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Questions and Answers
What is an effective method to manage dust mite exposure in the home?
What is an effective method to manage dust mite exposure in the home?
Which indoor mold is specifically mentioned as a common allergen?
Which indoor mold is specifically mentioned as a common allergen?
What is the primary allergenic protein found in cats?
What is the primary allergenic protein found in cats?
During which season is ragweed pollen most prevalent?
During which season is ragweed pollen most prevalent?
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What is a recommended strategy to minimize pollen exposure during peak season?
What is a recommended strategy to minimize pollen exposure during peak season?
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What is the best way to handle outdoor molds to minimize exposure?
What is the best way to handle outdoor molds to minimize exposure?
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What action is NOT recommended to reduce pet-derived allergens?
What action is NOT recommended to reduce pet-derived allergens?
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What is the suggested activity to do before bed to reduce pollen exposure?
What is the suggested activity to do before bed to reduce pollen exposure?
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Which type of allergic rhinitis is characterized by symptoms that worsen in specific seasons?
Which type of allergic rhinitis is characterized by symptoms that worsen in specific seasons?
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What risk factor is NOT associated with allergic rhinitis?
What risk factor is NOT associated with allergic rhinitis?
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During which phase of allergic rhinitis does the initial IgE production occur?
During which phase of allergic rhinitis does the initial IgE production occur?
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What common environmental trigger is associated with allergic rhinitis?
What common environmental trigger is associated with allergic rhinitis?
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Which group of individuals is least likely to be diagnosed with allergic rhinitis?
Which group of individuals is least likely to be diagnosed with allergic rhinitis?
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What occurs during the early phase of allergic rhinitis?
What occurs during the early phase of allergic rhinitis?
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What dietary habit may increase the incidence of allergic disorders in children and adolescents?
What dietary habit may increase the incidence of allergic disorders in children and adolescents?
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Which phase of allergic rhinitis begins 2-4 hours after allergen exposure?
Which phase of allergic rhinitis begins 2-4 hours after allergen exposure?
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What is indicated by 'Allergic shiners' in allergic rhinitis?
What is indicated by 'Allergic shiners' in allergic rhinitis?
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Which of the following describes intermittent allergic rhinitis?
Which of the following describes intermittent allergic rhinitis?
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Which condition is NOT a chronic complication of allergic rhinitis?
Which condition is NOT a chronic complication of allergic rhinitis?
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Which symptom is considered a hallmark of moderate to severe allergic rhinitis?
Which symptom is considered a hallmark of moderate to severe allergic rhinitis?
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What does 'Allergic salute' refer to in the context of allergic rhinitis?
What does 'Allergic salute' refer to in the context of allergic rhinitis?
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What characterizes persistent allergic rhinitis?
What characterizes persistent allergic rhinitis?
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Which component is NOT one of the treatment goals for allergic rhinitis?
Which component is NOT one of the treatment goals for allergic rhinitis?
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Which option describes the purpose of immunotherapy in allergic rhinitis treatment?
Which option describes the purpose of immunotherapy in allergic rhinitis treatment?
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Episodic allergic rhinitis is associated with which of the following conditions?
Episodic allergic rhinitis is associated with which of the following conditions?
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What is the primary cause of 'Dennie-Morgan lines' observed in patients with allergic rhinitis?
What is the primary cause of 'Dennie-Morgan lines' observed in patients with allergic rhinitis?
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What is a common symptom of allergic rhinitis that can affect both the eyes and nose?
What is a common symptom of allergic rhinitis that can affect both the eyes and nose?
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Which of the following is NOT a characteristic symptom of allergic rhinitis?
Which of the following is NOT a characteristic symptom of allergic rhinitis?
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What environmental factors allow dust mites to thrive?
What environmental factors allow dust mites to thrive?
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Which of the following is NOT a symptom associated with nasal obstruction in allergic rhinitis?
Which of the following is NOT a symptom associated with nasal obstruction in allergic rhinitis?
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A patient with allergic rhinitis presents with troublesome symptoms that impair work performance. This would classify their rhinitis as:
A patient with allergic rhinitis presents with troublesome symptoms that impair work performance. This would classify their rhinitis as:
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Which of the following symptoms could indicate sinus involvement in allergic rhinitis?
Which of the following symptoms could indicate sinus involvement in allergic rhinitis?
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What are the common symptoms associated with allergic rhinitis?
What are the common symptoms associated with allergic rhinitis?
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Which of the following is a distinguishing feature of non-allergic rhinitis compared to allergic rhinitis?
Which of the following is a distinguishing feature of non-allergic rhinitis compared to allergic rhinitis?
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Which type of rhinitis is specifically associated with changes during pregnancy?
Which type of rhinitis is specifically associated with changes during pregnancy?
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What is a common feature of occupational rhinitis?
What is a common feature of occupational rhinitis?
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Which of the following is not considered a typical symptom of rhinitis?
Which of the following is not considered a typical symptom of rhinitis?
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Which of these risk factors is associated with occupational rhinitis?
Which of these risk factors is associated with occupational rhinitis?
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How does the onset of non-allergic rhinitis differ from allergic rhinitis?
How does the onset of non-allergic rhinitis differ from allergic rhinitis?
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What is a common management approach for allergic rhinitis?
What is a common management approach for allergic rhinitis?
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Which group of patients is recommended to receive a diagnosis for allergic rhinitis before self-treatment?
Which group of patients is recommended to receive a diagnosis for allergic rhinitis before self-treatment?
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What is one of the treatment options for persistent or moderate-to-severe allergic rhinitis symptoms?
What is one of the treatment options for persistent or moderate-to-severe allergic rhinitis symptoms?
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Which treatment option is recommended for children greater than 2 years of age experiencing mild or episodic allergic rhinitis symptoms?
Which treatment option is recommended for children greater than 2 years of age experiencing mild or episodic allergic rhinitis symptoms?
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What additional option can be used for treating concurrent allergic conjunctivitis?
What additional option can be used for treating concurrent allergic conjunctivitis?
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Which of the following is not a symptom that excludes self-treatment of allergic rhinitis?
Which of the following is not a symptom that excludes self-treatment of allergic rhinitis?
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Which treatment option is specifically mentioned for older adults experiencing allergic rhinitis?
Which treatment option is specifically mentioned for older adults experiencing allergic rhinitis?
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What should patients with symptoms of uncontrolled asthma do regarding self-treatment for allergic rhinitis?
What should patients with symptoms of uncontrolled asthma do regarding self-treatment for allergic rhinitis?
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Which type of antihistamine is preferred for treating allergic rhinitis symptoms in older adults?
Which type of antihistamine is preferred for treating allergic rhinitis symptoms in older adults?
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Study Notes
Respiratory Disorders: Allergic Rhinitis & Sore Throat
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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
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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.
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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
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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
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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
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Causes: Infectious (viral/bacterial) and non-infectious
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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
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Common Non-Infectious Causes:
- Allergic rhinitis
- Sinusitis
- GERD
- Smoking/second-hand smoke exposure
- Exposure to dry air
- Trauma (e.g., tracheal intubation)
- Vocal strain
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Treatment (Adults)
- Systemic: E.g., acetaminophen/NSAIDs
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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).
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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.
