Inflammation and irritation of nasal mucus membranes
- =>Causes include
- Allergic-can be intermittent or perennial, seasonal.
- Nonallergic: trauma, kids sticking things up their nose, hormonal, smoking cocaine/drug use damages nasal mucosa, vasomotor decreased circulation to that area.
=>Allergic rhinitis is an IgE mediated inflammatory disease (can be seasonal or all year long): sensitization
to an allergen occurs with intial allergen exposure, which results in the production of antigen speficic immunoglubulin E. Causes sneezing, itching, rhinnorrhea and congestions.
Seasonal/intermittent vs perennial/persistentUsual triggers include pollen, dust mites, pet dander, molds (there's a mold count in texas...)Usually develops <20 years oldFamilial history
- =>Clinical Manifestations
- Triad of nasal congestion, sneezing, clear rhinorrhea (runny nose)
- Itchy, puffy eyes
- Pale, boggy nasal mucosa
- Enlarged turbinates Mouth breathing
- Allergic shiners (black eye without trauma, mucosa so blocked up that blood pools around tissues in eye causing a black eye.)
- =>Collaborative Care of Allergic Rhinitis
- Identify and eliminate allergens (most important in managing): Keep diary of potential triggers-allergen testing is beneficial for these patients
- -the bedroom should be the most allergic free: hepa filter, wood floors, no pets, clean bedding, run a/c?
- =>Drug therapy when allergen avoidance is ineffective
- Notes: second generation prefffered over first, adqaute fluid intake,
- Oral H1 blockers- loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra) (second generation of allergen blockers because no sedation occurs ! vs First generation: Benadryl)
- Corticosteroid Nasal Sprays- fluticasone (Flonase), mometasone (Nasonex), triamcinolone (Nasacort) (second line of defense, nasally administered so no systemic side effects despite being corticos, Use REGULARLY, not PRN)
oral phenylephrine (Sudafed-vasoconstriction clears all inflammation, but contraindicated in BP issues, rebound vasodilation/swellling can occur so limit for 2-3 days maybe to one nostril), topical phenylephrine (Neo-
- Synephrine--not as long acting), topical azelastine (Astelin), topical oxymetazolin (Afrin)
- Leukotriene receptor-blockers, mast cell stabilizers