Allergic Rhinitis Chapter 11 PDF

HergicRhinitis Chapter11 see Allergic rhinitis= systemic with prominent nasal symptoms, a ects upper respiratory tract **a ects 20% adults & 40% children in US Four phases: 1)Sensitization= Initial exposure, IgE production 2)Early= rapid release of mast cell mediator...

HergicRhinitis Chapter11 see Allergic rhinitis= systemic with prominent nasal symptoms, a ects upper respiratory tract **a ects 20% adults & 40% children in US Four phases: 1)Sensitization= Initial exposure, IgE production 2)Early= rapid release of mast cell mediators 3) Cellular recruitment= eisonophils come to nasal mucosa & cause in ammatory release 4) Late= mucus hypersensitivity & lower threshold Risk factors= family history, skin barrier, protein gene mutations, elevated IgE before age 6, higher socioeconomic class, eczema, and positive skin allergy test Triggers: -outdoor= pollen & diesel -indoor= dust, roaches, mold, smoke, pet dander -occupational= chemicals, latex, resin **Systemic antihistamines NOT recommended for kids 2-6 years old EXCEPT under advice of PCP -exception to this= cetirizine, fexofenadine, levocetirizine, loratidine **For adults >65 years ONLY loratidine allowed, BUT if under advice of PCP can use cetirizine, levocetirizine, & fexofenadine *Must rst classify person’s symptoms based on duration and severity Non-pharm: -allergen avoidance -outdoor= check pollen count, keep windows shut on days w/pollen, no yard work or outdoor sports -indoor= try to remove triggers (cat, mold, pets), lower humidity in home to reduce molds, wash bedding in hot water every week OTC-pharm: Antihistmines MOA= compete with histamine at central & peripheral histamine 1 receptor sites *preventing histamine receptor interaction & mediator release ~good for itching, sneezing, and runny nose (NOT nasal congestion) First Generation, non selective= sedating ~highly lipophilicity ~easily crosses BBB ~many drug interactions ~dangerous in high doses ~cardiac symptoms ~CNS symptoms (sedation, tremors, & sedation) -Chlorpheniramine (Chlor-Trimeton Allergy) -Clemastine (Tavist Allergy) -Diphenhydramine (Benadryl Allergy)= drug interactions with Phenytoin and Antacids -side e ects= CNS e ects, dry eyes, dry mucous membranes, urinary retention, & constipation Second Generation, peripherally selective= non-sedating -Cetirizine (Zyrtec) -Levocetirizine (Xyzal Allergy) -Loratidine (Claritin) -Fexofenadine (Allegra) -side e ects= more common with 1st gen. CNS (depression & stimulation) & anticholinergic e ects Intranasal Glucocorticoid: *good for itchy eyes and noses, sneezing, runny nose and congestion -Triamcinolone Acetonide (Nasacort)= approved for ≥2 years of age -Flonase (Fluticasone)= ONLY (treats nasal symptoms caused by allergic rhinitis), ≥4 years of age, shake bottle before use, minimal systemic absorption -side e ects= nasal discomfort, bleeding, or sneezing, change in vision, glaucoma, cataracts infection risk & growth inhibition -caution with growth inhibition in patients