Respiratory Disorders: Allergic Rhinitis & Sore Throat
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Questions and Answers

What is an effective method to manage dust mite exposure in the home?

  • Control humidity (correct)
  • Use of air purifiers
  • Increase household temperature
  • Seal off bedrooms
  • Which indoor mold is specifically mentioned as a common allergen?

  • Aspergillus
  • Penicillium (correct)
  • Alternaria
  • Cladosporium
  • What is the primary allergenic protein found in cats?

  • Der f 1
  • Fel d 1 (correct)
  • Gal d 1
  • Can f 1
  • During which season is ragweed pollen most prevalent?

    <p>Autumn (D)</p> Signup and view all the answers

    What is a recommended strategy to minimize pollen exposure during peak season?

    <p>Use air conditioning and filters (C)</p> Signup and view all the answers

    What is the best way to handle outdoor molds to minimize exposure?

    <p>Do not disturb decaying plant material (A)</p> Signup and view all the answers

    What action is NOT recommended to reduce pet-derived allergens?

    <p>Install new carpeting (A)</p> Signup and view all the answers

    What is the suggested activity to do before bed to reduce pollen exposure?

    <p>Shower to remove pollen (A)</p> Signup and view all the answers

    Which type of allergic rhinitis is characterized by symptoms that worsen in specific seasons?

    <p>Seasonal allergic rhinitis (C)</p> Signup and view all the answers

    What risk factor is NOT associated with allergic rhinitis?

    <p>Low socioeconomic level (D)</p> Signup and view all the answers

    During which phase of allergic rhinitis does the initial IgE production occur?

    <p>Sensitization phase (C)</p> Signup and view all the answers

    What common environmental trigger is associated with allergic rhinitis?

    <p>Ozone (B)</p> Signup and view all the answers

    Which group of individuals is least likely to be diagnosed with allergic rhinitis?

    <p>Senior citizens over 65 years old (B), Children under 2 years old (C)</p> Signup and view all the answers

    What occurs during the early phase of allergic rhinitis?

    <p>Release of histamine from mast cells (A)</p> Signup and view all the answers

    What dietary habit may increase the incidence of allergic disorders in children and adolescents?

    <p>Consuming at least 3 fast food meals per week (B)</p> Signup and view all the answers

    Which phase of allergic rhinitis begins 2-4 hours after allergen exposure?

    <p>Late phase (A)</p> Signup and view all the answers

    What is indicated by 'Allergic shiners' in allergic rhinitis?

    <p>It describes subcutaneous venodilation leading to infraorbital edema. (C)</p> Signup and view all the answers

    Which of the following describes intermittent allergic rhinitis?

    <p>Symptoms occur 4 days or less per week or 4 weeks or less in duration. (B)</p> Signup and view all the answers

    Which condition is NOT a chronic complication of allergic rhinitis?

    <p>Otitis media with effusion (C)</p> Signup and view all the answers

    Which symptom is considered a hallmark of moderate to severe allergic rhinitis?

    <p>Sleep disturbance (B)</p> Signup and view all the answers

    What does 'Allergic salute' refer to in the context of allergic rhinitis?

    <p>An upward swipe of the tip of the nose with the palm of the hand. (B)</p> Signup and view all the answers

    What characterizes persistent allergic rhinitis?

    <p>Symptoms occur more than 4 days per week and last more than 4 weeks. (A)</p> Signup and view all the answers

    Which component is NOT one of the treatment goals for allergic rhinitis?

    <p>Preventing colds (A)</p> Signup and view all the answers

    Which option describes the purpose of immunotherapy in allergic rhinitis treatment?

    <p>Used when severe symptoms are uncontrollable with medications. (A)</p> Signup and view all the answers

    Episodic allergic rhinitis is associated with which of the following conditions?

    <p>Contact with allergens not usually present in the person's environment. (B)</p> Signup and view all the answers

    What is the primary cause of 'Dennie-Morgan lines' observed in patients with allergic rhinitis?

    <p>Infraorbital edema. (C)</p> Signup and view all the answers

    What is a common symptom of allergic rhinitis that can affect both the eyes and nose?

    <p>Conjunctivitis (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic symptom of allergic rhinitis?

    <p>Pruritus of the fingers (A)</p> Signup and view all the answers

    What environmental factors allow dust mites to thrive?

    <p>Warm and humid environments. (C)</p> Signup and view all the answers

    Which of the following is NOT a symptom associated with nasal obstruction in allergic rhinitis?

    <p>Facial pain (B)</p> Signup and view all the answers

    A patient with allergic rhinitis presents with troublesome symptoms that impair work performance. This would classify their rhinitis as:

    <p>Moderate–Severe (C)</p> Signup and view all the answers

    Which of the following symptoms could indicate sinus involvement in allergic rhinitis?

    <p>Sinus pain (D)</p> Signup and view all the answers

    What are the common symptoms associated with allergic rhinitis?

    <p>Sneezing, rhinorrhea, nasal congestion, and nasal itching (C)</p> Signup and view all the answers

    Which of the following is a distinguishing feature of non-allergic rhinitis compared to allergic rhinitis?

    <p>Absence of nasal and ocular itching (D)</p> Signup and view all the answers

    Which type of rhinitis is specifically associated with changes during pregnancy?

    <p>Pregnancy rhinitis (B)</p> Signup and view all the answers

    What is a common feature of occupational rhinitis?

    <p>Symptoms improve on workdays (C)</p> Signup and view all the answers

    Which of the following is not considered a typical symptom of rhinitis?

    <p>Sore throat (D)</p> Signup and view all the answers

    Which of these risk factors is associated with occupational rhinitis?

    <p>Exposure to airborne irritants at work (C)</p> Signup and view all the answers

    How does the onset of non-allergic rhinitis differ from allergic rhinitis?

    <p>Onset occurs at a later age (C)</p> Signup and view all the answers

    What is a common management approach for allergic rhinitis?

    <p>Avoidance of identified allergens (A)</p> Signup and view all the answers

    Which group of patients is recommended to receive a diagnosis for allergic rhinitis before self-treatment?

    <p>Pregnant women (A), Children under 12 years (D)</p> Signup and view all the answers

    What is one of the treatment options for persistent or moderate-to-severe allergic rhinitis symptoms?

    <p>Oral antihistamine/decongestant combination (C)</p> Signup and view all the answers

    Which treatment option is recommended for children greater than 2 years of age experiencing mild or episodic allergic rhinitis symptoms?

    <p>Antihistamine nasal spray (A)</p> Signup and view all the answers

    What additional option can be used for treating concurrent allergic conjunctivitis?

    <p>Glucocorticoid nasal spray combined with antihistamine eye drops (A)</p> Signup and view all the answers

    Which of the following is not a symptom that excludes self-treatment of allergic rhinitis?

    <p>Sneezing (C)</p> Signup and view all the answers

    Which treatment option is specifically mentioned for older adults experiencing allergic rhinitis?

    <p>Glucocorticoid nasal spray (C)</p> Signup and view all the answers

    What should patients with symptoms of uncontrolled asthma do regarding self-treatment for allergic rhinitis?

    <p>Consult a healthcare provider before self-treatment (A)</p> Signup and view all the answers

    Which type of antihistamine is preferred for treating allergic rhinitis symptoms in older adults?

    <p>Minimally sedating antihistamines (A)</p> Signup and view all the answers

    Flashcards

    Rhinitis

    An inflammation of the nasal lining characterized by sneezing, rhinorrhea, nasal congestion, nasal itching, and cough.

    Allergic Rhinitis

    A type of rhinitis caused by an immune reaction to specific allergens like pollen, dust mites, or pet dander.

    Non-allergic Rhinitis

    A type of rhinitis not caused by allergens but by other factors like nasal irritants, hormonal changes, or medication.

    Pregnancy Rhinitis

    A type of rhinitits that occurs during the last 1 to 2 months of pregnancy and resolves within two weeks after delivery.

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    Occupational Rhinitis

    A type of rhinitis caused by exposure to irritants or allergens in the workplace.

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    Rhinorrhea

    A common symptom of rhinitis characterized by excessive nasal discharge.

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    Nasal Congestion

    A common symptom of rhinitis characterized by difficulty breathing through the nose.

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    Sneezing

    A common symptom of rhinitis characterized by an urge to sneeze.

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    Seasonal allergic rhinitis

    A type of allergic rhinitis that occurs during specific seasons due to seasonal allergens like pollen.

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    Perennial allergic rhinitis

    A type of allergic rhinitis that occurs year-round due to allergens like dust mites, pet dander, or mold.

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    Atopic family history

    A genetic predisposition to developing allergies, including allergic rhinitis.

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    Filaggrin gene mutation

    A protein mutation associated with increased risk of developing allergic rhinitis.

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    Elevated serum IgE

    A higher level of immunoglobulin E (IgE), an antibody involved in allergic reactions, in the blood before the age of 6.

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    Higher socioeconomic level

    Higher socioeconomic level is associated with an increased risk of developing allergic rhinitis.

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    Eczema

    A skin condition characterized by itchy, red patches, that is often associated with increased risk of allergy and allergic rhinitis.

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    Positive allergy skin tests

    Positive skin tests, such as prick tests, indicate an allergic reaction to specific allergens.

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    Dennie-Morgan lines

    A characteristic sign of allergic rhinitis where the lower eyelids are darkened and have accentuated folds.

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    Allergic shiners

    A common physical sign in patients with allergic rhinitis, characterized by infraorbital edema and darkening due to subcutaneous venodilation.

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    Allergic salute

    A habitual upward rubbing of the tip of the nose with the palm of the hand, often observed in children with allergic rhinitis.

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    Allergic gape

    A characteristic sign of allergic rhinitis, where a person breathes primarily through their open mouth due to nasal obstruction.

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    Nasal crease

    A horizontal crease just above the bulbar portion of the nose, often seen in patients with allergic rhinitis.

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    Sinusitis

    An inflammatory condition of the sinuses, often a complication of untreated allergic rhinitis.

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    Otitis media with effusion

    A condition characterized by fluid buildup in the middle ear, which can be a complication of allergic rhinitis.

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    Sleep apnea

    A condition where a person experiences difficulty breathing during sleep, often linked to nasal obstruction due to allergic rhinitis.

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    Intermittent Allergic Rhinitis (Mild)

    Allergic rhinitis symptoms that occur ≤4 days per week or ≤4 weeks per year, and do not include sleep disturbance, impairment in work/school performance, daily activities, leisure/sport activities, or troublesome symptoms.

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    Persistent Allergic Rhinitis (Severe)

    Allergic rhinitis symptoms that occur >4 days per week and >4 weeks per year, and include at least one symptom of sleep disturbance, impairment in work/school performance, daily activities, leisure/sport activities, or troublesome symptoms.

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    Intermittent Allergic Rhinitis (Moderate-Severe)

    Allergic rhinitis symptoms that occur ≤4 days per week or ≤4 weeks per year, and do not include sleep disturbance, impairment in work/school performance, daily activities, leisure/sport activities, or troublesome symptoms.

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    Persistent Allergic Rhinitis (Mild)

    Allergic rhinitis symptoms that occur >4 days per week and >4 weeks per year, and do not include sleep disturbance, impairment in work/school performance, daily activities, leisure/sport activities, or troublesome symptoms.

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    Episodic Allergic Rhinitis

    Allergic rhinitis triggered by exposure to a specific allergen that's not usually present in the person's environment.

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    Bilateral Symptoms

    Both sides of the nose are affected.

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    Frequent Paroxysmal Sneezing

    Sudden, forceful expulsions of air from the nose.

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    Anterior Watery Rhinorrhea

    Clear, runny nasal discharge.

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    Dust mites

    Dust mites are microscopic creatures commonly found in homes, feeding on dead skin flakes.

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    How to lessen dust mite exposure?

    To reduce dust mites, use zipped covers for pillows and mattresses, vacuum regularly, control humidity, and minimize areas where they can live.

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    Outdoor molds

    Outdoor molds like Alternaria and Cladosporium can trigger allergies.

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    How to reduce exposure to outdoor molds?

    To reduce exposure to outdoor molds, avoid disturbing decaying plant material.

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    Indoor molds

    Indoor molds like Penicillium and Aspergillus thrive in damp environments.

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    How to reduce exposure to indoor molds?

    To reduce indoor mold exposure, lower humidity, remove houseplants, and apply fungicide to moldy areas.

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    Pet allergens

    Pet allergies often involve proteins from animals such as cats and dogs, with Fel d 1 being a common cat allergen.

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    How to reduce pet allergen exposure?

    To reduce pet allergen exposure, keep animals outside the house, use air filters or cleaners, clean regularly, reduce carpets, and wash pets frequently.

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    What is allergic rhinitis?

    A type of rhinitis caused by an immune reaction to specific allergens like pollen, dust mites, or pet dander.

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    What is non-allergic rhinitis?

    A type of rhinitis not caused by allergens but by other triggers like nasal irritants, hormonal changes, or medication.

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    Why are symptoms of non-allergic rhinitis a reason to exclude self-treatment?

    Symptoms of non-allergic rhinitis are a reason to exclude self-treatment for allergic rhinitis.

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    Why is undiagnosed or uncontrolled asthma a reason to avoid self-treating allergic rhinitis?

    If you have undiagnosed or uncontrolled asthma, you should see a doctor before self-treating allergic rhinitis.

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    Who should see a doctor before self-treating allergic rhinitis?

    Children under 12, pregnant women, and lactating women are recommended to see a doctor before self-treating allergic rhinitis.

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    What are treatment options for mild allergic rhinitis in older children and adults?

    For mild or episodic allergic rhinitis symptoms in older children and adults, minimally sedating oral antihistamine, antihistamine nasal spray, or glucocorticoid nasal spray are treatment options.

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    What are treatment options for persistent or moderate-to-severe allergic rhinitis in older children and adults?

    For persistent or moderate-to-severe allergic rhinitis symptoms in older children and adults, glucocorticoid nasal spray is recommended. Additional options include adding antihistamine nasal spray, minimally sedating oral antihistamine, or minimally sedating oral antihistamine/decongestant combination.

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    What are treatment options for allergic rhinitis in older adults?

    For older adults experiencing allergic rhinitis, glucocorticoid nasal spray, minimally sedating antihistamine, or antihistamine nasal spray are treatment options.

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    Study Notes

    Respiratory Disorders: Allergic Rhinitis & Sore Throat

    • Learning Objectives
      • Identify causes/risk factors and signs/symptoms of allergic rhinitis and sore throat
      • Evaluate patient eligibility for self-treatment
      • Discuss clinical particulars of medications (prescription-only, pharmacy-only, OTC) for allergic rhinitis and sore throat
      • Recommend pharmacological and non-pharmacological management strategies
      • Provide appropriate patient counseling

    Rhinitis

    • Symptoms: One or more of the following: sneezing, rhinorrhea, nasal congestion, nasal itching, cough
    • Common Forms:
      • Allergic rhinitis
      • Non-allergic rhinitis
        • Onset later in life
        • Absence of nasal/ocular itching
        • Prominent sneezing, nasal congestion, and postnasal drainage
        • Perennial symptoms
    • Pregnancy Rhinitis: Nasal congestion in the last 1-2 months of pregnancy. Symptoms resolve within 2 weeks of delivery.
    • Occupational Rhinitis: Caused by airborne allergens or irritants in the workplace. Symptoms often worse at work and better on days off. Triggers include proteins from laboratory animals, food proteins from food processing, and organic dusts from woodworking.

    Allergic Rhinitis - Introduction

    • Types: Seasonal and perennial allergic rhinitis
    • Diagnosis: Can be diagnosed at any age, but rare in children < 2 years old and cases decrease after age 65.
    • Risk Factors:
      • Family history of atopy
      • Filaggrin gene mutation
      • Elevated serum IgE (>100 IU/mL) before age 6
      • Higher socioeconomic level
      • Eczema
      • Positive reactions to allergy skin tests
    • Diet: Diet may be a risk factor in children and adolescents. Individuals consuming ≥3 fast-food meals per week show an increased incidence of allergic disorders.
    • Triggers: Indoor and outdoor environmental allergens (e.g., pollen, mold spores, ozone, tobacco smoke, diesel exhaust particles, house-dust mites, cockroaches, mold spores, pet dander).

    Allergic Rhinitis - Pathogenesis

    • Phases:
      • Sensitization: Initial allergen exposure stimulates IgE production
      • Early phase: Occurs within minutes of subsequent allergen exposure; rapid release of mast cell mediators (e.g., histamine) and additional mediators.
      • Cellular recruitment: Circulating leukocytes are attracted to nasal mucosa and release more inflammatory mediators.
      • Late phase: Begins 2-4 hours after allergen exposure. Mast cell activation and new mediator synthesis and release occur.

    Allergic Rhinitis - Clinical Presentation

    • Types: Episodic (symptoms occur upon exposure to/contact with allergen not normally part of the person's environment).
    • Symptoms: Bilateral symptoms, frequent paroxysmal sneezing, anterior watery rhinorrhea, variable degree of nasal obstruction, frequent pruritus (itching) of eyes, nose, and/or palate, frequent conjunctivitis, sinus pain and throat pain may be present.
    • Clinical Signs: "Allergic shiners" (infraorbital edema/darkening), "Dennie-Morgan lines" (accentuated lines/folds below lower eyelids), "Allergic salute" (upward swipe of nosetip), "Allergic gape" (open-mouth breathing secondary to nasal obstruction), "Nasal crease" (horizontal crease).

    Allergic Rhinitis - Complications

    • Acute: Sinusitis, otitis media with effusion
    • Chronic: Sinusitis, nasal polyp formation, sleep apnea, hyposmia
    • Asthma: Allergic rhinitis is implicated in the development or exacerbation of asthma in children and adults.

    Allergic Rhinitis - Treatment

    • Goals: Reduce symptoms, improve patient's functional status and sense of well-being
    • Components:
      • Pharmacotherapy: Minimally sedating oral antihistamines, antihistamine nasal sprays, glucocorticoid nasal sprays. Other agents, such as decongestants, may be added for severe symptoms.
      • Allergen Avoidance: Dust mites (e.g., cover pillows/mattresses with zipped covers, use vacuum cleaners, control humidity, reduce areas that harbor dust mite colonies); mold spores (e.g., don't disturb decaying plant material, lower household humidity, remove houseplants, apply fungicide to moldy areas); pet-derived allergens (e.g., keep animals outside, use air filters/cleaners, regular house cleaning/vacuum cleaners, reduce reservoirs like carpets, regularly wash the pet); pollens (avoidance during peak pollen seasons by keeping windows closed, using air conditioners, staying indoors).
      • Immunotherapy: Specific treatment modalities.

    Sore Throat

    • Causes: Infectious (viral/bacterial) and non-infectious

    • Common Infectious Causes:

      • Respiratory viruses: 25-45% of cases (e.g., adenovirus, rhinovirus, coronavirus); signs/symptoms include sore throat, fatigue, nasal congestion, and cough
      • Group A Streptococcus (GAS): 5-15% of cases; signs/symptoms include acute sore throat, fever, pharyngeal edema, patchy tonsillar exudates, prominent/tender anterior cervical lymphadenopathy
    • Common Non-Infectious Causes:

      • Allergic rhinitis
      • Sinusitis
      • GERD
      • Smoking/second-hand smoke exposure
      • Exposure to dry air
      • Trauma (e.g., tracheal intubation)
      • Vocal strain
    • Treatment (Adults)

      • Systemic: E.g., acetaminophen/NSAIDs
      • Local (Topical): Lozenges, throat sprays, gargles
        • Advantages: High concentration at affected area, reduced systemic side effects, rapid onset, shorter duration
        • Disadvantages: May not be effective for prolonged relief
      • Other relief methods: Adjusting food/drink temperature/texture to reduce pain, use of demulcents (e.g., honey, glycerin, pectin).
    • Active ingredients in common lozenges and throat sprays are detailed (e.g., antiseptics, local anesthetics, NSAIDs).

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    Description

    This quiz covers the causes, symptoms, and management of allergic rhinitis and sore throat. It evaluates patient treatment eligibility and discusses medication options, both prescription and over-the-counter. Ideal for those studying respiratory disorders and their clinical treatments.

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