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Allergy Rhinitis

Types and Pharm

QuestionAnswer
Mechanism of allergic rhinitis? Airborne allergens bind with specific IgE in the nose.
Mechanisms of non-allergic rhinitis? Entopy (local nasal IgE synthesis despite negative skin tests); nocioceptive dysfunction (hyperactive sensory receptor); ANS abnormalities (hypo- or hyperactive dysfunction of para/sympathetic nerves in the nose).
Mechanism of allergic rhinitis? Airborne allergens bind with specific IgE in the nose.
Mechanisms of non-allergic rhinitis? Entopy (local nasal IgE synthesis despite negative skin tests); nocioceptive dysfunction (hyperactive sensory receptor); ANS abnormalities (hypo- or hyperactive dysfunction of para/sympathetic nerves in the nose).
Symptoms of allergic rhinitis? Sneezing, itching; allergic crease; turbinates - pale, moist, boggy, with bluish tinge.
Symtoms of non-allergic rhinitis? Nasal congestion, rhinorrhea; develops at a later age.
Effect of antihistamines on non-allergic rhinitis? No benefit.
First line therapy for allergic rhinitis? Intranasal steroids.
Causes of vasomotor rhinitis? irritants (odors, smoke); weather (no benefit from steroids); gustatory; sexual arousal (honeymoon rhinitis).
Treatment for vasomotor rhinitis? Ipratropium
Causes of Drug-Induced rhinitis? Aspirin/NSAIDs; alpha-agonists/antagonists; vasodilators; antihypertension drugs; oral contraceptives; sildenafil (anniversary rhinitis); cocaine.
Symptoms of rhinitis medicamentosa? Beefy red mucosa without mucous. (Rebound.)
Causes of Infectious rhinitis? Acute upper respiratory tract infection (thick discharge, sneezing, obstruction 7-10 days); chronic rhinosinusitis (>12 weeks + CT confirmation, thick sinus lining, facial pain, congestion, obstruction, purulent discharge)
Treatment for infectious rhinitis? Antibiotics
Symptoms of NARES (Non-Allergic Rhinitis Eosinophilic Syndrome)? Middle-aged patient, perennial sneezing, itching, rhinorrhea.
Causes of Immunologic rhinitis? Wegener's granulomatosis, sarcoidosis, polychondritis, midline granulomas, Churg-Strauss, amyloidosis, granulomatous infections.
Treatment for immunologic rhinitis? Intranasal steroids.
Causes of Occupational rhinitis? Chemicals, aerosols, flour, latex (asthma-associated).
Treatment for occupational rhinitis? Avoidance.
Causes of hormonal rhinitis (metabolic or endocrine)? Pregnancy, menstruation, hypothyroidism.
Treatment for pregnancy-induced hormonal rhinitis? Intranasal budesonide (Rhinocort).
Causes of structural rhinitis? Polyps, deviated septum, adenoidal hypertrophy, tumors, CSF leak (salty, metallic taste due to Beta-2 transferrin in secretions).
Treatment for most structural rhinitis? Surgery.
Causes of Atrophic rhinitis? Infectious - primary (idiopathic) Klebsiella ozonae (stinky snot; seen in youths from warm climates); Secondary - complication from surgery/trauma.
Treatment for atrophic rhinitis? Saline rinses, maybe antibiotics.
List drugs used to manage allergic rhinitis. Antihistamine (!st: diphenhydramine; 2nd: loratiadine, fexofenadine), decongestant (phenylephrine, pseudoephedrine), corticosteroid (fluticasone), mast cell stabilizer (cromolyn), anticholinergic (ipratropium), leukotriene modifier (montelukast).
Most effective drug against allergic rhinitis? Intranasal corticosteroids.
Explain histamine's actions in allergic rhinitis. Histamine causes vasodilation and increased venous permeability leading to inflammation of nasal mucosa and nasal congestion.
Therapeutic uses for 1st generation H1-receptor antagonists? Allergy treatment, sedation, antiemetic, anticholinergic.
Therapeutic uses for 2nd generation H1-receptor antagonists? Allergy treatment.
Which generation of antihistamine can have CNS side effects? 1st Generation, due to ability to cross the Blood Brain Barrier.
1st Gen antihistamine side effects? Sedation, excitement in children, dry mouth, blurred vision, tachycardia, urinary retention, hallucinations. Anticholinergic toxicity.
Which agent can cause Churg-Strauss syndrome (allergic granulatomous vasculitis)? Montelukast.
List the 5 immunoglobulins in order of abundance. IgG > IgA > IgM > IgD > IgE
Non-reactive causes of nasal discharge? Kartagener's Syndrome (congenital), facial trauma, nose bleeds, foreign body, malignant nasal neoplasms, cluster headaches.
Created by: tobyburke
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