Allergic Rhinitis - Self Care

Allergic rhinitis is a _______ _______

systemic disease

Allergic rhinitis is prominent in _________ _________

nasal symptoms

Triggers of allergic rhinitis (2)

indoor environmental allergens and outdoor environment allergens

Examples of indoor environmental allergens (4)

house-dust mites, cockroaches, mold spores, pet dander

Examples of outdoor environmental allergens (2)

pollen and mold pores

Phases of allergic rhinitis (4)

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

What is included in the sensitization phase? (3)

following initial allergen exposure, IgE produced, no symptoms

What is included in the early phase? (3)

occurs within minutes of subsequent allergen exposure, release of mast cell mediators, release of inflammatory mediators

What is the release of mast cell mediators?

histamines, proteases (minor)

What is the release of inflammatory mediators?

prostagladines, leukotrienes

Within the cellular recruitment phase, ________ are attracted to ________ ________ and release more _________ ________

eosinophils; nasal mucosa: inflammatory mediators

The late phase begins ____ - ____ hours after _______ ______ and ________ _____

2-4 hours; allergen exposure; mucus hypertension

What are the 3 classification of allergic rhinitis?

intermittent (IAR), persistent allergic rhinitis (PER), and episodic (situational)

Intermittent symptoms occur _______OR _______

4 or less days per week; 4 or less weeks

Persistent allergic rhinitis symptoms occur _______ AND _______

more than 4 days per week; more than 4 weeks

Episodic is _____ ________ or __________ with potential allergen

on exposure; contact

What are the 6 symptoms of allergic rhinitis?

bilateral, paoxysmal sneezing, watery rhinorrhea, itching of the eyes, nose, and/or palate, nasal obstruction, and conjuvetivities

What are the 2 most prominent symptoms of allergic rhinitis?

itching of eyes, nose, and/or palate and conjuvetivitis

Systemic symptoms of allergic rhinitis (3)

fatigue, irritability, cognitive impairment

Exclusions to self-treatment

children under 12, symptoms of otitis media, sinusitis, bronchitis, and symptoms of undiagnosed or uncontrolled asthma

Steps of treat for allergic rhinitis are _______, ________, ________

avoidance; pharmacotherapy; immunotherapy

Uses of saline nasal sprays or drops (2)

moisten irritated mucosal membranes and loosen encrusted mucus

Ocean Premium Saline Nasal Spray

sodium chloride 0.65%

________ ________ relieves _______ ________ irritation and dryness. Use the _____ _____ with _______, and distilled, sterile, or boiled tap water

nasal irrigation; nasal mucosal; neti pot; saline

Active ingredients for intranasal corticosteroids (INCS) (5)

budesonide, fluticasone furoate, fluticasone propionate, mometasone furoate, triamcinolone acetonide

Mechanisms of action

inhibit multiple cell type and mediators and “stop the allergic cascade”

What are intranasal corticosteroids (INCS) used for?

itchy nose, sneezing, runny nose, congestion

itchy and watery eyes (fluticasone furoate, fluticasone propionate)

Adverse effects of intranasal corticosteroids

nasal discomfort or bleeding, sneezing, cough, and long-term use changes (vision, glaucoma, cataract formation, increased risk of infection, growth inhibition in children)

Can you use intranasal corticosteroids in pediatric patients? what can the ages 2, 4, and 6 take?

yes;

2 years and older: intranasal fluticasone furoate, momentasone furoate, triamcinolone aceate

4 years and older: intranasal fluticasone propionate

6 years and older: intranasal budesonide

Can you use intranasal corticosteroids in pregnant patients?

yes

Can you use intranasal corticosteroids in lactating patients?

yes

Rhinocort allergy spray (intranasal cortisteriods)

Budesonide 32mcg/spray

Flonase Allergy Relief (intranasal cortisteriods)

Fluticasone propionate 50mcg/spray

Do not recommend Flonase Allergy Relief to some with a ______ ______ since medication is not ______ ______

cat allergy; fast acting

Nasacort allergy 24 HR (intranasal cortisteriods)

Triamcinolone acetonide 55mcg/spray

Types of ORAL antihistamines (2)

first-generation (sedating, nonselective) and second-generation (nonsedating, peripherally selective)

Active ingredient of first-generation anti-histamines (3)

brompheniramine, chlorpheniramine, diphenhydramine

Characteristics of first-generation antihistamines (3)

high lipophilic, readily cross BBB, anticholinergic effects

Active ingredients of second-generation antihistamines (4)

fexofenadine, loratadine, cetirizine, levocetirizine

Characteristics of second-generation antihistamines (3)

large - protein-bound lipophobic molecules with charged side chains, do not readily cross BBB, NO anticholinergic effects

Active ingredients of TOPICAL antihistamines (1)

azelastine

Mechanism of action for antihistamines compete with ___________ at the __________ and ___________ histamine type 1 (H1) __________ _______

histamine; central; peripheral; receptor sites

Mechanism of action of antihistamine, they prevent _________-________ interaction and subsequent _________ _________

histamine-receptor; mediator release

ONLY _________-__________ antihistamines can ________ the release of mast cell mediators

second-generation; inhibit

What are the uses of antihistamines? (3)

itching, sneezing, running nose, NO effect on nasal congestion

Adverse effects with ORAL FIRST-generation in CNS (2)

depression (sedation, impaired performance) and stimulation (anxiety)

Adverse effects with ORAL FIRST-generation in anticholinergic effects (4)

dry eyes and mucous membranes (mouth, nose), blurred vision, urinary retention, constipation

Adverse effects with ORAL FIRSt-generation in photosensitizing (1)

sunscreen

Adverse effects with ORAL SECOND-generation (1)

possible sedation (cetirizine, levocetirizine)

Adverse effects with TOPICAL SECOND-generation in CNS (4)

possible sedation, bitter taste, nasal stinging/burning, drowsiness

Drug interactions with antihistamines (4)

amiodarone, CNS depressants, erythromycin, phenytoin, MAOIs

Food interactions with antihistamines are fexofenadine and _______ ______ must be separated by ________ hours

fruit juices; 2

Disease interactions (FIRST-generation)

narrow-angle glaucoma, acute asthma exacerbation, symptomatic prostatic hypertrophy

Can you use antihistamines in pediatric patients?

Not first-generation; Yes, second-generation (loratadine - first-line treatment); Yes Azelastine (6 years or older)

Can you use antihistamines in geriatric patients?

Not first-generation; Yes, second-generation (loratadine - first-line treatment)

Can you use antihistamines in pregnant patients? What antihistamines are low risk and moderate risk?

Yes, diphenhydramine, chlorpheniramine

Levocetirizine, loratadine, cetirizine (low risk)

Fexofenadine, azelastine (moderate risk)

Can you use antihistamines in lactating patients?

No, but chlorpheniramine, fexofenadine, and loraradine are best options if needed

Chlor-Trimeton allergy (4, 8, 12 Hour) Tablets (systemic FIRST-generation)

Chlorpheniramine 4, 8, or 12 mg, respectively

Benadryl allergy tablets (systemic FIRST-generation)

diphenhydramine HCL 25mg

Zyrtec tablets (systemic SECOND-generation)

cetirizine 10mg

Allegra allergy 24 HR tablets (systemic SECOND-generation)

fexofenadine 180mg

Xyzal allergy 24 HR tablets (systemic SECOND-generation)

levocetirizine 5 mg

Claritin non-droswy tablets (systemic SECOND-generation)

loratadine 10mg

astepro allergy spray (nasal antihistamine)

azelastine hydrochloride 0.15% (205.5 mcg/spray)

Uses of decongestants

nasal congestion

Mechanism of Action for cromolyn sodium

mast cell stabilizer

Uses of cromolyn sodium

prevents and treats symptoms of allergic rhinitis

Adverse effects of allergic rhinitis (3)

sneezing, nasal stinging, burning

Patients _______ and older ________ in each nostril ____-____ times ____ at regular intervals

2 year; 1 spray; 3-6; daily

Treatment is more effective if started _____ symptoms begin

before

Initial clinical improvement ____-____ days

3-7

Achieve maximal therapeutic benefit ___-___ weeks

2-4

Can you use cromolyn sodium in pediatric patients?

Yes, 2 year and older

Can you use cromolyn sodium in geriatric patients?

Yes, first-line treatment

Can you use cromolyn sodium in pregnant patients?

Yes, first-line treatment

NasalCrom Spray (cromolyn sodium)

cromolyn sdoium 5.2mg/spray

Refer on when symptoms do not decrease after ___-___ weeks of treat and when signs and symptoms of ________ __________ develop

1-2 weeks; bacterial infection