Allergic Rhinitis

What is the adult dose of Loratadine?

- 10 mg once daily

Intranasal cromolyn may be used in children as long as they are older than age ---.

- 5

What is the adult dose of Cetirizine?

- 5-10 mg once daily

What is the adult dose of Fexofenadine?

- 60 mg twice daily or 180 mg once daily

The Allergic Salute often causes ---, creases in the nose, often a facial feature of allergic rhinitis.

- Allergic Crease

--- occurs when nose is rubbed upward, often a facial feature of allergic rhinitis.

- Allergic Salute

Blood pool under the eye due to nasal congestion are facial features of allergic rhinitis. What are they called?

- Allergic Shiners

What is the pharmacologic therapy for Allergic Rhinitis?

- Antihistamines - Antihistamines act as an anticholinergic to help dry up any rhinorrhea or PND that may cause coughing - First generation antihistamines can cause drowsiness helping with insomnia - diphenhydramine acts as an antitussive to fight dry cough - the antihistamine action helps with itching

--- is contraindicated in lactating women. Why?

- Antihistamines - Antihistamines may pass through breast milk

Lines under they eye (caused by swelling) are facial features of allergic rhinitis. What are they called?

- Dennie's lines

True/ False. Second generation antihistamines have anticholineric effects? What does this mean?

- False - if a patient has a runny nose due to allergies, the second generation med will dry up the patient - it the patient has a runny nose due to a cold, the second generation med will NOT dry up the patient

What is the dosing for Nasalcrom?

- use 1 spray in each nostril 3-6 times per day - drug has half life of 1-2 hours

What is Intermittent Allergic Rhinitis?

- when allergic symptoms occur < 4 days /week OR < 4 weeks - mild IAR = symptoms do not impair sleep or daily activities - moderate-to-severe IAR = impaired sleep or daily activities or troublesome symptoms

What is Persistent Allergic Rhinitis?

- when allergic symptoms occur >4 days per week AND > 4 weeks - mild PAR = when symptoms do not impair sleep or daily activities, no troublesome symptoms - moderate-to-severe PAR = when symptoms impair sleep or daily activities or troublesome symptoms

Is Intranasal Cromolyn (Nasalcrom) an effectia recommended drug for allergic rhinitis?

- yes - does not cause rebound congestion - no drug interactions - must use 3-7 days to see effect, 2-4 weeks to see maximum effect

What is the treatment approach for allergic rhinitis?

Allergic rhinitis can be treated in three steps. * Each step should be maximized before moving to the next step. 1. Avoiding allergens 2. Pharmacotherapy 3. Immunotherapy

note:

Allergic rhinitis is not allergies, but instead the manifestation of allergies. For this class, allergies and Allergic Rhinitis are the synonymous

The full pathophysiology of allergic rhinitis.

- Initial contact with an allergen, such as pollen, sensitizes the immune system and leads to the production of IgE. These IgE can then bind to and activate mast cells - On reexposure, allergen binds and cross links IgE molecules on the surface of mast cells under mucosal surfaces such as in the throat and nasal mucosa - The binding of the antigen with IgE causes the subsequent release of mediators, including histamin e, which in turn leads to allergenic symptoms in the nose, eyes, and throat

What is Nasalcrom?

- Intranasal Cromolyn - decongestant - an OTC used to treat allergic rhinitis

What are precautions to take when suggesting antihistamines?

- Lower respiratory tract disease ( bronchitis, emphysema )

What is the mechanism of action for an antihistamine?

- Mast cell releases histamine that causes symptoms, such as itchy, watery eyes. - Antihistamines prevent histamine from binding to histamine receptors on blood vessels and nerves. - If histamine were to bind to BVs it would cause vasodilation, causing redness and fluid leakage - if histamine were to bind to nerves, itching would occur

True/False. Anticholinegic effects can aggravate confusion, dementia, and hallucinations in patients.

- True

True/False. Symptoms of allergic rhinitis are worse in the morning, better during the day, and better at night.

- True

True/False. Congestion is a common symptom of allergic rhinitis and can be treated with a decongestant.

- True - can be controlled with systemic or topical decongestants - remember topical decongestants cannot be used for more than 3-5 days or may cause rebound congestion

What are contraindications when taking antihistamines?

- acute asthma exacerbation - peptic ulcer - symptomatic BPH - newborns - narrow-angle glaucoma - nursing mothers - MAOIs

--- is a systemic disease with prominent nasal symptoms.

- allergic rhinitis

What is perennial rhinitis?

- allergies that occur all year around

What is seasonal rhinitis?

- allergies that occur in certain seasons - aka hay fever

--- should be avoided in elderly and children because of paradoxical effects.

- antihistamines

What are allergens?

- anything that causes Allergic Rhinitis

What are nonpharmacologic therapies for allergies?

- avoid allergens - lower household humidity to less than 40% to avoid dust mites and indoor mold - keep house clean and launder all bedding weekly in hot water - avoid outdoor activity when pollen counts are high ( keep house and car windows closed ) - use ventilation systems to remove pollen, mold spores, and cat allergens from household air

What are the 5 first generation antihistamine (generic) drug names?

- brompheniramine - chloropheniramine - dimenhydrinate - diphenylhydramine - doxylamine

What are the exclusions for self-treatment for patients with a cold?

- children <12 years - pregnant or lactating women - symptoms of non-allergic rhinitis - symptoms of Otis media, sinusitis, bronchitis, or other infections - symptoms of undiagnosed asthma, COPD, or lower respiratory disorder - moderate-to-severe persistent allergic rhinitis or symptoms unresponsive to treatment - severe side effects of treatment

--- is the drug of choice when suggesting a medication to a pregnant woman with a cold.

- chlorpheniramine

Fluticasone propionate (Flonase) is a nasal spray that is used for ---.

- eye related allergies.

First generation antihistamines have anticholinergic effects. What does this mean?

- first generation cross the BBB, and therefore have anticholinergic effects - anti SLUD - "dry up" the patient

What is the difference between first and second generation antihistamines?

- first generation: crosses blood-brain barrier (binding nonselectivelt to receptors in CNS), therefore has sedating effects - second generation: does not cross BBB (only binds to histamine receptors in PNS), and therefore does not have sedating effects.

--- are also known as "allergy shots" that are given in the upper arm and contain small amounts of allergens.

- immunotherapy - does not cure allergies or allergic rhinitis, but is intended to make symptoms better over time

Brompheniramine and chlorpheniramine are (more/less) sedative than clemastine, diphenyhydramine, and doxylamine?

- less

What is the drug of choice for children as long as it is approved by PCP?

- loratadine

What are the 3 second generation antihistamine (generic) drug names?

- loratadine - cetirizine - fexofenadine

What are the drugs of choice for elderly with a cold?

- loratadine - intranasal cromolyn

What are symptoms of allergic rhinitis?

- red, irritated eyes - rhinorrhea (runny nose) - itchy eyes, nose, and palate - frequent sneezing - post nasal drip (PND) - cough due to PND - nasal congestion - systemic symptoms: fatigue, irritability, malaise, cognitive impairment

What are nasal wetting agents?

- saline, propylene, and polyethylene glycol sprays that aid in the removal of mucus from the nose - may relieve nasal mucosal irritation and dryness, decreasing congestion, runny nose and sneezing - mild burning or stinging may result with saline irrigation, but no significant side effects otherwise

What are some side effects of antihistamines?

- sedation/drowsiness - anticholinergic effects * may cause paradoxical effects in children and elderly

What are some complications due to allergic rhinitis?

- sinusitis - Otis media - sleep apnea - nasal polyps - diminished sense of smell

What is unique about Nasacort Allergy (triamcinolone acetonide)?

- treats both congestion and runny nose

What are the 2 classifications of Allergic Rhinitis?

1. Intermittent Allergic Rhinitis (IAR) 2. Persistent Allergic Rhinitis (PAR)

What are the 4 stages of the pathophysiology of Allergic Rhinitis?

1. Sensitization - the initial allergen exposure and results in the production of IgE 2. Early Phase - occurs within minutes of allergen exposure; rapid release of mast cells mediators such as histamine 3. Cellular recruitment - circulating leukocytes are attracted to nasal mucosa and release more inflammatory mediators 4. Late phase- occurs 2-4 hours after antigen exposure, mucus hypersecretion (runny eyes and nose), persistent inflammation

Allergies tend not to affect what age?

<2 and >65