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Chapter49
Allergic Rhinitis
27
Medical
Professional
10/02/2011

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Cards

Term
Desloratadine indications

What is fexofenadine not indicated for?
Definition
Desloratadine - Allergic rhinitis symptoms including sneezing, rhinorrhea, nasal itch, and conjunctivitis. ALSO - nasal congestion

Fexofenadine is not indicated for relief of nasal congestion
Term
How are antihistamines most effectively used ?

Can they be used on an as needed basis?

How are they normally dosed?
Definition
Best as prophylaxis, but can be as needed. Normally dosed daily.
Term
First Generation Antihistamines ?

What should be noted about these ?
Definition
First generation antihistamines - chlorpheniramine & Diphenhydramine

Note - Anticholinergic side effects will be worse with these than second generation. Be weary in the elderly
Term
What side effects are to be expected with antihistamines ?

Which newer antihistamine is more likely than the others to cause sedation?
Definition
Sedation & anticholinergic effects with antihistamines. greater SEs: First gen > Second gen.

Cetirizine is more likely to cause sedation that other second generation antihistamines
Term
Explain the management of allergic rhinitis from beginning to end.
Definition
FIGURE 1 pg 643
Term
Managing initial allergic rhinitis symptoms: Rhinorrhea, sneezing, itching, conjunctival symptoms

managing congestion?
Definition
Managing initial allergic rhinitis symptoms: Rhinorrhea, sneezing, itching, conjunctival symptoms --> ANTIHISTAMINE

managing congestion --> DECONGESTANT (phenylephrine of pseudoephedrine)
Term
If management with antihistamines and decongestant are not doing the trick, what regimen should be employed?
Definition
Regular use of intranasal steroids, along with PRN antihistamine and PRN decongestant
Term
If regular use of intranasal steroids, along with PRN antihistamine and PRN decongestant are ineffective, what regimen should be used?

If symptoms are prolonged?

If symptoms are severe?
Definition
Prolonged symptoms - consider immunosuppressive therapy

Severe symptoms: oral prednisone 50 mg qday for a week + intranasal steroids, then continue intranasal steroids
Term
List the intranasal steroids
Definition
Beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone, triamcinolone
Term
What is recommended oral or topical decongestants for allergic rhinitis?
Definition
Oral, use of topical decongestants for more than 3-7 days is assocaited with rhinitis medicamentosa
Term
What drugs should be avoided with decongestants?
Definition
MAOIs
Term
What conditions is it not recommended to use decongestants with?
Definition
HTN, hyperthyroidism, ischemic heart disease
Term
What is the mainstay for moderate-severe rhinitis?
Definition
Intranasal corticosteroids
Term
Which intranasal corticosteroid is available as a dry powder inhaler?
Definition
Budesonide
Term
How long of a trial is necessary to determine if the intranasal corticosteroid is working?
Definition
2-4 weeks
Term
Which intranasal corticosteroid has been associated with mild growth suppression?
Definition
Beclomethasone
Term
Sodium cromoglycate
Safe?
Dosing?
effectiveness vs corticosteroids?
Definition
Sodium cromoglycate
Safe - YES, excellent safety profile
Dosing - usually QID
effectiveness vs corticosteroids - NOT as effective as corticosteroids
Term
Which is the Intranasal antihistamine
benefit?
dose it treat congestion?
Definition
Which is the Intranasal antihistamine - Levocabastine

benefit - no systemic effects

Dose it treat congestion - No
Term
Intranasal ipratropium

When is it useful?
Definition
Intranasal ipratropium

When is it useful - When the only symptom is rhinorrhea, eg. "skiers nose"
Term
When is immunotherapy indicated?
Definition
- Indicated when this is evidence of IgE-mediated sensitivity to a specific antigen and the patient cannot avoid it.

- Symptoms are difficult to control with conventional drug therapy and allergen avoidance.
Term
What should be avoided during the first trimester in pregnancy when treating allergic rhinitis?
Definition
Decongestants
Term
What anti-allergy agents have been proven somewhat safe in pregnancy?
Definition
BBCCM

Beclomethasone, budesonide, comoglycate, and chlorphinramine, and montelukast
Term
What age group should not use decongestants?
Definition
age <6
Term
How long should the course of oral corticosteroids be used in severe cases ?
Definition
5-7 days, usually along with intranasal steroids that would be continued after the 1 week treatment with oral corticosteroids
Term
Can loratadine be chewed ?
Definition
YES!
Term
When to refer to a specialist:
Definition
When to refer to a specialist:
- Inadequate control of symptoms despite adherence and correct use of therapies
- adverse reactions
reduced quality of life or ability to function due to the condition
- when trying to identify allergens
- comorbid conditions such as asthma and recurrent sinusitis
- immunotherapy
Term
What intranasal corticosteroids are usually recommended for children? why?
Definition
mometasone and fluticasone due to bioavailability and lack of growth suppression
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