Self-Care: Allergic Rhinitis

What is the sensitization phase?

allergen exposure → stimulates IgE medicated immunse response

What is the early phase?

within minutes

• release of mast cell mediators

• sneezing

What is cellular recruitment?

circulating leukocytes

What is late phase?

nasal congestion, postnasal drainage

Exclusions to allergic rhinitis?

• children under < 12 years

• Pregnancy

• nonallergic rhinitis

• uncontrolled asthma

How long is intermittent allergic rhinitis?

<4 days per week or <4 weeks

How long is persistent allergic rhinitis?

symptoms >4 days per week AND >4 weeks

At what age does allergic rhinitis cases decrease

65 years

What are the allergen avoidances for seasonal allergies?

• avoid the outdoors when pollen is high

• close windows

• avoid outdoor activities that increase exposure

• air-conditioning, HEPA filters

What are the allergen avoidances for perennial allergies?

• avoid dust mites

• no pets

• avoid triggers (smoke, perfume)

Nasal irrigation: nonpharmacologic therapy

• isotonic or hypertonic

• neti pots

• remember that tiktok girl LOL

What are adverse effects of intranasal corticosteroids?

epistaxis, headache, bitter taste, pharyngitis, nasal dryness, sneezing

• bad nose spray technique → septal perforation

Drug effects for intranasal corticosteroids??

• CYP3A4 inhibitors

  • Systemic azole antifungals

  • protease inhibitor (HIV)

Instanasal: Triamcinolone Brand Name

Nasacort

Triamcinolone dosing in adults and children >12 years?

2 sprays in each nostril once daily

• reduce to 1 spray as symptoms improve

Triamcinolone Dosing 6- <12 years?

1 spray in each nostril daily

• increase to 2 in each if worse

• back to 1 in each if better

Triamcinolone Dosing 2-5 years?

1 spray in each nostril

Triamcinolone Dosing children <2 years?

DO NOT USE

Fluticasone

Intranasal Corti

Fluticasone dosing in adults and children >12 years of age ?

2 sprays in each nose once daily

• reduce to 1 spray in each if improve

Fluticasone dosing 4-11 years?

1 spray in each nostril once daily

Fluticasone dosing children <4 years

Do not use

What Fluticasone can you use if ur 2<x<4?

flonase sensimist

Budesonide

Intranasal corti

Budesonide dosing in adults and children >12 years?

2 sprays in each nostril once daily (128 mcg)

• reduce to 1 spray in each if improve

Budesonide dosing 6-<12 years?

1 spray in each nostril (64 mcg)

• can increase to 2 sprays in each nose daily

Budesonide dosing <6 years of age?

DO NOT USE

Mometasone furoate

intranasal corticoid

Mometasone furoate dosing for adults and children >12 years

2 sprays in each nostril once

1 spray in each nostril daily

Oral Antihistamine

2nd gen (not sedating) antihistamines

Oral Antihistamine examples?

• Cetirizine (Zyrtec)

• Fexofenadine (Allegra)

• Loratadine (Claritin)

• Levocetirine (XYZAL)

Oral Antihistamines’ MOA

selective block h1 receptors, less lipophilic

Oral Antihistamine drug interactions?

• CNS depressants (alcohol)

• Fexofenadine: grapefruit, apple, OJ

What Oral Antihistamine is highest protein binding?

Loratadine

Loratadine needs to etabolize to do what?

desloratadine

What Oral Antihistamine has the shortest half-life?

Cetirizine: 8 hours

What oral antihistamine has the longest half-life?

Fexofenadine: 14 hours

What Oral Antihistamine has less systemic side effects?

Instranasal antihistamine

What to do if the antihistamine doesnt work anymore?

switch to a different antihistamine

1st generation antihistamines

• controversial

• more risks

What generation of antihistamines is more preferred?

2nd gen

Ocular Antihistamines purpose?

treat allergic rhinitis (itching, redness, watery eyes)

Ocular Antihistamines brand name?

Ketoifen (Alaway, Zaditor)

H1 antihistamines brand name

Pataday

H1 antihistamines pataday

• eyedrops

• use older than 2 yrears

• remove contact lenses and wait 10+ min before reinserting contacts

Astepro usage?

seasonal and perennial allergic rhinitis

What is the max amt of days to use nasal decongestants

5 days (rhinitis medicamentosa)

Mast Cell Stabilizers brand?

instansal cromlyn (NasalCrom)

Mast Cell Stabilizers MOA

reduces inflammation and stabilizes mast cells preventing mediator release

Mast Cell Stabilizers usage

onset: 3-7 daysm → max: 2-4 weeks (before allergy season)

Mast Cell Stabilizers dosing?

1 spray in each 3-6x per day

Mast Cell Stabilizers adverse effects

sneezing, stinging, burning

What is the PO drug of chouce for children <12 years?

Loratadine

Dont use decongestants in childen of what age?

<6

What intranasal corticoids are safe under age 2?

fluticasone and triamcinolone

What should elderly avoid for antihistamines?

1st gen

What is first line for antihistamines for preganancy?

intranasal cromolyn

What gen is first line for pregnancy?

1st gen followed by 2nd gen

What should pregnant people avoid?

decongestants

What antihistamine should pregnant people avoid all together?

Fexofenadine

What should you most use for lactation

Cromolyn

What if you need to take antihistamines if lactating?

use 2nd gen only, and after last feeding of the day