Therapeutics: Allergic Rhinitis
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What mediates Allergic rhinitis?
- Immune IgE mediated
- Genetically predisposed
- Inhaled allergens
- Delayed inflammatory process
What are the Drug therapy general types for Allergic Rhinitis?
Symptom treatment or Prevention
What are the general types of allergic rhinitis?
Seasonal and Perennial
When does Seasonal allergic rhinitis usually occur?
- Generally/Usually spring – Fall
- Allergens usually found OUTDOORS
What type of allergic rhinitis causative agent is found in Spring?
What type of allergic rhinitis causative agent is found in Late Spring – Summer?
What type of allergic rhinitis causative agent is found in Late summer – Fall?
When does Perennial allergic rhinitis usually occur?
- All year
- Allergens found INDOORS
What usually causes Perennial allergic rhinitis?
Dust, Dander, animal excretions, Cockroaches, Chemicals, Mold spores
What are the Early stage Symptoms of Allergic rhinitis?
Rhinorrhea, Sneezing, Congestions, Itchy/water eyes, ears, nose and palate
What general type of drugs would you use for Early stage allergic rhinitis?
Antihistamines to Dry the secretions – Use drops for only itchy eyes
What are the Late stage Symptoms of Allergic rhinitis?
Congestions, Hyperresponsive reactions – Inflammation worsens these symtoms
What general type of drugs would you use for Late stage allergic rhinitis?
Use Decongestants, NSAIDs or Anti-inflammatory sprays
When should you use Systemic route for allergic rhinitis treatment?
What are the Diagnosis techniques for allergic rhinitis?
- Epicutaneous (prick or puncture)
- Intradermal (known amount under dermis)
- Nasal challenge (inhale), Repeated exposure
What is the 1st type of Treatment you should try for allergic rhinitis?
- Non-pharmacologic =
- doors/windows closed
- air conditioning/dehumidifier
- pets outside
- dust free bedding casing (not shown effective)
What is the 2nd type of Treatment you should try for allergic rhinitis?
- Good = Antihistamines, Decongestatns, Nasal steroids, Mast Cell stabilizers, Leukotriene inhibitors, Allergy desensitization
- Fair= Anti-cholinergics or Surgery (mostly used for broken nose)
When are Antihistamines a good choice?
Need to Dry secretions in Early phase
Which 2nd gen Antihistamines may cause drowsiness?
Cetirizine and leveocetirizine cross BBB and may cause sedation
What are the 1st gen Antihistamines?
Chlorpheniramines, Diphenhydramine, Clemastine
What are the 2nd gen Antihistamines?
Fexofenadine (allegra)*, Loratadine (Claratin)*, Desloratadine (Clarinex), Cetirizine (Zyrtec)*, Levocetirizine (Xyzal) * = OTC
What are the Decongestants for allergic rhinitis?
- Topical (Neosnephrine) or systemic Phenylephrine
- Systemic Pseudophedrine
Why can’t you use Topical Neosnephrine (Phenylephrine) more than 3-5 days?
- Any more causes Rhinitis Medicamentosa
- Wash out for 24-48 hours before restarting
What is the efficacy of Systemic Phenylephrine ?
When should you use Systemic Pseudophedrine cautiously?
- BP at dose >240 mg/day
- Don’t use if uncontrolled HTN, previous MI, stroke, CV issue
- Use if: BP controlled by drugs or diet
What are Coticosteroids mostly used for?
Mostly for perennial (can be used for seasonal)
What is the MOA of corticosteroids?
Rreduce inflammation, neutrophil chemotaxis, edema, mast cell mediated late phase. Mild vasoconstriction
How long does it take for Corticosteroids to become effective?
Take days to week to work = Prevention
What are the PO corticosteroids?
Budesonide, Ciclesonide, Flunisolide, Fluticasone propionate, Mometaseon furoate
What are the aerosol corticosteroids?
Ciclesonide (Zetonna) and Beclomethasone (Qnasl) = less cheap
What is the MOA of Leukotriene Modifiers?
Block leukotrieines from arachadonic acid cascade
What is the efficacy of Leukotriene modifiers?
- Inferior to corticosteroids and antihistamines – may use as add-on
- Good for asthmatics with allergic rhinitis
What are the alternate methods for treating Allergic Rhinitis?
- Saline washes (Neti-Pot) – easy and wired sensation
- Cromolyn Sodium – Delayed onset, start before season starts, OTC
- Ipratropium Bromide = antisecretory – not very effective = use others first
What are the Ocular therapies?
- Antihistmaines: Azelastine (Optivar), Olopatadine (Pantanol), Ketotifen (Zaditor)
- Mast Cell Stabilizers: Lodoxamide (Alomide), Cromolyn (Opticrom), Nedocromil (Alocril)
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