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Questions and Answers
What is the primary role of ocular antihistamine drops?
Which nasal treatment is considered the most effective single therapy for allergic rhinitis?
What symptom can indicate a need for nasal antihistamines?
Which of the following allergens is associated with an increased risk of asthma development in children?
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What is indicated by 'cobblestoning' in the posterior pharynx?
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What is a notable effect of oral antihistamines compared to nasal treatments?
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What causes the transverse crease across the nose observed in allergy sufferers?
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What is the expected peak age range for allergy symptom development?
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What is the main purpose of a skin prick test?
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What is a significant potential consequence of using nasal decongestants as monotherapy?
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Which treatment approach is recommended when stopping nasal decongestants?
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What typically occurs after the cessation of oxymetazoline when used alone?
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What does a positive skin prick test indicate?
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Why should nasal decongestant sprays not be used for extended periods?
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What does serum IgE testing primarily assess?
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What is often advised in conjunction with nasal decongestants to optimize treatment efficacy?
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What is the primary use of pseudoephedrine in treatment?
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Which medication is most effective for managing profuse rhinorrhea?
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What type of rhinitis is characterized by persistent symptoms throughout the year?
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In immunotherapy, what is the main purpose of gradually administering allergens over several years?
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Which of the following treatments is NOT effective for non-allergic rhinitis?
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What is the typical treatment recommendation for patients with nasal polyps?
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Which medication can be combined with a second-generation antihistamine in a single pill?
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What is the risk associated with subcutaneous and sublingual immunotherapy?
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Samter's triad is characterized by the presence of which three conditions?
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Which of the following is the first line treatment for non-allergic rhinitis?
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Study Notes
Oral Decongestant
- Supplement for nasal congestion
- Available over-the-counter
- Can be combined with second-generation antihistamines, for example, Claritin D.
- Multiple adverse effects
Montelukast
- Useful for patients with asthma
Cromolyn Sodium Intranasal Spray
- Take 4 times per day
- Can be taken throughout allergy season
Ipratropium Bromide
- Effective for managing profuse rhinorrhoea
Immunotherapy
- Administered by an allergist or immunologist
- Subcutaneous and sublingual immunotherapy
- Prevents the progression of asthma in children
- Requires weekly administration of minute allergen amounts for 2-3 years
- Dosing is gradually increased over 2-3 years to desensitize the immune system
- Customized based on allergy testing results
- Small risk of anaphylaxis
Non-Allergic Rhinitis
- Absence of allergic findings and post-nasal drip
- Symptoms often worse during winter months
- First-line treatment: Intranasal glucocorticoids + intranasal antihistamine
- Oral antihistamines are unhelpful
- Nasal ipratropium bromide is effective for managing rhinorrhoea
Nasal Polyps
- Benign, pedunculated tumors of the nasal mucosa
- Caused by chronically inflamed nasal mucosa
- Symptoms include: anosmia, nasal passage obstruction, hypo-nasal speech, mouth breathing
- Associated with Samter’s Triad: nasal polyps, aspirin sensitivity, asthma
- Often a sign of underlying nasal mucosal inflammation
- Manage underlying nasal mucosal inflammation with oral steroid, short-course if total nasal obstruction due to polyp
- ENT referral for surgical removal if total nasal obstruction
- Anterior rhinoscopy shows inflamed nasal mucosa and a polyp that resembles a peeled grape
Kawasaki Disease
- Rare, but significant immune dysfunction
- Repeated exposure to triggers like pollens, dust mite feces, animal dander, cockroaches, can lead to a release of histamine
- Characterized by fever > 101.3 degrees for five or more days
- Cardiac imaging is necessary
- Managed with antihistamine therapy: nasal antihistamines for "on-demand" use, azelastine spray for nasal congestion, ocular antihistamine drops for allergic conjunctivitis, oral antihistamine for itching, sneezing, rhinorrhea
Allergy Testing
- Skin prick test (most common) - positive result is a "wheal and flare"
- Serum IgE testing - no risk of anaphylaxis
Nasal Symptoms
- Transverse crease across the nose due to the "allergic salute"
- Rhinoscopy shows pale, boggy, blue-tinged nasal mucosa and clear nasal discharge
Allergic Rhinitis Treatment
- Nasal corticosteroids are the most effective single therapy for allergic rhinitis
- First-line treatment: Fluticasone (Flonase), Triamcinolone (Nasacort)
- More effective for nasal symptoms than oral antihistamines
- Provides relief for eye symptoms as well
- Takes several days for maximum effect
Decongestants
- Nasal decongestants are effective for nasal congestion
- Examples: Oxymetazoline
- Should be combined with nasal steroid (not monotherapy)
- Rhinitis medicamentosa: severe rebound nasal congestion following cessation of nasal decongestant spray as monotherapy
- Treatment: Start nasal glucocorticoid and gradually withdraw nasal decongestant
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Description
Test your knowledge on the pharmacological treatments for nasal congestion and related conditions. This quiz covers oral decongestants, montelukast, intranasal sprays, immunotherapy, and non-allergic rhinitis. Review the indications, adverse effects, and treatment protocols involved.
