Allergic Rhinitis

Risk factors for Allergic Rhinitis

Family History

Filaggrin

Elevated serum IgE

Eczema

Skin Tests

Consumption of ?fast-food meals/week

How do you classify allergic rhinitis

If it is >4 days AND >4 weeks it is persistent

If it is less than 4 days or less than 4 weeks it is intermittent

Moderate-severe would keep you up at night. Mild would not

Symptoms of allergic rhinitis

Bilateral

Frequent sneezing

Watery Rhinorrhea

Itchy eyes

Sinus pain

Conjunctivitis

Hyposmia can occur

Complications of allergic rhinitis

Acute: Sinusitis, otitis media via effusion

Chronic: nasal polyp formation, sleep apnea, sinusitis, hyposmia

Primary nonpharmacologic therapy for allergic rhinitis

avoidance

First line treatment of allergic rhinitis

INCS

Ex. Fluticasone or Budesonide

Intranasal Antihistamine

Azelastine HCl

1st gen antihistamines

Brompheniramine, Chlorpheniramine, Diphenhydramine, Doxylamine

1st gen antihistamines dosing regimen

q4-6

contraindicated in BPH, uncontrolled diabetes, glaucoma, lactating women,

Max dosing of diphenhydramine >12 yo , 6-12, and 2-6

>12 is 300 mg

6-12 is 150 mg

<6 is 37.5

Nonsedating

Fexofenadine, Loratidine

most sedating of the nonsedating is cetirizine

nonsedating antihistamine dosing

once daily dosing

fexofenadine doses

>12 is 60-180 mg per day

6-12 is 60 mg

<6 is 60 mg

loratidine dosages

10 mg >6

<6 is 5 mg

cetirizine dosages

>6 is 10 mg

<6 is max 5

levocetirizine dosing

>12 is 5 mg

6-12 is 2.5

<6 is 1.25

counseling point for systemic decongestants

do not use for more than 3 days (oxymetazoline)

Example of mast cell stabilizer

cromolyn: safe for pregnancy

pregnancy and lactation considerations

Loratadine, cetirizine and levocetirizine is preferred for pregnancy

INC is okay

Cromolyn is best

Antihistamines are contraindicated in lactation

Contraindications for self treatment in allergic rhinitis

Child <12 yo WITHOUT diagnosis from PCP

Pregnant and Lactating women WITHOUT diagnosis from PCP

Symptoms of non-allergic rhinitis: Nasal obstruction. thick, pus-like muscus

Otitis media, sinusitis or spreading infection

Uncontrolled asthma, copd