Term
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Definition
| inflammation of the nasal mucous membranes due to Type I hypersensitivity rxns mediated by IgE Abs produced after exposure to allergens |
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Term
| Early Phase Allergic Response |
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Definition
occurs within min;
results in rapid release of histamine, kinins, PGs, leukotrienes, mast cells;
Lasts up to 90 min |
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Term
| Late Phase Allergic Response |
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Definition
occurs within 4-8 hrs after initial exposure;
Inflammatory response;
Causes persistent chronic symptoms, predominantly congestion;
Priming response occurs due to persistent inflammation;
Lasts for hrs, even days; |
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Term
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Definition
characterized by:
inflammation of mucous membranes (nose, eyes, sinuses);
clear rhinorrhea, water eyes, sneezing (seasonal), pruritus of nose, eyes, and palate (seasonal), nasal congestion (perennial), postnasal drip, cough, irritability |
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Term
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Definition
repetitive & predictable;
occurs during different seasons;
peaks during spring & fall;
triggered by tree & grass pollen, ragweed pollen, & mold (fall);
sneezing and pruritus of nose, eyes, and palate are most often seen with this form |
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Term
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Definition
no cyclic pattern;
occurs all year round;
triggered by: pets, dust mites, cockroaches, animal dander, mold spores, cigarette smoke;
Nasal congestion is common |
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Term
| Symptoms of Asthma Exacerbation |
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Definition
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Term
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Definition
| earaches, pain on sides of nose, eyes, or above teeth |
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Term
| Symptoms of Upper Respiratory Tract Infection |
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Definition
| fever, COLORED nasal discharge |
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Term
| Symptoms of Pink Eye (bacterial or viral) |
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Definition
| conjunctivitis with NO nasal symptoms |
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Term
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Definition
helps to determine triggers & what pts should avoid;
fastest & least expensive: results in 20 min;
tests several allergens at same time;
make superficial wound in outermost layer of skin & place a drop of Ag on wound & allow to enter skin;
Observe skin closely for sx of rxn;
AVOID antihistamines before test - 3 to 5 days for 1st gen., 10 days for 2nd gen. |
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Term
| RAST (Radioallergosorbent test) Blood test |
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Definition
identifies presence of an IgE Ab against that allergen they test for - individual allergen must be listed;
Expensive;
Takes longer to get results;
May CONTINUE to take antihistamines |
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Term
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Definition
PREVENT allergic rxn;
minimize symptoms;
improve QOL;
decrease social stigma |
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Term
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Definition
avoid exposure to pets/animals, wash them frequently;
Wash sheets in hot water & dry in hot heat;
Encase pillows & mattresses;
Remove carpet in bedroom & replace w/ tile or hardwood floor;
Keep A/C on & windows shut on high pollen days;
Wear a mask when vacuuming & dusting;
Use a dehumidifier & HEPA filters;
Shut car windows;
Stop smoking or smoke outside house; |
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Term
| Oral Antihistamines (1st Gen. - chlorpheniramine, diphenhydramine; 2nd Gen. - loratidine, cetirizine, desloratidine, fexofenadine, levoceterizine) |
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Definition
Place in Therapy: mild to moderate AR;
MoA: H1-receptor antagonists;
Helps to PREVENT sx rather than relieve sx;
Perennial AR: Take on REGULAR BASIS;
Seasonal AR: Take 1-2 hrs PRIOR to exposure to triggers; |
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Term
| Side Effects of Oral Antihistamines (1st Gen. - chlorpheniramine, diphenhydramine; 2nd Gen. - loratidine, cetirizine, desloratidine, fexofenadine, levoceterizine) |
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Definition
DROWSINESS, decreased mental alertness;
Dry mouth (use sugar free candy for temp. relief);
Urinary retention;
Constipation;
GI upset; |
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Term
| Contraindications for Oral Antihistamines (1st Gen. - chlorpheniramine, diphenhydramine; 2nd Gen. - loratidine, cetirizine, desloratidine, fexofenadine, levoceterizine) |
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Definition
narrow angle glaucoma, BPH (meds: tamsulosin, terazosin, finasteride, dutasteride);
newborns or premature infants;
nursing mothers;
Esophageal narrowing/abnormal peristalsis; |
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Term
| Patient Counseling for Oral Antihistamines (1st Gen. - chlorpheniramine, diphenhydramine; 2nd Gen. - loratidine, cetirizine, desloratidine, fexofenadine, levoceterizine) |
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Definition
For seasonal allergies: take 1-2 hrs prior to trigger;
For perennial allergies: take every day;
Take w/w-o food. Take at bedtime if drowsiness occurs;
Should feel relief in 1-3 hrs but max benefit not for a few days;
Avoid driving, operating heavy machinery, and additive depressive effects of EtOH, sedatives, & CNS depressants;
Children & elderly may experience paradoxical excitation; |
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Term
| Topical - Intranasal Antihistamines (azelastine - Astelin/Astepro, olopatadine - Patanase) |
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Definition
Place in Therapy:
alternative to oral antihistamines;
Only indicated for seasonal AR;
Differences:
higher cost, faster onset of action, no advantage in efficacy, different side effect profile;
Side Effects:
- drowsiness, bitter taste, HA, nasal burning & dryness |
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Term
| Pt Counseling for Nasal Antihistamines |
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Definition
Gently blow nose;
Tilt head forward, breathe out, and close one nostril with your finger;
Hold the spray bottle vertically;
Aim toward the back of the nose while gently sniffing; |
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Term
| chlorpheniramine (Chlor-Trimeton) |
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Definition
1st gen. antihistamine;
OTC;
Adult Dosing:
- 4 mg q4 hrs,
SR: 8-12 mg HS or q8 hrs;
Increased anticholinergic effects, useful in insomnia; |
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Term
| diphenhydramine (Benadryl) |
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Definition
1st Gen. Antihistamine;
OTC;
Dosing:
12.5 - 50 mg po q4-6 hrs;
Increased anticholinergic effects, useful in insomnia; |
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Term
| loratidine (Claritin, Alavert) |
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Definition
2nd Gen. Antihistamine;
OTC;
Dosing:
- 10 mg once daily;
Less sedation, less anticholinergic SEs; |
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Term
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Definition
2nd Gen. Antihistamine;
OTC;
Dosing: 5-10 mg once daily;
most sedating 2nd gen.;
Less anticholinergic SEs;
Can be used in children < 2 yrs old |
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Term
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Definition
2nd Gen. Antihistamine;
RX only;
Dosing: 10 mg once daily;
Less sedating, less anticholinergic SEs; |
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Term
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Definition
2nd Gen. Antihistamine;
RX only;
Dosing: 60 mg BID or 180 mg once daily; |
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Term
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Definition
2nd Gen. Antihistamine;
RX only;
Dosing: 5 mg once daily; |
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Term
| azelastine (Astelin/Astepro) |
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Definition
intranasal antihistamine;
RX only;
Dosing: 1-2 sprays (137 mcg) in each nostril BID;
good for PRN use, quick onset of 30 min; |
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Term
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Definition
intranasal antihistamine;
RX only;
Dosing: 2 sprays (665 mcg) in each nostril BID;
Good for PRN use; Quick onset of 30 min; |
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Term
| Oral Decongestants (Pseudoephedrine - PSE, phenylephrine - PE) |
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Definition
Place in Therapy:
- only effective for relieving nasal CONGESTION;
- no for long-term use, use PRN ONLY!
MoA: sympathomimetic agents that act on alpha-adrenergic receptors in nasal mucosa, producing vascoconstriction;
SEs:
- CNS stimulation, HTN;
Caution: hyperthyroidism, HTN, CAD, BPH, DM;
C/I's: severe uncontrolled HTN, severe CAD, severe DM, MAOI use; |
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Term
| phenylephrine (Sudafed PE) |
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Definition
OTC oral nasal decongestant;
Dosing:
- 120 mg PO q12 hrs; |
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Term
| pseudoephedrine (PSE - Sudafed) |
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Definition
OTC oral nasal decongestant;
Dosing:
- 30-60 mg PO q4-6 hrs; |
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Term
| phenylephrine (Neo-synephrine), naphazoline (Privine), tetrahydrozoline (Tyzine), oxymetazoline (Afrin), xylometazoline (Otrivin) |
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Definition
topical nasal decongestants;
Therapy should NOT exceed 3 days;
All have frequent dosing; |
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Term
| Differences between Topical and Oral Decongestants |
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Definition
little or no systemic absorption;
faster onset of action;
SEs: burning, stinging, dryness, irritation, if used for >3 days risk of rebound congestion (rhinitis medicamentosa) |
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Term
| Treatment of Rebound Congestion (rhinitis medicamentosa) |
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Definition
D/C topical nasal decongestant;
Use saline drops instead;
May start nasal corticosteroids;
Use short course of oral corticosteroids per physician if needed; |
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Term
| Intranasal Corticosteroids (ICS) - ciclesonide (Omnaris), fluticasone furoate (Veramyst), fluticasone propionate (Flonase), mometasone (Nasonex) |
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Definition
Place in Therapy:
- 1st line tx for moderate-severe or persistent symptoms;
Perennial AR: take all yr long;
Seasonal AR: Take 2-4 wks prior to allergy season, then continue for 2-4 wks after season.
MoA:
- decrease formation & release of inflammatory mediators from mast cells, decrease # of inflammatory cells in nasal mucosa, exert a direct local anti-inflammatory effect;
SEs:
- LESS than systemic drugs;
- HA, cough, nosebleeds, Nasal irritation, burning, stinging, dryness, nasal septualperforation;
Onset:
- some relief in 24-48 hrs, optimal effect in 2-3 wks; may achieve max. benefit in 6-8 months; |
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Term
| Patient Education for Intranasal Corticosteroids (ICS) - ciclesonide (Omnaris), fluticasone furoate (Veramyst), fluticasone propionate (Flonase), mometasone (Nasonex) |
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Definition
may use decongestant 1st to reduce nasal blockage; Need regular use for efficacy;
Proper technique:
- may need to shake & prime bottle prior to 1st use;
- blow nose prior to use;
- tilt head slightly forward/close other nostril with finger;
- inject in nostril while breathing in;
- avoid nasal septum;
- avoid sneezing or blowing nose for at least 10 min after administration |
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Term
| cromolyn (Nasalcrom) Nasal Spray OTC |
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Definition
Place in therapy:
- less effective than oral nonsedating antihistamines or steroids;
- not for ocular symptoms;
- use up to 1 wk prior to anticipated exposure;
MoA: anti-inflammatory & stabilizes mast cells;
Onset: slow, 2 wks;
SEs: good safety profile;
Dosing:
- Use 1 spray in each nostril 3-4x daily, may increase to 6x daily;
PREFERRED IN PREGNANCY |
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Term
| Opthalmic Agents for AR - (naphazoline/pheniramine - Naphcon-A, Ketotifen - Zaditor, olopatadine - Patanol/Pataday, emedastine - Emadine, azelastine - Optivar) |
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Definition
Place in Therapy:
- acute allergic conjunctivitis - use OTC prodcuts;
- seasonal/perennial allergic conjunctivitis - use RX ophthalmic agents;
SEs: HA, eye irritation, dry eyes, visual disturbances;
Pt Counseling:
- keep eye open;
- pull down lower lid, forming pouch;
- place drop into pouch;
- look up to prevent draining;
If taking multiple meds, wait 5-15 min in between; |
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Term
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Definition
1st leukotriene receptor antagonist approved for tx of seasonal AR;
Place in Therapy:
- effective alone or in combo w/ antihistamine, use if pt has comorbid asthma;
- second-line tx option;
Dosing:
- 10 mg once daily; |
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Term
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Definition
recombinant humanized anti-IgE monoclonal Ab;
Place in Therapy:
- injectable (SC) tx, very expensive, low risk of cancer;
-2nd line therapy |
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Term
| Immunotherapy (Hyposensitization allergy shots) |
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Definition
used in pts who do not respond to drug tx;
- SC injection w/ pt-specific allergens;
- most effective for pollen-related allergens;
injections initially given WEEKLY;
Conc. of allergens gradually increases until reach maintenance dose at 4-8 months;
repeat maintenance doses for 3-4 wks for 3-5 yrs |
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