Allergic rhinitis

what are the four phases of allergic rhinitis

sensitization phase, early phase, cellular recruitment phase, late phase

sensitization phase is characterized by _____ exposure

IgE

what symptoms occur during the sensitization phase

none

when does the sensitization phase occur

immediately following initial exposure

when does the early phase occur

within minutes of allergen exposure

what two types of mediators are released during the early phase

mast cell and inflammatory

what do mast cell mediators release in allergic rhinitis

histamine, proteases

what do inflammatory mediators release in allergic rhinitis

prostaglandins, leukotrienes

what happens during the cellular recruitment phase

eosinophils are attracted to the nasal mucosa, releases more inflammatory mediators

what does the late phase occur

2-4 hours after allergen exposure

what happens during the late phase

mucus hypersecretion

what is intermittent allergic rhinitis classified as

symptoms occur less than or equal to 4 days a week or less than or equal to 4 weeks

what is persistent allergic rhinitis classified as

symptoms occur greater than 4 days a week or greater than 4 weeks

what is episodic allergic rhinitis classified as

on exposure or in contact with potential allergen

exclusions for self treatment for allergic rhinitis

children less than 12, symptoms of otitis media, sinusitis, bronchitis, symptoms of undiagnosed asthma

what are the three steps in treatment of allergic rhinitis

avoidance, pharmacotherapy, immunotherapy

what can be used as nonpharmacologic therapy for allergic rhinitis

saline nasal spray, nasal irrigation

what does nasal irrigation do

relieves nasal mucosa irritation and dryness

what type of water needs to be used in a neti pot

distilled, sterile or boiled tap water

active ingredients in intranasal corticosteroids

-budesonie fluticasone furoate

-fluticasone propionate

-mometasone furoate

-triamcinolone acetonide

method of action of intranasal corticosteroids

inhibits multiple cell types and mediators, stops the allergic cascade

adverse effects of intranasal corticosteroids

nasal discomfort/bleeding, sneezing, cough

complications of using intranasal corticosteroids for long term use

-glaucoma

-cataract formation

-increased risk of infections

-child growth inhibition

what intranasal corticosteroids can children 2 years and above be recommended

fluticasone furoate, mometasone furoate, triamiconolone acetate

what additional intranasal corticosteroid can children 4 years and above be recommended

fluticasone propionate

what additional intranasal corticosteroid can children 6 years and above be recommended

intranasal budesonide

can intranasal corticosteroids be used in pregnant and lactating patients

yes

what are the intranasal corticosteroid products that can be used to treat allergic rhinitis

Rhinocort allergy spray, Flonase allergy relief, Nasacort allergy

ingredients in Rhinocort allergy spray

budesonide

ingredients in Flonase allergy spray

fluticasone propionate

ingredients in Nasacort allergy

triamcinolone acetonide

which generation of antihistamines cross the blood brain barrier and have anticholinergic effects

first generation

active ingredients in first generation antihistamines

bropheniramine, chlorpheniramine, diphenhydramine

active ingredients in second generation antihistamines

fexofenadine, loratadine, cetirizine, levocetirizine

active ingredients in topical antihistamines

azelastine

what is the method of action of antihistamines

-compete with histamine at the central and peripheral histamine type 1 receptor sites

-prevents histamine-receptor interaction and subsequent mediator release

what is the additional method of action that only second generation antihistamines has

inhibits the release of mast cell mediators

main adverse effects of first generation antihistamines

-dry eyes and mucous membranes

-constipation

adverse effects of second generation antihistamines

cetirizine and levocetirizine only - possible sedation

adverse effects of topical antihistamines

possible sedation, nasal stinging/burning

foods that interact with antihistamines

fexofenadine and fruit juices

what antihistamines can be given to pediatrics and which is first line

only second generation, loratadine first line

what can be prescribed only in pediatrics 6 years and older

azelastine

what antihistamines can be given to geriatrics and which is first line

only second generation, loratadine first line

which antihistamines are safe in pregnancy

diphenhydramine, chlorpheniramine

which antihistamines are considered low risk in pregnancy

levocetirizine, loratadine, cetirizine

which antihistamines are considered moderate risk in pregnancy

fexofenadine, azelastine

can antihistamines be used in lactating patients

no

what are the best antihistamine options for lactating patients if necessary

chlorpheniramine, fexofenadine, loratadine

what are first generation antihistamine products

chlor-trimeton allergy, benadryl

active ingredient in chlor-trimeton allergy

chlorpheniramine

active ingredient in Benadryl

diphenhydramine

second generation antihistamine products

Zyrtec, Allegra, Xyzal, Claritin

active ingredient in Zyrtec

cetirizine

active ingredient in Allegra

Fexofenadine

active ingredient in xyzal

levocetirizine

active ingredient in claritin

Loratadine

topical product name

astepro

active ingredient in astepro

azelastine

method of action of cromolyn sodium

mast cell stabilizer

uses of cromolyn sodium

prevents and treats symptoms of allergic rhinitis

dosing of cromolyn sodium

1 spray in each nostril 3-6 times daily

when will you see initial improvement of symptoms when using cromolyn sodium

3-7 days

when will you see the maximum therapeutic benefit when using cromolyn sodium

2-4 weeks

true or false: cromolyn sodium is safe to use in all special populations, and should be used as first line in these patients

true

cromolyn sodium product name

NasalCrom spray

when to refer allergic rhinitis on

symptoms do not decrease after 1-2 weeks of treatment, signs and symptoms of bacterial infection develop