Allergic Rhinitis

Question 1

Allergic Rhinitis

Answer 1

Inflammatory disorder of the upper airway

Question 2

Allergic Rhinitis symptoms

Answer 2

– Sneezing
– Rhinorrhea
– Pruritus
– Nasal congestion
– For some people: Conjunctivitis, sinusitis, and
asthma

Question 3

Seasonal

Answer 3

pollen - grass, tree, ragweed

Question 4

perennial

Answer 4

dust mites, cat and dog dander

Question 5

allergic rhinitis

Answer 5

Allergens bind to immunoglobulin E (IgE)

on mast cells

Question 6

Triggers release of inflammatory mediator

Answer 6

– Histamine, leukotrienes, prostaglandins

Question 7

Three pollen seasons

in Minnesota

Answer 7

Tree
Grass
Weed
Ragweed

Question 8

Tree

Answer 8

early
April until the end of
May.

Question 9

Grass

Answer 9

– early

June to mid-July

Question 10

Weed

Answer 10

– midJune until a hard frost

occurs

Question 11

ragweed

Answer 11

early August through

mid-October

Question 12

Classes of Drugs Used for

Allergic Rhinitis

Answer 12

• Glucocorticoids (intranasal)
• Antihistamines (oral and intranasal)
• Sympathomimetics (oral and intranasal)

Question 13

Intranasal Glucocorticoids are the first

Answer 13

choice—most effective for treatment and

prevention of rhinitis

Question 14

Intranasal Glucocorticoids exampoles

Answer 14

Budesonide [Rhinocort Aqua], fluticasone
propionate [Flonase], triamcinolone [Nasacort
Allergy}

Question 15

Intranasal Glucocorticoids adverse effects

Answer 15

– Drying of nasal mucosa or sore throat
– Epistaxis (nosebleed)
– Headache
– Rarely, systemic effects (adrenal suppression and slowing
of linear pediatric growth)

Question 16

Intranasal Glucocorticoids preferred treatment choice in

Answer 16

in pregnancy for moderate
to severe AR, use lowest effective dose (typically
choose budesonide – pregnancy category B)

Question 17

Oral Antihistamines are

Answer 17

H1 receptor antagonists

Question 18

H1 are 1st line for

Answer 18

• 1st line – mild to moderate AR

Question 19

H1 do not reduce

Answer 19

Do not reduce nasal congestion

Question 20

H1 are most effective

Answer 20

• Most effective if taken prophylactically

Question 21

H1 should be taken

Answer 21

regularly throughout the allergy season, even
when symptoms are absent, to prevent an initial histamine
receptor activation

Question 22

Antihistimine types

Answer 22

• 1st and 2nd/3rd generation

Question 23

– 2nd and 3rd generation – less

Answer 23

tendency to cause sedation

preferred fewer CNS effects

Question 24

• Mild adverse effects: Sedation with

Answer 24

first generation (much less
with second generation)

Question 25

• Anti-cholinergic effects – drying of nasal secretions, dry mouth,
constipation, urinary hesitancy – common with

Answer 25

1st generation,

rare with 2nd-generation

Question 26

Intranasal Anti-histamines

examples

Answer 26

Azelastine and Olopatadine

Question 27

Intranasal Anti-histamines

indicated for

Answer 27

Indicated for allergic rhinitis in adults and in

children over 12 years old

Question 28

Intranasal Anti-histamines

systemic absorption can be

Answer 28

can be sufficient to

cause somnolence

Question 29

Intranasal Anti-histamines

SE

Answer 29

Nosebleeds, headaches

• Unpleasant taste

Question 30

Intranasal Anti-histamines

combination

Answer 30

corticosteroid/anti-histamine

sprays

Question 31

Intranasal Anti-histamines have

Answer 31

rapid onset. 15 min

Question 32

Intranasal Cromolyn Sodium is

Answer 32

Mast cell stabilizer

Question 33

Intranasal Cromolyn Sodium reduces

Answer 33

Reduces symptoms by suppressing the
release of histamine and other inflammatory
mediators from mast cells

Question 34

Intranasal Cromolyn Sodium is used as

Answer 34

Prophylaxis

Question 35

Intranasal Cromolyn Sodium administer before

Answer 35

Administer before symptoms start

Question 36

Intranasal Cromolyn Sodium response develops in

Answer 36

develops in 1 to 2 weeks

Question 37

Intranasal Cromolyn Sodium minimal

Answer 37

adverse reactions: Less than with

any other drug for allergic rhinitis

Question 38

Other drugs that can be used for allergic rhinitis

Answer 38

• Anti-leukotriene agents
• Ipratropium bromide
• Short courses of oral glucocorticoids
usually abolish symptoms of allergic
rhinitis and may be indicated for severe
allergic rhinitis symptoms that are
preventing the patient from sleeping or
going to work.
• Nasal saline irrigation

Question 39

animal dander avoidence

Answer 39

– remove from house. Or keep animal
out of patient’s bedroom. HEPA room air filter. Seal or
put filter on air ducts that leave to the individual’s
bedroom.

Question 40

house mites avoidance

Answer 40

encase pillows and mattresses in a DM
cover, was bedding in hot water weekly (>130 degrees).
Remove carpet from bedrooms.

Question 41

cockroaches avoidance

Answer 41

– professional extermination, vacuum and
wet wash home, use poison bait o r traps, no food or
garage exposed, repair plumbing leaks, cracks, crevices.

Question 42

indoor mold avoidence

Answer 42

– reduce indoor humidity to 50%, are
condition, fix all leaks and eliminate water sources, clean
moldy surfaces.

Question 43

Refer

Answer 43

• Children with moderate-to-severe allergic rhinitis.
• Prolonged or severe symptoms of rhinitis or significant residual
symptoms despite pharmacologic therapy and avoidance measures.
• Patients whose management might be enhanced by identification of
allergic triggers.
• Patients with coexisting asthma or nasal polyposis
• Patients with significant complications of allergic rhinitis, such as
recurrent otitis media or recurrent sinusitis.
• Patients with intolerable adverse effects from medications or side
effects that interfere with school/work productivity.
• Patients who are interested in immunotherapy as a treatment option.
• Patients who have required systemic glucocorticoids to control
symptoms