate + azelastine

Question 4

Name the intranasal steroid sprays which are safe to use in pregnancy

Answer 4

Category B nasal sprays:
- Rhinocort

Category C nasal sprays:

• Flonase
• Nasonex

DO NOT USE Triamcinolone (assoc with respiratory tract malformations albiet small # of cases); also avoid beclomethasone

Question 5

Name the antihistamines that are safe to use in pregnancy

Answer 5

Category B AHs (animal reproduction studies have failed to demonstrate a risk to the fetus; no adequate, well controlled studies in pregnant women):

• Reactine/Cetirizine
• Levocetrizine
• Loratadine/Claritin

Category C AHs (animal repro studies have shown an adverse effect on fetus):

• Desloratadine/Aerius
• Fexofenadine/Allegra

Minimal amount is excreted in breastmilk*