Allergic Rhinitis

What is Rhinitis and what are the characteristic symptoms

Rhinitis is the inflammation of the mucous membranes of the nose

Rhinorrhoea(nasal discharge)

Nasal congestion

Sneezing

Nasal itching

Can also be accompanied by ocular symptoms

Redness, itching, discharge

What are the classification and causes of rhinitis

Acute

• Viral infections (common cold)

• Foreign bodies

• Drug-induced

Chronic

• Allergic (intermittent, persistent)

• Non-allergic

• Mixed

What’s the duration for intermittent and persistent rhinits

Intermittent

< 4days/ week or Less than 4 weeks

Persistent

At least 4 days/week and for at lest 4 weeks

What’s the clinical assessment for rhinitis

Patient History

• Symptoms

• Other medical conditions and medications

• Factors that trigger or relieve symptoms

Diagnosis based on

Clinical symptoms

Worsening of symptoms on exposure to triggers

Family history of atopy (ast

Question	Relevance
Unilateral or bilateral?	Unilateral: rhinitis in general, polyps Unilateral: deviated nasal septum, foreign body and tumour Bilateral symptoms with AR develop within minutes
Seasonal Variation	Symptoms in the summer months suggest intermittent allergic rhinitis, whereas year-round symptoms suggest perennial rhinitis.
History of asthma, eczema, or intermittent allergic rhinitis in the family	If a first-degree relative suffers from atopy, intermittent allergic rhinitis is much more likel
Triggers	When pollen counts are high, symptoms of intermittent allergic rhinitis worsen. Infective rhinitis and vasomotor rhinitis will be unaffected by pollen count. Patients with persistent rhinitis might suffer from worsening symptoms when pollen counts are high, but symptoms should still persist when indoors compared with intermittent rhinitis sufferers who usually see relief of symptoms when away from pollen.

hma)

When do you refer for rhinitis

Wheezing or difficulty breathing

Ear ache or facial pain or headache

Unilateral discharge

What’s the management strategies for allergic rhinitis

Patient education

Allergen avoidance

Pharmacotherapy

What would be some of the recommendations to avoid allergens

Stay indoors, keep windows and doors closed

Wear sunglasses when outside

What is saline rinse used for

Rinse nose

Mild cases

Symptomatic relief

Keeps nose free of allergens

List the medication classes and formulations possible to treat allergic rhinitis

Antihistamines

• Systemic- oral formulations

• Topical- intranasal spray, eye drops

Corticosteroids

• Topical -intranasal spray

Decongestants

• Systemic- oral formulations

• Topical- intranasal pray/drops, eye drops

Mast cell stabilitsers

• Topical- intranasal spray, eye drops

What must you assess the patient for when dealing with rhinits

must assess patient for asthma

What does antihistamines do what are the symptoms that it alleviates

Act by blocking the effects o histamine

relieve rhinorrhoe, sneezing and itching

What are the differences between the three generations fo oral antihistamines

First generation

• Lack selectivity for H1 receptor

• Can cause significant sedation

Second generation

• Improved H1 receptor selectivity

• Cause less sedation

• Longer half life

Third generation

• Selectivity blocks peripheral histamine H1 receptor

• Cause less sedation

What are the side effects for oral antihistamines and what are the interactions

Side effects= Drowsiness

Interactions- Concurrent use of alcohol or other CNS depressants may cause additional reductions in alertness

What’s the first choice for moderate to severe allergic rhinits

Corticosteroid nasal spray

Slow onset of action

Correct administration

What are the different corticosteroid available

Fluticasone

Becolmetasone

Triamcinolone

What are the mast cell stabilizers available

Sodium cromoglicate

For where there are ocular symptoms