The truth About Allergic Rhinitis

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This is a guidebook having to do with (blank) rhinitis (blank) Manjul Dixit M.D.

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The truth About Allergic Rhinitis

  1. 1. A Quick Tour OfALLERGIC RHINITISManjul Dixit, M.D.
  2. 2. 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
  3. 3. 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
  4. 4. Clinical Manifestations Repetitive sneezing  Eye symptoms Watery rhinorrhea  Ear symptoms Nasal pruritus  Postnasal drainage Nasal congestion
  5. 5. 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
  6. 6. Types of Rhinitis
  7. 7. Conditions that mimic rhinitis
  8. 8. The Allergic Reaction
  9. 9. 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
  10. 10. Diagnosis of AR History Physical / Nasal Examination Laboratory Testing - Skin Prick Test - Peak Nasal Inspiratory Flow Rate - Rhinomanometry
  11. 11. 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
  12. 12. 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
  13. 13. Management of AR Allergen Avoidance Pharmacotherapy Immunotherapy - Subcutaneous - Sublingual
  14. 14. Pharmacotherapy
  15. 15. Actions of Various Nasal Preparations in the Treatment of RhinitisNasal Sneezing Itching Rhinorrhea CongestionPreparationAntihistamines +++++ ++++ +++ 0Anticholinergics 0 0 +++++ 0Corticosteroids +++++ +++++ +++ +++Decongestants 0 0 + +++++Antileukotrienes +++ ++ 0 ++++
  16. 16. 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
  17. 17. The “Ideal” Drugs Are……“Corticosteroids are undoubtedly thepharmacotherapeutic agents with the broadestapplication for the treatment of many types ofrhinitis”
  18. 18. 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
  19. 19. THANK YOU!!!! For more information please visit http://athertonallergists.com/

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