Podcast
Questions and Answers
What is allergic rhinitis primarily characterized by?
What is allergic rhinitis primarily characterized by?
Which type of allergic rhinitis occurs due to perennial exposure to allergens?
Which type of allergic rhinitis occurs due to perennial exposure to allergens?
Which allergen is most commonly associated with seasonal allergic rhinitis in late summer to early fall?
Which allergen is most commonly associated with seasonal allergic rhinitis in late summer to early fall?
What is a significant factor associated with the higher risk of developing allergic rhinitis?
What is a significant factor associated with the higher risk of developing allergic rhinitis?
Signup and view all the answers
Which of the following medications is a common cause of drug-induced rhinitis?
Which of the following medications is a common cause of drug-induced rhinitis?
Signup and view all the answers
What is NOT a characteristic function of the nasal cavity?
What is NOT a characteristic function of the nasal cavity?
Signup and view all the answers
Episodic allergic rhinitis occurs due to what type of exposure?
Episodic allergic rhinitis occurs due to what type of exposure?
Signup and view all the answers
Which first generation antihistamines are likely to cause the most sedation?
Which first generation antihistamines are likely to cause the most sedation?
Signup and view all the answers
What is the primary mechanism by which corticosteroids exert their effects in allergic rhinitis?
What is the primary mechanism by which corticosteroids exert their effects in allergic rhinitis?
Signup and view all the answers
Which of the following best describes desloratadine's relationship to loratadine?
Which of the following best describes desloratadine's relationship to loratadine?
Signup and view all the answers
What risk is associated with systemic corticosteroids that is not present with intranasal or ophthalmic corticosteroids?
What risk is associated with systemic corticosteroids that is not present with intranasal or ophthalmic corticosteroids?
Signup and view all the answers
How do α-1 adrenergic agonists relieve nasal congestion?
How do α-1 adrenergic agonists relieve nasal congestion?
Signup and view all the answers
What is the primary function of mucous membranes?
What is the primary function of mucous membranes?
Signup and view all the answers
How do nasal turbinates influence airflow in the nasal cavity?
How do nasal turbinates influence airflow in the nasal cavity?
Signup and view all the answers
Which type of hypersensitivity reaction involves autoantibodies causing tissue injury?
Which type of hypersensitivity reaction involves autoantibodies causing tissue injury?
Signup and view all the answers
What are the roles of eosinophils in allergic reactions?
What are the roles of eosinophils in allergic reactions?
Signup and view all the answers
Which definition is correct for sensitization in the context of allergens?
Which definition is correct for sensitization in the context of allergens?
Signup and view all the answers
Which of the following best describes an allergen?
Which of the following best describes an allergen?
Signup and view all the answers
During the process of allergic rhinitis, which immune response phase involves the release of histamine?
During the process of allergic rhinitis, which immune response phase involves the release of histamine?
Signup and view all the answers
What immune cells are primarily involved in type I hypersensitivity reactions?
What immune cells are primarily involved in type I hypersensitivity reactions?
Signup and view all the answers
Which of the following is an example of a type III hypersensitivity reaction?
Which of the following is an example of a type III hypersensitivity reaction?
Signup and view all the answers
What is the recommended household humidity level to reduce mold growth in patients with allergic rhinitis?
What is the recommended household humidity level to reduce mold growth in patients with allergic rhinitis?
Signup and view all the answers
Which counseling point is NOT recommended for intranasal drug delivery?
Which counseling point is NOT recommended for intranasal drug delivery?
Signup and view all the answers
Which of the following drugs is classified as a First Generation Antihistamine?
Which of the following drugs is classified as a First Generation Antihistamine?
Signup and view all the answers
What is a primary advantage of intranasal drug delivery for allergic rhinitis management?
What is a primary advantage of intranasal drug delivery for allergic rhinitis management?
Signup and view all the answers
How do First Generation Antihistamines primarily differ from Second Generation Antihistamines?
How do First Generation Antihistamines primarily differ from Second Generation Antihistamines?
Signup and view all the answers
Which of the following is a common adverse effect of First Generation Antihistamines?
Which of the following is a common adverse effect of First Generation Antihistamines?
Signup and view all the answers
Which counseling point is essential for reducing allergic rhinitis triggers in the home?
Which counseling point is essential for reducing allergic rhinitis triggers in the home?
Signup and view all the answers
What potential side effect may occur when using intranasal antihistamines?
What potential side effect may occur when using intranasal antihistamines?
Signup and view all the answers
What is the pharmacologic effect of H1 receptor blockade in the peripheral nervous system?
What is the pharmacologic effect of H1 receptor blockade in the peripheral nervous system?
Signup and view all the answers
What is the primary function of TH2 cells in the context of allergic rhinitis?
What is the primary function of TH2 cells in the context of allergic rhinitis?
Signup and view all the answers
Which mechanism does histamine use to elicit symptoms in allergic rhinitis?
Which mechanism does histamine use to elicit symptoms in allergic rhinitis?
Signup and view all the answers
What is a common symptom associated with the late phase of allergic rhinitis?
What is a common symptom associated with the late phase of allergic rhinitis?
Signup and view all the answers
What physical exam finding is commonly associated with allergic rhinitis?
What physical exam finding is commonly associated with allergic rhinitis?
Signup and view all the answers
Which of the following is NOT considered a complication of allergic rhinitis?
Which of the following is NOT considered a complication of allergic rhinitis?
Signup and view all the answers
What role does prostaglandins play in the early phase of allergic reactions?
What role does prostaglandins play in the early phase of allergic reactions?
Signup and view all the answers
Which allergen test is the most sensitive and fastest in determining allergies?
Which allergen test is the most sensitive and fastest in determining allergies?
Signup and view all the answers
What physiological change mainly contributes to nasal congestion during an allergic reaction?
What physiological change mainly contributes to nasal congestion during an allergic reaction?
Signup and view all the answers
Which symptom is commonly noted during a physical exam of a patient with allergic rhinitis?
Which symptom is commonly noted during a physical exam of a patient with allergic rhinitis?
Signup and view all the answers
What mechanism leads to the sensation of nasal itching during an allergic reaction?
What mechanism leads to the sensation of nasal itching during an allergic reaction?
Signup and view all the answers
What is the primary goal of immunotherapy in allergic rhinitis treatment?
What is the primary goal of immunotherapy in allergic rhinitis treatment?
Signup and view all the answers
What is a notable disadvantage of subcutaneous immunotherapy (SCIT) compared to other treatments?
What is a notable disadvantage of subcutaneous immunotherapy (SCIT) compared to other treatments?
Signup and view all the answers
Which adverse effect could be considered the most severe in subcutaneous immunotherapy?
Which adverse effect could be considered the most severe in subcutaneous immunotherapy?
Signup and view all the answers
What is the recommended timing to start sublingual immunotherapy for effective results?
What is the recommended timing to start sublingual immunotherapy for effective results?
Signup and view all the answers
What specific aspect of immunotherapy contributes to long-lasting clinical benefits even after discontinuation?
What specific aspect of immunotherapy contributes to long-lasting clinical benefits even after discontinuation?
Signup and view all the answers
What type of hypersensitivity reaction is characterized by an IgE antibody and mast cell-mediated response?
What type of hypersensitivity reaction is characterized by an IgE antibody and mast cell-mediated response?
Signup and view all the answers
Which type of hypersensitivity reaction primarily involves antibodies that are typically self-reactive?
Which type of hypersensitivity reaction primarily involves antibodies that are typically self-reactive?
Signup and view all the answers
Acute infectious conjunctivitis, commonly referred to as pinkeye, is caused by which type of organism?
Acute infectious conjunctivitis, commonly referred to as pinkeye, is caused by which type of organism?
Signup and view all the answers
Which of the following best describes the role of the conjunctiva in eye health?
Which of the following best describes the role of the conjunctiva in eye health?
Signup and view all the answers
What are immune complexes associated with in type III hypersensitivity reactions?
What are immune complexes associated with in type III hypersensitivity reactions?
Signup and view all the answers
What common symptom is associated with allergic conjunctivitis?
What common symptom is associated with allergic conjunctivitis?
Signup and view all the answers
Which type of immune response category does not primarily involve antibodies?
Which type of immune response category does not primarily involve antibodies?
Signup and view all the answers
What is a primary method to reduce mold growth in households for individuals with allergic rhinitis?
What is a primary method to reduce mold growth in households for individuals with allergic rhinitis?
Signup and view all the answers
What is a recommended practice to minimize exposure to dust mites?
What is a recommended practice to minimize exposure to dust mites?
Signup and view all the answers
Which of the following represents an effective nonpharmacotherapy approach for patients with seasonal allergic rhinitis?
Which of the following represents an effective nonpharmacotherapy approach for patients with seasonal allergic rhinitis?
Signup and view all the answers
What benefit does intranasal drug delivery for allergic rhinitis provide?
What benefit does intranasal drug delivery for allergic rhinitis provide?
Signup and view all the answers
Which type of filter is effective in removing dust mite allergen but has limited effect on heavy allergens?
Which type of filter is effective in removing dust mite allergen but has limited effect on heavy allergens?
Signup and view all the answers
For patients preferring nonpharmacotherapy, what alternative treatment may be considered for allergic rhinitis?
For patients preferring nonpharmacotherapy, what alternative treatment may be considered for allergic rhinitis?
Signup and view all the answers
To effectively manage allergic conjunctivitis, which method can be utilized?
To effectively manage allergic conjunctivitis, which method can be utilized?
Signup and view all the answers
What is the role of nasal irrigation in managing allergic rhinitis?
What is the role of nasal irrigation in managing allergic rhinitis?
Signup and view all the answers
What should individuals with allergic rhinitis avoid to reduce their symptoms during pollen season?
What should individuals with allergic rhinitis avoid to reduce their symptoms during pollen season?
Signup and view all the answers
What is one of the main effects of corticosteroids in the nasal tissue of patients with allergic rhinitis?
What is one of the main effects of corticosteroids in the nasal tissue of patients with allergic rhinitis?
Signup and view all the answers
Which ophthalmic corticosteroid is recommended for allergic conjunctivitis due to its reduced risk of increasing intraocular pressure?
Which ophthalmic corticosteroid is recommended for allergic conjunctivitis due to its reduced risk of increasing intraocular pressure?
Signup and view all the answers
What is a potential consequence of using oral corticosteroids for allergic rhinitis?
What is a potential consequence of using oral corticosteroids for allergic rhinitis?
Signup and view all the answers
What action should be taken regarding contact lenses when using ophthalmic corticosteroids?
What action should be taken regarding contact lenses when using ophthalmic corticosteroids?
Signup and view all the answers
Which of the following actions do corticosteroids specifically NOT perform in the treatment of allergic rhinitis?
Which of the following actions do corticosteroids specifically NOT perform in the treatment of allergic rhinitis?
Signup and view all the answers
What characteristic distinguishes Loteprednol from other ophthalmic corticosteroids?
What characteristic distinguishes Loteprednol from other ophthalmic corticosteroids?
Signup and view all the answers
In allergic conjunctivitis, which of the following pharmacological classes is preferred over corticosteroids?
In allergic conjunctivitis, which of the following pharmacological classes is preferred over corticosteroids?
Signup and view all the answers
Why are intranasal corticosteroids generally preferred for managing allergic rhinitis over oral corticosteroids?
Why are intranasal corticosteroids generally preferred for managing allergic rhinitis over oral corticosteroids?
Signup and view all the answers
Which of the following best describes the duration for a typical short course of oral corticosteroids for severe nasal symptoms?
Which of the following best describes the duration for a typical short course of oral corticosteroids for severe nasal symptoms?
Signup and view all the answers
What is a significant potential consequence of using ophthalmic vasoconstrictors for more than ten days?
What is a significant potential consequence of using ophthalmic vasoconstrictors for more than ten days?
Signup and view all the answers
Which population is least susceptible to adverse effects from systemic activation of α1-adrenergic receptors by decongestants?
Which population is least susceptible to adverse effects from systemic activation of α1-adrenergic receptors by decongestants?
Signup and view all the answers
What is the recommended maximum duration for the use of intranasal decongestants to avoid rhinitis medicamentosa?
What is the recommended maximum duration for the use of intranasal decongestants to avoid rhinitis medicamentosa?
Signup and view all the answers
Which method is advised regarding the use of contact lenses when applying ophthalmic vasoconstrictors?
Which method is advised regarding the use of contact lenses when applying ophthalmic vasoconstrictors?
Signup and view all the answers
Which type of decongestant is known for potentially causing significant systemic side effects?
Which type of decongestant is known for potentially causing significant systemic side effects?
Signup and view all the answers
What is a primary function of oral decongestants in treating symptoms?
What is a primary function of oral decongestants in treating symptoms?
Signup and view all the answers
What adverse effect can result from using ophthalmic vasoconstrictors?
What adverse effect can result from using ophthalmic vasoconstrictors?
Signup and view all the answers
Which condition is linked to the potential adverse effects from decongestants that stimulate α1-adrenergic receptors?
Which condition is linked to the potential adverse effects from decongestants that stimulate α1-adrenergic receptors?
Signup and view all the answers
What is the recommended practice for using intranasal decongestants when significant nasal mucosal edema is present?
What is the recommended practice for using intranasal decongestants when significant nasal mucosal edema is present?
Signup and view all the answers
What should be the course of action if allergic conjunctivitis is not relieved by other treatments?
What should be the course of action if allergic conjunctivitis is not relieved by other treatments?
Signup and view all the answers
Study Notes
Allergic Rhinitis Definitions
- Rhinitis: Inflammation of the nasal mucous membrane, causing nasal congestion, rhinorrhea, sneezing, and itching
- Allergic Rhinitis: An IgE-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens
- Allergic Conjunctivitis: Inflammation of the conjunctiva, characterized by itching, redness, and tearing, caused by an IgE-mediated response
Allergic Rhinitis Types
- Seasonal Allergic Rhinitis: Allergic response to allergens present at specific times of the year (e.g., tree, grass, weed pollens)
- Perennial Allergic Rhinitis: Allergic response to year-round allergens (e.g., mold spores, house dust mites, animal dander, cockroaches)
- Episodic Allergic Rhinitis: Allergic response to allergens encountered sporadically, not commonly present in a patient's environment.
Allergens in Different Rhinitis Types
- Seasonal Allergic Rhinitis: Caused by tree pollens (spring), grass pollens (late spring-early summer), and weed pollens (late summer-early fall)
- Perennial Allergic Rhinitis: Caused by mold spores, house dust mite fecal proteins, animal dander, and cockroaches
Allergic Rhinitis Symptoms Prediction
- Spring: Tree pollens
- Late Spring/Early Summer: Grass pollens
- Late Summer/Early Fall: Weed pollens
Risk Factors for Allergic Rhinitis
- Family history of atopy
- Higher socioeconomic status
- Higher serum IgE levels (>100 IU/mL) before age six
- Positive allergy skin prick test
Drug-Induced Rhinitis
- ACE inhibitors
- Aspirin and NSAIDs
- a-receptor antagonists
- Clonidine
- Guanfacine
- Phosphodiesterase-5 selective inhibitors
Nasal Cavity Structure and Function
- The nasal cavity provides an airway for respiration, moistens and warms inspired air (while cleaning and filtering it).
- It serves as a resonating chamber for speech and houses olfactory receptors.
- The nasal cavity is lined with mucous membrane containing goblet cells and serous glands that trap and destroy bacteria.
Mucous Membrane Structure and Function
- The mucous membrane is an epithelium supported by connective tissue, coated with mucus
- Mucus secreted by goblet cells traps dust, bacteria, and debris.
- Serous fluid containing lysozyme destroys trapped bacteria, while mucus traps debris and bacteria.
Nasal Turbinates and Airflow
- Nasal turbinates (conchae) are mucosal projections that increase surface area
- Swollen turbinates reduce airflow
Conjunctiva Structure and Function
- Thin, transparent mucous membrane lining the eyelids and covering the visible part of the eye.
- Secretes oils and mucus to lubricate the eye
Hypersensitivity Reactions
- Type I (Immediate Hypersensitivity): IgE-mediated (e.g., allergic rhinitis, food allergies)
- Type II (Antibody-Mediated): Autoantibodies cause tissue injury (e.g., Graves' disease)
- Type III (Immune Complex-Mediated): Immune complexes cause inflammation (e.g., systemic lupus erythematosus)
- Type IV (T cell-Mediated): T cells mediate autoimmune reactions (e.g., type 1 diabetes mellitus)
Allergen Definition
- Allergen: A protein that elicits an allergic response
Sensitization
- Sensitization: Process by which an individual becomes sensitive to an allergen
- APCs present allergen to CD4 T cells, activating B cells and producing IgE
- IgE binds to mast cells and basophils, sensitizing them to future allergen exposure
Roles of Mast Cells, Basophils, and Eosinophils
- Mast Cells: Release histamine and other mediators during allergic reactions
- Basophils: Similar to mast cells, they release histamine upon activation
- Eosinophils: Release toxic proteins that contribute to tissue damage and inflammation
Allergic Rhinitis Phases
- Early Phase: Occurs within minutes; involves mast cell degranulation, histamine, prostaglandins, and leukotrienes release
- Late Phase: Occurs 4-8 hours later; involves recruitment of eosinophils and TH2 cells, causing prolonged inflammation
Rhinitis Symptoms
- Symptoms: Clear nasal discharge, sneezing, nasal congestion, itchy nose, palate, and ears, allergic conjunctivitis
- Physical exam findings: Transverse nasal crease, allergic shiners, pale nasal mucosa
Allergic Rhinitis Complications
- Sleep disturbance (inability to sleep)
- Fatigue
- Poor work or school performance
- Postnasal drip and cough
- Loss of taste or smell
- High-arched or V-shaped palate
- Permanent transverse crease across the nose
- Dark circles under the eyes
Allergen Testing
- Epicutaneous skin test (scratch/prick test): Fast, least expensive; positive within 15-30 minutes
- Intradermal skin test: More complex for testing allergens requiring a larger dose. Used if epicutaneous tests are negative.
- Radioallergosorbent test (RAST): In vitro, more expensive, less sensitive than skin tests
Nonpharmacological Patient Counseling
- Identify and avoid triggers
- Reduce mold growth (keep household humidity below 50%)
- Use impermeable covers for mattresses and pillows
- Wash bed linens in hot water
- Use washable rugs instead of carpeting
- Use HEPA filters to remove allergens
- Wear masks during outdoor activities during pollen seasons
Intranasal Drug Delivery Rationale
- Delivers medication directly to the site of inflammation
- Minimizes systemic drug exposure
Patient Counseling for Intranasal Drug Delivery
- Clear nasal passages before administration
- Avoid blowing the nose for 10 min after administration
- Avoid directing the spray away from the nasal septum
- Do not use in patients with recent nasal surgery
Local Intranasal Drug Effects and Potential Interactions
- Local irritation may occur initially
Pharmacologic Classes of Drugs for Allergic Rhinitis
- First-generation antihistamines: Diphenhydramine, Chlorpheniramine
- Second-generation antihistamines: Loratadine, Cetirizine
- Intranasal antihistamines: Azelastine
- Intranasal corticosteroids: Fluticasone, Mometasone
- Mast cell stabilizer: Cromolyn
- Sympathomimetic decongestants: Pseudoephedrine, Phenylephrine
- Leukotriene receptor antagonist: Montelukast
H1 Receptor Blockade Effects
- Peripheral: Reduces allergic symptoms
- Central: Causes sedation and drowsiness
First vs. Second-Generation Antihistamines
- First-generation: Cross the blood-brain barrier, cause sedation, and block muscarinic receptors, leading to anticholinergic effects
- Second-generation: Do not cross blood-brain barrier, less sedative, minimal anticholinergic effects
Antihistamine Chemical Classifications
- Ethanolamine Ether: Diphenhydramine
- Alkyl Amine: Chlorpheniramine
- Phenothiazine: Promethazine
Loratadine and Desloratadine Relationship
- Desloratadine is loratadine's active metabolite, formed via CYP3A4 metabolism.
Antihistamine Sedative Effects Ranking
- Most sedating: Promethazine, Diphenhydramine
- Least sedating: Brompheniramine, Chlorpheniramine
a-Adrenergic Receptor Activation Effects
- Causes vasoconstriction, reducing blood flow, and congestion
Vasoconstriction Effective Congestion Relief Mechanism
- Binding to a-1 receptors in vascular smooth muscle, causing vasoconstriction, and reducing nasal swelling
Neurotransmitters Mimicked by Pseudoephedrine/Phenylephrine
- Mimic norepinephrine and epinephrine, selectively stimulating alpha-1 receptors to reduce nasal congestion
Rhinitis Medicamentosa/Conjunctivitis Medicamentosa Definitions
- Rhinitis Medicamentosa: Rebound congestion from prolonged intranasal decongestant use
- Conjunctivitis Medicamentosa: Rebound hyperemia from prolonged ophthalmic vasoconstrictor use
Corticosteroid Mechanisms and Effects
- Block immune mediator release,
- reduce neutrophil chemotaxis,
- decrease edema
- Inhibit mast cell-mediated reactions
Corticosteroid Risk HPA Axis Suppression Ranking
- Systemic: High risk of HPA axis suppression.
- Intranasal and Ophthalmic: Minimal risk due to low systemic absorption
Oral Pseudoephedrine vs. Phenylephrine Effectiveness
- Pseudoephedrine undergoes less first-pass metabolism than phenylephrine, providing higher biovailability
Intranasal vs. Oral Antihistamine Mechanisms
- Intranasal: Localized action, additional mast cell-stabilizing effects.
- Oral: Act systemically
Immunotherapy for Allergic Rhinitis
- Adverse effects: Local reactions, anaphylaxis
- Good candidates: Severe symptoms unresponsive to other treatments
- Poor candidates: Uncontrolled asthma, cardiovascular disease.
Subcutaneous vs. Sublingual Immunotherapy
- Subcutaneous: More allergens covered, longer-lasting effects (via injections)
- Sublingual: No injections, can be administered at home
Antihistamine Metabolism and Interactions
- Second-generation antihistamines are metabolized by CYP3A4
- Inhibitors of CYP3A4 increase second-generation antihistamine levels
- CNS depressants (e.g., ethanol, benzodiazepines) can interact with antihistamines, potentiating sedation.
Complementary Medications for Allergic Rhinitis
- Butterbur: Decreases histamine and leukotriene levels
- Tinospora cordifolia: Reduces mast cell histamine release
Allergic Rhinitis Drug Choices and Pregnancy
- Second-generation antihistamines (loratadine, cetirizine)
- Intranasal corticosteroids (budesonide)
- Intranasal cromolyn
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
