Term
| What are the 3 types of allergic rhinitis? |
|
Definition
| episodic, seasonal (intermittent), and perennial (persistent) |
|
|
Term
| What is rhinitis medicamentosa? |
|
Definition
| drug-induced rhinitis - caused by using a nasal decongestants for longer than 2-3 days |
|
|
Term
| Name 5 causes of non-allergic rhinitis. |
|
Definition
| Infection, idiopathic or vasomotor, drug-induced, hormonal, or anatomical abnormalities |
|
|
Term
| In what age group is the highest incidence of allergic rhinitis? |
|
Definition
|
|
Term
| What % of rhinitis patients are symptomatic > 4 months/year? |
|
Definition
|
|
Term
| What % of patients are symptomatic > 9 months/year? |
|
Definition
|
|
Term
| What % of rhinitis is purely allergic? |
|
Definition
|
|
Term
| What % of rhinitis is purely non-allergic? |
|
Definition
|
|
Term
| What % of rhinitis is mixed allergic and non-allergic? |
|
Definition
|
|
Term
| What % of rhinitis has an allergic component? |
|
Definition
|
|
Term
| What % of rhinitis has a non-allergic component? |
|
Definition
|
|
Term
| Name 6 predisposing factors for allergic rhinits. |
|
Definition
1. asthma
2. atopic dermatitis
3. family history of allergy
4. exposure to second hand smoke
5. occupational/environmental exposures
6. early introduction of formula and foods |
|
|
Term
| What is 1 of the top 10 reasons for patients to present to primary care physicians? |
|
Definition
|
|
Term
| What % of the population is affected by rhinitis? |
|
Definition
|
|
Term
| When is it important to determine the etiology of rhinitis and why? |
|
Definition
| With chronic symptoms - it helps guide therapy. |
|
|
Term
| What is allergic rhinitis? |
|
Definition
| a symptomatic disorder of the nose induced by IgE-mediated inflammation after allergen exposure |
|
|
Term
| What are the symptoms of allergic rhinitis? |
|
Definition
| rhinorrhea, nasal obstruction, nasal itching, and sneezing |
|
|
Term
| Name 3 comorbidities of allergic rhinits? |
|
Definition
| asthma, conjunctivitis, and rhinosinusitis |
|
|
Term
| What happens during sensitization to an allergen? |
|
Definition
| IgE directed at specific proteins (allergen) are produced and mast cells covered in this IgE presents in the nasal mucosa |
|
|
Term
| What happens during exposure to allergens (after sensitization)? |
|
Definition
| allergens elute across the mucous membrane and bind IgE on the mast cells; this triggers an allergic response |
|
|
Term
| What happens in the early phase response of the allergic reaction? |
|
Definition
| IgE antibodies on mast cells are cross-linked and the mast cells degranulate - releasing histamine and chemical mediators. Arachidonic acid metabolites are newly produced following activation. |
|
|
Term
| What seasonal allergen is likely the cause of allergic rhinitis in the spring? |
|
Definition
|
|
Term
| What seasonal allergen is likely the cause of allergic rhinitis in spring to late summer? |
|
Definition
|
|
Term
| What seasonal allergen is likely the cause of allergic rhinitis in late summer to early fall? |
|
Definition
|
|
Term
| What are some causes of perennial allergic rhinitis? |
|
Definition
| overlapping allergies, dust mite fecal proteins, animal dander, cockroaches, or mold |
|
|
Term
T/F
There may be a genetic component to allergic rhinitis. |
|
Definition
|
|
Term
T/F
Allergic rhinitis sufferers may have an inherited predisposition to phenotype 2 helper T (H2) cells. |
|
Definition
|
|
Term
| What type of patients exhibit exaggerated responses to normal substances? |
|
Definition
|
|
Term
| Name 9 aspects of the early phase response of the allergic reaction. |
|
Definition
| stimulation of irritant receptors (sneezing), pruritis, vascular permeability, mucosal permeability, smooth muscle contraction ("obstruction"), influx of inflammatory cells, mucus secretion, chemotaxis, airway permeability |
|
|
Term
| When does the late phase response begin? |
|
Definition
| 4-8 hours after allergen exposure |
|
|
Term
| What causes the late phase response of an allergic reaction? |
|
Definition
cytokines released by mast cells
IL-3, 4, 5, 6, 8 |
|
|
Term
| What happens during the late phase response of the allergic reaction? |
|
Definition
| profound infiltration and activation of migrating cells - this causes obstruction and hyperresponsive inflamed mucosa |
|
|
Term
| What is the predominant source of histamine in the late phase reaction of an allergic reaction? |
|
Definition
|
|
Term
| What is hyperresponsive inflamed mucosa? |
|
Definition
| irritated mucosa that responds to any irritant or responds to lower levels of the allergen |
|
|
Term
| Why is it important to treat intermittent (seasonal) allergic rhinitis prophylactically? |
|
Definition
| To avoid hyperresponsive inflamed mucosa - get ahead of it so that you can treat it more easily |
|
|
Term
| Name 4 indications for allergy testing. |
|
Definition
1. ID of allergens
2. chronic or recurrent symptoms
3. symptoms that are not controlled by avoidance and medication
4. need for immunotherapy (meds not tolerated or cost of meds is prohibitive) |
|
|
Term
| What are allergic shiners? |
|
Definition
| Dark areas around eyes caused by allergies; There is little correlation between symptoms and size |
|
|
Term
| Name 10 possible signs that are in conjunction with allergic rhinitis. |
|
Definition
1. allergic shiners
2. watery eyes, itchy
3. transverse nasal crease - allergic salute
4. pale blue, edematous turbinates
5. clear, watery nasal discharge (bilateral)
6. lymphoid hyperplasia
7. nasal scrapings show eosinophils under microscope
8. blockage of the eustachian tubes
9. cough
10. pain on deep palpation of the sinuses |
|
|
Term
| When do you read a positive control for puncture/prick testing for allergies? |
|
Definition
|
|
Term
| When do you read allergens for puncture/prick testing for allergy testing? |
|
Definition
|
|
Term
| What is considered a positive allergen response? |
|
Definition
|
|
Term
| Why are positive and negative controls in allergy testing important? |
|
Definition
| validates the skin response |
|
|
Term
| What does a positive negative control mean? (reaction to negative control - saline) |
|
Definition
| dermagraphism - physical urticaria |
|
|
Term
| What does a negative positive control mean? (not reacting to histamine) |
|
Definition
medication reaction - use of antihistamine prior to testing
OR hypoactive skin |
|
|
Term
| Explain the grading for multitest response. |
|
Definition
0 - no reaction to 1-3 mm wheal
1+ - erythema with 3 mm wheal
2+ - erythema with 5 mm wheal
3+ - erythema with 7-10 mm wheal
4+ - erythema with > 10 mm wheal
5+ - erythema with > 10 mm wheal with pseudopods |
|
|
Term
| What are the 4 categories of treatment for allergic rhinitis? |
|
Definition
I. Avoidance of ID'd allergens
II. Pharmacotherapy
III. Immunotherapy
IV. Surgery |
|
|
Term
| How do you avoid dust mites if allergic? |
|
Definition
Use plastic covers and vacuum frequently
Avoid overstuffed chairs, curtains, stuffed animals, dust-collecting boxes under bed, etc. |
|
|
Term
| How do you avoid cockroaches if allergic? |
|
Definition
|
|
Term
| What % of atopic patients will have a + skin prick test to cats? |
|
Definition
|
|
Term
| What % of people will have a + skin prick test to dogs? |
|
Definition
|
|
Term
| What % of people have a + skin prick test to dust mites? |
|
Definition
|
|
Term
| What are people allergic to from pets? |
|
Definition
| animal dander - small protein particles |
|
|
Term
| What causes animal dander to become airborne? |
|
Definition
| vacuuming, walking on carpeted floors, etc. |
|
|
Term
| Name some realistic advice for allergic pet owners. |
|
Definition
| Make pet an outside pet, keep pet out of bedroom and confined to a non-carpeted area with HEPA filter, etc. |
|
|
Term
| Is washing a cat to reduce allergies realistic? |
|
Definition
| No, they return to baseline after only 3 hours |
|
|
Term
Effective/Not
Confine animals to non-carpeted area with HEPA. |
|
Definition
|
|
Term
Effective/Not
Remove carpeting - it accumulates 100x more allergen than polished floors. |
|
Definition
|
|
Term
Effective/Not
Wash laundry at 60 C with one rinse, any temp with 2 rinses, or use steam washing machine to reduce allergens. |
|
Definition
|
|
Term
Effective/Not
Use a face mask for vacuuming or cleaning litter box. |
|
Definition
|
|
Term
Effective/Not
Use tightly woven fabrics for bedding covers to capture dander. |
|
Definition
|
|
Term
Effective/Not
Limit or remove fabric covered furniture. |
|
Definition
|
|
Term
Effective/Not
Neuter male pets or select female pets. |
|
Definition
|
|
Term
Effective/Not
Require passive carries of animal dander to change clothes before exposure to patient. |
|
Definition
|
|
Term
Effective/Not
HEPA vaccum. |
|
Definition
|
|
Term
Effective/Not
Washing pets with water or shampoo. |
|
Definition
|
|
Term
Effective/Not
Steam cleaning carpet or upholstery. |
|
Definition
|
|
Term
Effective/Not
Oral agents/sprays to reduce animal shedding. |
|
Definition
|
|
Term
Effective/Not
Wash hands after petting animal and before touching face. |
|
Definition
|
|
Term
Effective/Not
MERV 12 filters on HVAC system |
|
Definition
|
|
Term
Effective/Not
HEPA free standing unit |
|
Definition
|
|
Term
Effective/Not
6 air exchanges per hour in the home. |
|
Definition
|
|
Term
Effective/Not
Tannic acid spray for carpeting or upholstery. |
|
Definition
|
|
Term
Effective/Not
Use of a multiple intervention approach. |
|
Definition
|
|
Term
AR/ VMR/ Both
Intranasal corticosteroid |
|
Definition
|
|
Term
AR/ VMR/ Both
Intranasal antihistamine |
|
Definition
|
|
Term
AR/ VMR/ Both
oral antihistamine |
|
Definition
|
|
Term
AR/ VMR/ Both
Decongestant |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
AR/ VMR/ Both
Ipratropium bromide |
|
Definition
|
|
Term
AR/ VMR/ Both
nasal saline |
|
Definition
|
|
Term
AR/ VMR/ Both
Oral corticosteroids |
|
Definition
|
|
Term
| What is the treatment plan for episodic AR? |
|
Definition
treat the symptoms
nasal decongestant, nasal antihistamine, oral antihistamine, eye drops, or nasal saline |
|
|
Term
| What is the treatment plan for mild persistent allergic rhinitis? |
|
Definition
1 regular medication
nasal corticosteroid or nasal antihistamine
monetlukast, ipratropium bromide |
|
|
Term
| What is the treatment plan for mild to moderate persistent allergic rhinitis? |
|
Definition
2 regular medications
nasal corticosteroid and nasal antihistamine
oral antihistamine, montelukast |
|
|
Term
| What is the treatment plan for moderate to severe allergic rhinitis? |
|
Definition
2-3 medications
nasal corticosteroid and nasal antihistamine
montelukast, ipratropium bromide, oral antihistamine, nasal saline |
|
|
Term
| What is the treatment plan for severe persistent allergic rhinitis? |
|
Definition
| continue all regularly used medications and add short term use corticosteroids |
|
|
Term
| How long should you use corticosteroids to treat severe persistent allergic rhinitis? |
|
Definition
Dose packs for 5-7 days
4x per year (no more than every 3 months) |
|
|
Term
| Name 5 OTC nasal decongestants. |
|
Definition
1. phenylephrine
2. naphazoline
3. tetrahydrozoline
4. oxymetazoline
5. xylometazoline |
|
|
Term
| What are possible side effects of OTC nasal decongestants? |
|
Definition
| rebound vasodilation and rhinitis medicamentosa |
|
|
Term
| How do OTC nasal decongestants work? |
|
Definition
| stimulate the alpha-adrenergic receptors causing constriction of the blood vessels and engorgement of the vessels within the sinus is reduced, relieving the "obstructed" sensation |
|
|
Term
| What are the physiologic effects of nasal saline? |
|
Definition
| directly cleanses the nose, removes inflammatory mediators, and improves mucociliary function |
|
|
Term
| What % improvement in symptom can be seen in AR patients by adding nasal saline |
|
Definition
|
|
Term
| What % of nasal saline users report side effects? |
|
Definition
|
|
Term
| What are some possible side effects of nasal saline use? |
|
Definition
| ear fullness, stinging sensation, and rarely, epistaxis |
|
|
Term
| What prescription eye drops can be used to relieve ocular itching? |
|
Definition
|
|
Term
|
Definition
prescription NSAID eye drop
relieves ocular itching |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
OTC
antihistamine and mast cell stabilizer |
|
|
Term
|
Definition
Rx
antihistamine and mast cell stabilizer |
|
|
Term
|
Definition
antihistamine and vasoconstricter
limit to 2-3 days because of the naphazoline |
|
|
Term
| naphazoline + pheniramine |
|
Definition
antihistamine and vasoconstrictor
limit to 2-3 days because of naphazoline |
|
|
Term
T/F
When using eye drops to treat AR symptoms, combination products work better than individual agents. |
|
Definition
|
|
Term
|
Definition
1st gen oral antihistamine
causes drowsiness |
|
|
Term
|
Definition
1st gen oral antihistamine
less drowsy than diphenhydramine |
|
|
Term
|
Definition
| 1st gen oral antihistamine |
|
|
Term
|
Definition
| 1st gen oral antihistamine |
|
|
Term
| How do first gen oral antihistamines work? |
|
Definition
| competitively blocks the effects of histamine at the H1 receptor sites; does not activate the H1 receptor; nonselective - cross the blood brain barrier |
|
|
Term
|
Definition
Rx
1st gen oral antihistamine
antiemetic, sedative, anxiolytic |
|
|
Term
T/F
First gen oral antihistamines cross the blood brain barrier because they are lipid soluble. |
|
Definition
|
|
Term
| What cardiovascular effects do first gen oral antihistamines have? |
|
Definition
| increase BP and cause prolonged QT interval |
|
|
Term
|
Definition
| 2nd gen oral antihistamine |
|
|
Term
|
Definition
2nd gen oral antihistamine
> 12 180 mg QD
doesn't have a lot of drug-drug interactions |
|
|
Term
|
Definition
2nd gen oral antihistamine
2 mo.s-5 yrs 2.5 mg PO QD |
|
|
Term
|
Definition
| 2nd gen oral antihistamine |
|
|
Term
|
Definition
2nd gen oral antihistamine
> 6 yrs 5 mg PO QPM |
|
|
Term
| What is the mechanism of action of second generation oral antihistamines? |
|
Definition
| competitively blocks the effects of histamine at H1 peripheral receptor sites; does not activate the H1 receptor; selective - do not cross blood-brain barrier |
|
|
Term
T/F
There are cardiovascular effects produced by second gen oral antihistamines. |
|
Definition
|
|
Term
| Name 3 anticholinergic effects of second gen oral antihistamines. |
|
Definition
1. drying effect - nasal, dec. lacrimal hypersecrection (watery eyes)
2. dry mouth
3. difficulty voiding urine |
|
|
Term
| What types or antihistamines should BPH patients avoid? Why? |
|
Definition
| 2nd gen oral antihistamines; can cause difficulty voiding urine |
|
|
Term
| How are second gen nasal antihistamines dosed? |
|
Definition
| 1-2 sprays each nostril BID |
|
|
Term
azelastine hydrochloride
(saline) |
|
Definition
2nd gen nasal antihistamine
bitter taste
approved for age 5 and up |
|
|
Term
azelastine hydrochloride
(sucralose/sorbitol) |
|
Definition
2nd gen nasal antihistamines
approved for age 12 and up |
|
|
Term
|
Definition
2nd gen nasal antihistamine
age 12 and up |
|
|
Term
|
Definition
nasal steroid
seasonal and perennial allergic and nonallergic rhinitis |
|
|
Term
fluticasone furoate
(dose) |
|
Definition
nasal steroid
2-11 years: 1 spray per nostril QD-BID
Adults: 2 sprays per nostril BID |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
nasal steroid - AQ prep
2-11 years: 1 spray each nostril QD
adults: 2 sprays each nostril QD |
|
|
Term
|
Definition
|
|
Term
| beclomethasone diproponate |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What % of patients on nasal steroids experience epistaxis? |
|
Definition
|
|
Term
| Why might you not want to use beclamethasone in pediatric patients? |
|
Definition
| delayed height attainment |
|
|
Term
| What medications should be avoided in glaucoma patients and why? |
|
Definition
| nasal steroids - may increase intraocular pressure |
|
|
Term
T/F
Nasal steroids may cause posterior subscapular cataracts. |
|
Definition
|
|
Term
|
Definition
mast cell stabilizer
begin 1 week before to prevent symptoms of allergic rhinits
Side effects: nasal stinging, sneezing |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
anticholinergic agent
side effects: nasal dryness, epistaxis, headache |
|
|
Term
|
Definition
leukotriene receptor blocker
2-5 years - 4 mg PO QHS
6-14 years - 5 mg PO QHS
Adults - 10 mg PO QD |
|
|
Term
|
Definition
leukotriene receptor blocker
hepatotoxicity |
|
|
Term
|
Definition
leukotriene receptor blocker
hepatotoxicity |
|
|
Term
| How do leukotriene receptor blockers work? |
|
Definition
| they prevent the action of leukotriene in increasing the inflammatory response to allergens |
|
|
Term
| When is immunotherapy used? |
|
Definition
| when optimal avoidance measures and medication therapy are insufficient to control symptoms - or if medications are too expensive or will be so long term that they will become expensive |
|
|
Term
| How is immunotherapy done? |
|
Definition
| allergy testing to ID triggers then desensitization to allergens |
|
|
Term
| What are the outcomes of immunotherapy? |
|
Definition
| reduces the need for excessive use of medications to control symptoms, decreases the development of new allergies, and reduces the risk of developing asthma |
|
|
Term
| When is an ENT referral ndicated? |
|
Definition
| Symptoms are not resolved by other treatments |
|
|
Term
| When is surgery indicated? |
|
Definition
| nasal obstruction from polyps, severe septal deviation, adenoidal hypertrophy |
|
|
