Allergic Rhinitis (AR) Overview

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Questions and Answers

What is the most common underlying cause of allergic rhinitis?

Asthma
Exposure to environmental allergens (correct)
Genetic predisposition
Inflammation of the pharynx

What is the relationship between allergic rhinitis and other atopic conditions?

Allergic rhinitis is associated with asthma, conjunctivitis, and atopic dermatitis (correct)
Allergic rhinitis is not associated with any other atopic conditions
Allergic rhinitis is only associated with food allergies in children
Allergic rhinitis is only associated with asthma

What is the role of IgE in the pathophysiology of allergic rhinitis?

IgE is responsible for the genetic predisposition to allergic rhinitis
IgE mediates the association between allergic rhinitis and asthma
IgE triggers the inflammatory response in the nasal membranes (correct)
IgE is not involved in the pathogenesis of allergic rhinitis

What is the relationship between parental history and the risk of developing allergic rhinitis in children?

Children with both affected parents have a 50% chance of developing allergic rhinitis (B) Signup and view all the answers

At what age is the incidence of allergic rhinitis highest?

School-aged children (B) Signup and view all the answers

Which of the following is not considered a risk factor for developing allergic rhinitis?

Obesity (C) Signup and view all the answers

What is the role of inflammation in the pathogenesis of allergic rhinitis?

Inflammation is the primary cause of the symptoms of allergic rhinitis (A) Signup and view all the answers

Which of the following is not a common comorbidity associated with allergic rhinitis?

Hypertension (C) Signup and view all the answers

Which of the following is NOT a recommended goal of therapy for allergic rhinitis?

Maximize adverse effects of treatment (B) Signup and view all the answers

Which of the following is a common symptom that would indicate a need for medical evaluation rather than self-treatment of allergic rhinitis?

Unilateral symptoms (C) Signup and view all the answers

Which of the following is a common adverse effect associated with the use of intranasal saline spray or irrigation for the treatment of allergic rhinitis?

Burning or irritation (D) Signup and view all the answers

Which of the following is considered a primary prevention strategy for allergic rhinitis?

Avoidance of known allergens (D) Signup and view all the answers

Which of the following allergens is NOT specifically mentioned in the text as a common source of allergens for patients with allergic rhinitis?

Pesticides (C) Signup and view all the answers

Which of the following is NOT a recommended therapeutic approach for the management of allergic rhinitis?

Surgical intervention (A) Signup and view all the answers

Which of the following is a common symptom that would indicate the need for medical evaluation rather than self-treatment of allergic rhinitis?

Recurrent nosebleeds (B) Signup and view all the answers

Which of the following is a recommended non-pharmacological management strategy for allergic rhinitis?

Use of intranasal saline spray or irrigation (C) Signup and view all the answers

What is the PRIMARY mechanism by which topical decongestants can lead to non-allergic rhinitis when used for a prolonged period?

Rebound vasodilation and congestion (B) Signup and view all the answers

Which of the following is NOT a common symptom seen in the late reaction phase of allergic rhinitis?

Fever (D) Signup and view all the answers

Which of the following complications of allergic rhinitis is MOST likely to lead to dental overbite and high-arched palate in children?

Chronic mouth breathing (A) Signup and view all the answers

In the pathophysiology of allergic rhinitis, the ___ phase is characterized by the initial symptoms of nasal pruritus, sneezing, and minor nasal congestion.

Immediate Reaction (D) Signup and view all the answers

Which of the following is the LEAST likely to be a symptom of the late reaction phase in allergic rhinitis?

Fever (A) Signup and view all the answers

Which of the following is the MOST important factor to consider when differentiating allergic rhinitis from other upper respiratory tract conditions?

Timing and seasonality of symptoms (B) Signup and view all the answers

Which of the following is the LEAST likely to be a complication of allergic rhinitis?

Myocardial infarction (A) Signup and view all the answers

Which symptom is more commonly associated with animal and outdoor allergens in patients with allergic rhinitis?

Eye Symptoms (A) Signup and view all the answers

In children with allergic rhinitis, what dental issue may develop due to chronic mouth breathing?

Overbite (A) Signup and view all the answers

What is the onset of action for intranasal corticosteroids?

Within 6-8 hours (C) Signup and view all the answers

Why are intranasal corticosteroids preferred over oral and intranasal antihistamines for moderate to severe allergic rhinitis?

Higher effectiveness against nasal symptoms (A) Signup and view all the answers

In what cases are short courses of oral corticosteroids typically required for allergic rhinitis?

Severe cases unresponsive to other treatment (C) Signup and view all the answers

What is the recommended dosing regimen for intranasal corticosteroids?

Regular use (D) Signup and view all the answers

Why might patients prefer intranasal corticosteroids in aerosol form over spray form?

Improved tolerability (A) Signup and view all the answers

What is the most beneficial therapeutic approach to persistent allergic rhinitis symptoms that do not respond to one antihistamine?

Switching to another antihistamine (C) Signup and view all the answers

Which allergy symptom can some intranasal corticosteroids like mometasone and fluticasone furoate modestly benefit?

Ocular symptoms (C) Signup and view all the answers

Which of the following statements about the management of allergic rhinitis is correct?

Patients should be referred for further assessment if they have unilateral symptoms or signs not typically associated with allergic rhinitis. (C) Signup and view all the answers

Which of the following measures has been shown to effectively reduce allergic symptoms associated with house dust mites?

All of the above measures have been shown to effectively reduce allergic symptoms associated with house dust mites. (D) Signup and view all the answers

Which of the following statements about environmental control measures for outdoor mould allergens is correct?

Keeping air conditioning units on recirculate or the indoor cycle can help reduce mould exposure. (B) Signup and view all the answers

Which of the following statements about pollen avoidance measures is NOT true according to the text?

Using window or attic fans is recommended to circulate outdoor air and reduce indoor pollen levels. (D) Signup and view all the answers

Which of the following is NOT a recommended measure for reducing indoor mould growth?

Keeping houseplants, which are a common source of mould. (A) Signup and view all the answers

Which of the following statements about the benefits of environmental control measures for allergic rhinitis is correct?

While some measures have been shown to reduce allergen levels, a corresponding reduction in allergic symptoms has not been demonstrated. (D) Signup and view all the answers

Which of the following statements about the prevention of allergic rhinitis is correct?

Prevention is the first step in the management of allergic rhinitis, but little evidence supports individual measures. (A) Signup and view all the answers

Which of the following statements about the management of house dust mite allergens is NOT supported by the information in the text?

Replacing old mattresses is unnecessary if they are encased in allergen-proof casings. (A) Signup and view all the answers

Which of the following statements regarding the management of animal allergens in allergic rhinitis is incorrect?

Placing litter boxes in areas connected to the home's air supply is recommended to minimize allergen exposure. (C) Signup and view all the answers

Which of the following statements regarding the use of saline irrigation for allergic rhinitis is correct?

Unused saline should be discarded at the end of each day or subjected to heat sterilization before reuse. (B) Signup and view all the answers

Which of the following statements regarding the use of antihistamines for allergic rhinitis is incorrect?

Antihistamines are recommended as first-line therapy for moderate to severe persistent allergic rhinitis. (B) Signup and view all the answers

Which of the following statements regarding the avoidance of occupational allergens in allergic rhinitis is correct?

Individuals affected by occupational rhinitis should minimize or eliminate exposure to common causes such as animal or vegetable proteins, enzymes, pharmaceuticals, and chemicals. (A) Signup and view all the answers

Which of the following statements regarding the avoidance of irritants in allergic rhinitis is correct?

Tobacco smoke, insect sprays, air pollution, and fresh tar or paint should be avoided by all patients with allergic rhinitis. (A) Signup and view all the answers

Which of the following statements regarding the use of saline irrigation for allergic rhinitis is incorrect?

The optimal dose, frequency, and delivery method for saline irrigation have been well-established and standardized. (D) Signup and view all the answers

Which of the following statements about second-generation antihistamines is accurate?

They are generally recommended over first-generation antihistamines due to their improved adverse effect profile. (D) Signup and view all the answers

Which of the following statements accurately describes the role of antihistamines in the treatment of allergic rhinitis?

Antihistamines decrease nasal itching, sneezing, rhinorrhea, conjunctival itching, and lacrimation, but generally do not relieve nasal congestion. (C) Signup and view all the answers

Which of the following statements accurately describes the adverse effects of first-generation antihistamines?

They should be used with caution in patients with cardiovascular disease or chronic lung disease due to their potential to cause tachycardia. (C) Signup and view all the answers

Which of the following statements accurately describes the mechanism of action of antihistamines in the treatment of allergic rhinitis?

They act as competitive antagonists for the histamine-1 (H1) receptor and change the receptor's three-dimensional configuration, decreasing its affinity for histamine. (D) Signup and view all the answers

According to the information provided, which of the following statements regarding the use of intranasal antihistamines is accurate?

The intranasal antihistamine azelastine is clinically similar to oral second-generation antihistamines for the relief of nasal symptoms. (A) Signup and view all the answers

Which of the following statements accurately describes the recommended treatment approach for persistent allergic rhinitis (PAR)?

If intranasal corticosteroids are not effective for moderate to severe PAR, combination therapy with intranasal antihistamines is recommended. (B) Signup and view all the answers

According to the information provided, which of the following statements about the efficacy of antihistamines compared to intranasal corticosteroids is accurate?

Two meta-analyses demonstrated that intranasal corticosteroids were more effective than antihistamines for relieving congestion and sneezing. (B) Signup and view all the answers

What distinguishes sodium cromoglycate from corticosteroids in the treatment of allergic rhinitis?

It is less effective for symptom reduction (B) Signup and view all the answers

Why are decongestants recommended cautiously for allergic rhinitis patients?

They may worsen nasal congestion in the long term (B) Signup and view all the answers

Why should decongestants be used adjunctively for allergic rhinitis with caution?

They can lead to systemic adverse effects (A) Signup and view all the answers

What is recommended for patients with allergic rhinitis who have an inadequate response to monotherapy?

Combination therapy (D) Signup and view all the answers

Why might some experts suggest using a first-generation antihistamine at bedtime for allergic rhinitis?

To promote sleep (C) Signup and view all the answers

Intranasal budesonide and mometasone have NOT been shown to cause which of the following with prolonged use at recommended doses?

Growth suppression (B) Signup and view all the answers

What is a concern regarding the long-term safety of butterbur?

Hepatic injury risk (A) Signup and view all the answers

Why is it not recommended to use a combination of oral antihistamines and intranasal corticosteroids for initial management of allergic rhinitis?

Insufficient evidence for effectiveness (C) Signup and view all the answers

Which natural health product has shown efficacy in randomized controlled trials but is not available in North America?

Butterbur (C) Signup and view all the answers

Which type of decongestant is least likely to cause rebound nasal congestion when used for an extended period?

Topical oxymetazoline (C) Signup and view all the answers

Which statement regarding the use of montelukast for allergic rhinitis is MOST accurate?

Montelukast is more effective than intranasal corticosteroids for reducing asthma symptoms in patients with coexisting allergic rhinitis and asthma. (C) Signup and view all the answers

Which of the following is the MOST likely reason why intranasal corticosteroids are preferred over oral and intranasal antihistamines for moderate to severe allergic rhinitis?

Intranasal corticosteroids are more effective at reducing nasal congestion. (C) Signup and view all the answers

Which of the following statements regarding the use of topical decongestants for allergic rhinitis is MOST accurate?

Topical decongestants are more effective than oral decongestants for relieving nasal obstruction. (D) Signup and view all the answers

Which of the following statements about the use of allergen immunotherapy for allergic rhinitis is MOST accurate?

Allergen immunotherapy is the only treatment that can modify the natural history of allergic rhinitis. (A) Signup and view all the answers

Which of the following statements regarding the use of saline irrigation for allergic rhinitis is CORRECT?

Saline irrigation can effectively reduce the need for intranasal corticosteroids. (A) Signup and view all the answers

Which of the following is the LEAST likely to be a complication of untreated or poorly controlled allergic rhinitis?

Increased risk of cardiovascular disease (B) Signup and view all the answers

Which of the following statements regarding the management of animal allergens in allergic rhinitis is INCORRECT?

Replacing carpets with hard flooring is not an effective measure for reducing animal allergens. (D) Signup and view all the answers

Which of the following statements regarding the use of intranasal corticosteroids during pregnancy is accurate?

Beclomethasone, budesonide, and fluticasone propionate have accumulated more safety data than other intranasal corticosteroids during pregnancy. (A) Signup and view all the answers

Which of the following statements regarding the use of antihistamines during breastfeeding is accurate?

Both first- and second-generation antihistamines are considered safe during breastfeeding, with the potential for infant somnolence being monitored. (B) Signup and view all the answers

Which of the following statements regarding the use of decongestants during pregnancy is correct?

Oral decongestants should be avoided in the first trimester, but topical decongestants may be used as they do not present a risk to the fetus. (B) Signup and view all the answers

Which of the following statements regarding the use of immunotherapy during pregnancy is accurate?

Courses of immunotherapy started prior to conception may be continued if beneficial and not causing systemic reactions, but doses should not be increased during pregnancy. (A) Signup and view all the answers

Which of the following statements regarding the use of montelukast for allergic rhinitis during pregnancy is accurate?

Montelukast may be a reasonable option for allergic rhinitis coexisting with asthma during pregnancy, but monitoring for neuropsychiatric adverse effects is warranted. (D) Signup and view all the answers

Which of the following statements regarding the use of bilastine and rupatadine during pregnancy and breastfeeding is correct?

If possible, bilastine and rupatadine should be avoided during pregnancy and breastfeeding as no adequate nor well-controlled studies have taken place. (A) Signup and view all the answers

Which of the following statements regarding the use of topical sodium cromoglycate during breastfeeding is accurate?

The manufacturer recommends caution when using topical sodium cromoglycate during breastfeeding, although specific information on its use is not available. (B) Signup and view all the answers

Which of the following statements regarding the use of pseudoephedrine during breastfeeding is correct?

The American Academy of Pediatrics considers pseudoephedrine to be compatible with breastfeeding. (B) Signup and view all the answers

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Study Notes

Allergic Rhinitis (AR) is a symptomatic nose disorder caused by inflammation triggered by allergen exposure in sensitized individuals and mediated by IgE.
AR is associated with asthma, conjunctivitis, atopic dermatitis, and food allergies in children.
Approximately 7 million Canadians (~20% of the population) are affected by AR, with the highest incidence in school-aged children and increasing prevalence with age.
Children with one affected parent have a 30% chance of developing AR, while those with both affected parents have a 50% chance.
Symptoms that may indicate the need for further evaluation in AR include fever, purulent nasal or ocular secretions, facial pain, loss of taste or smell, and more.
The therapeutic approach for AR aims to provide relief of signs and symptoms, prevent symptoms through daily allergen avoidance, minimize treatment adverse effects, and improve quality of life.
Non-pharmacological management options for AR include saline formulations like isotonic and hypertonic solutions, which can help reduce symptoms and the need for pharmacologic therapy.

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