Allergic Rhinitis

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    When was it built? By whom? Why? Art appreciation like in JAMA. The Taj Mahal is a mausoleum located in Agra , India , that was built under Mughal Emperor Shah Jahan in memory of his favorite wife, Mumtaz Mahal . The Taj Mahal is considered the finest example of Mughal architecture , a style that combines elements from Persian , Turkish , Indian , and Islamic architectural styles. Taj Mahal is an integrated symmetric complex of structures that was completed around 1648.

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    Allergic Rhinitis - Presentation Transcript

    1.                                                                                                                                
    2. Neil L. Kao, M.D., F.A.C.P., Clinical Assistant Professor, U.S.C. School of Medicine WELCOME!
    3.  
      • Epidemiology Of Allergic Rhinitis
      • Allergic rhinitis was reported the second most prevalent chronic condition in the United States in 1994
      • Affects 40 to 50 million people
      • Incidence highest in people ages 15-25 years
      • Affects 10% to 30% of adults, 40% of children
      • In one study, 57% of patients with chronic rhinitis had nonallergic or mixed rhinitis
      • The Burden of Allergic Rhinitis
      • 50% patients symptomatic > 4 months/year
      • 20% patients symptomatic > 9 months/year
      • 10,000 children out of school daily
      • 10,000,000 office visits annually
      • 2,000,000 days of missed school
      • $5.3 billion for direct and indirect costs in year 1996
      • And this accounts only for allergic rhinitis, nonallergic rhinitis is another issue
      • Blais, MS. Costs of allergic rhinitis in Current Views of Rhinitis
    4.                                                                                                                                
    5. Nasal Anatomy
    6.  
    7.  
    8. Definition of Allergic Rhinitis
      • Rhinitis is an inflammation of the mucous membranes of the nose. Allergic rhinitis involves reactions in the nasal mucosa from repeated allergen exposures that causes immediate hypersensitivity. These reactions may be seasonal or perennial.
    9. Causes of Allergic Rhinitis
    10.                                                                                                                                                                  
    11.  
    12.  
    13.  
    14.                                                                                                                                                       
    15. Questions of clinical relevance
      • What is wrong with the patient?
      • What can I do for the patient?
      • What will the outcome be?
      • What will it cost?
      • What, specifically, must I do to behave in the best traditions of our profession?
      • J SC Med Assoc 1995; 91: 243-4.
    16. Allergy History Screen
    17.  
    18.  
    19. Physical Examination
      • Allergic shiner
      • Dennie Morgan line
      • Allergic crease, congested nasal breathing, sniffling
      • Allergic salute, mouth breathing
      • Nasal mucosa may appear normal or pale bluish, swollen with watery secretions but only if patient is symptomatic
      • Exclude structural problems (polyps, deflected nasal septum)
      • Others :
      • nasal voice, constant mouth breathing, frequent snoring, coughing, repetitive sneezing, chronic open gape of the mouth, weakness, malaise, irritability
    20.  
    21.  
    22. Diagnosis of Allergic Rhinitis
      • History
      • Physical / Nasal Examination
      • Nasal smear for eosinophils, WBC, bacteria
      • Skin Prick Test (in vivo) > serum RAST, as in more accurate, quicker. Recommended by A.C.P. unless ST can not be done
      • Blood: CBC/diff, IgE levels (poor screening tests)
                               
    23. Allergy Prick Skin Tests                                                                                                      
    24.  
    25. Causes of Rhinitis
      • Allergy
      • NARES syndrome
      • Occupational, hobbies
      • Hormonal
      • Drug induced
      • Anatomic defects
      • Infections, viral
      • Irritants
      • Adverse food reaction
      • Emotional
      • Atrophic
      • Ciliary dyskinesia
      • Immunodeficiency diseases
    26.                                                                                                                                
    27.  
    28. Allergic Rhinitis Therapy
          • Hope, compassion, empowerment
          • Education
          • Avoidance of triggers
          • Medications
          • Allergy Immunotherapy (shots)
    29. Educational Resources
      • American Academy of Allergy, Asthma, and Immunology -- http://www.aaaai.org
      • American College of Allergy, Asthma, and Immunology – http://www.acaai.org
      • Asthma & Allergy Foundation of America -- http://www.aafa.org
      • Allergy & Asthma Network/Mothers of Asthmatics, Inc. -- http://www.aanma.org
      • My website has links to the above, pollen counts, and more -- http:// www.kaoallergyasthma.blogspot.com
    30.  
    31. Weed pollen count Mold spore count Tree pollen count Grass pollen count
    32.  
    33.  
    34.  
    35. Irritants to avoid
      • Smoke or exhaust from any source
      • Paints, glues, cleaning products, aerosols, perfumes
      • Photocopier exhaust
      • Paper dust
      • Dry wall board dust
    36.  
    37. Anti-Histamine medications
      • Act by preventing histamine from binding to its receptors
      • Primarily helpful in controlling sneezing, itching, runny nose; ineffective in relieving nasal congestion
      • 1 st generation anti-histamines (short half-life, sedating, older):
      • chlorpheniramine (OTC), diphenhydramine (OTC) (Benedryl)
      • 2 nd generation anti-histamines (long half-life, no or lower sedating, newer, mildly higher cost, preferred): cetirizine (OTC) (Zyrtec), azelastine (Astelin nose spray), fexofenadine (Allegra), loratadine (OTC) (Alavert, Claritin), desloratadine (Clarinex), levocetirizine (Xyzal), olopatadine (Patanase nose spray)
    38. Intranasal corticosteroid sprays
      • Potent topical activity: all have equal efficacy
      • Administration of low doses directly at site of action
      • Considerable efficacy at low doses
      • High topical: systemic activity ratios
      • Rapid first-pass hepatic metabolism of any systemically absorbed drug, to compounds with negligible activity
      • Markedly greater inhibition of EAR than with oral steroids
      • No effect on growth
    39. Additional medications
      • Decongestants: oral (-D, OTC e.g. Sudafed). Do NOT use topical OTC sprays – potent BUT addicting
      • Leukotriene receptor antagonist (Montelukast [Singulair]): not as effect as AH1 or CS, so not first line therapy
      • Expectorant to thin mucus (guaifenesin), long-acting only available as OTC Mucinex, mildly helpful
      • Antibiotic if complicating bacterial infection present
      • Do not forget eyedrops for symptoms
      • Saline rinses for nose and eyes, use lots of volume and repeat throughout the day
    40.  
    41. Concept of "minimal persistent inflammation“ causing chronic disease Threshold level for symptoms Symptoms inflammation Ciprandi et al, J Allergy Clin Immunol 1996 An inflammatory process which is actually present even in asymptomatic subjects who are exposed to allergens 0 , 1 1 1 0 1 0 0 0 2 4 6 8 1 0 1 2 M o n t h s mite allergen (µg/g of dust) Minimal persistent inflammation
    42.  
    43. Allergy Immunotherapy (Injections)
      • When medications and avoidance don’t work
      • Only therapy that can raise T-cell tolerance to allergens so there is no allergic immune response
      • Usually prescribed by a specialist
      • Most effective for dust mites, pollen, cat allergy
      • May also be effective for dog, mold allergy
      • Cost, discomfort, time, normal course 3-5 years
    44.  
      • Let us,then, be up and doing,
      • With a heart for any fate;
      • Still achieving, still pursuing,
      • Learn to labor and to wait.
      • Henry Wadsworth Longfellow
    45.                                                                                                             

    + Neil KaoNeil Kao, 2 years ago

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