A Quick Tour OfALLERGIC RHINITISManjul Dixit, M.D.
Allergic Rhinits: DefinitionAllergic rhinitis is clinically defined as a symptomaticdisorder of the nose induced by an IgE-mediatedinflammation after allergen exposure of the membraneslining the nose
Interesting Facts• 10% to 20% of population have intermittent rhinitis• 30% to 50% of patients have persistent rhinitis• Up to 15% of patients are children 6 to 7 years of age• Up to 40% of patients are adolescents 13 to 14 years of age• 18% to 21% of patients are young adults 15 to 24 years of age• less than 8% of patients are adults over 65 years of age• Allergic rhinitis is one of the major 10 conditions that lead tomedical consultation in U.S. managed-case populations
Quality Of Life• Fatigue• Sleep Disorders• Learning Problems• Chronic Rhinosinusitis• Dental Abnormalities• Speech Disorders• Emotional problems• Impaired activity and social functioning• Poor perception of general health• > 800,000 missed days of work, school, anddecreased productivity days• $5.4 to $7.7 billion dollars lost
ARIA ClassificationIntermittent Persistent• < 4 days per week • ≥ 4 days per week• or < 4 weeks • and ≥ 4 weeksMild Moderate-severe normal sleep one or more items& no impairment of daily abnormal sleep activities, sport, leisure impairment of daily& normal work and school activities, sport, leisure& no troublesome symptoms abnormal work and school troublesome symptoms ARIA Report 2001
PHYSICAL EXAMINATION Allergic shiner Dennie Morgan line Allergic crease Allergic salute 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
Why?-Trees: Spring and Fall Oak, Maple, Cedar, Olive and Elm- Grasses: Early Summer and Fall Kentucky Blue Grass, Orchard, Redtop, Timothy, and Bermuda-Weed: Late Summer and Fall Pigweed, Sage, Mugwort, lamb’s quarters-Outdoor Molds: Summer and Early Fall Alternaria and Cladosporium Dry and Windy days-Indoor Molds: Aspergillus and Penicillium-Pets-Cockroaches
Actions of Various Nasal Preparations in the Treatment of RhinitisNasal Sneezing Itching Rhinorrhea CongestionPreparationAntihistamines +++++ ++++ +++ 0Anticholinergics 0 0 +++++ 0Corticosteroids +++++ +++++ +++ +++Decongestants 0 0 + +++++Antileukotrienes +++ ++ 0 ++++
The “Ideal” Drug For Allergic RhinitisShould Have The Following Features: Inhibit both early and late phases Be an H1 blocker Counter effects of other mediators Fast-acting, to control the early phase Dosing-od or bd for compliance No side effects Manage all symptoms Intranasal administration
The “Ideal” Drugs Are……“Corticosteroids are undoubtedly thepharmacotherapeutic agents with the broadestapplication for the treatment of many types ofrhinitis”
Intranasal corticosteroid therapy Potent topical activity 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
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