Allergic rhinitis is a type I hypersensitivity reaction mediated by IgE antibodies. It has a prevalence of 10-20% in the US and is characterized by symptoms like sneezing, rhinorrhea, nasal congestion and pruritus. Risk factors include family history of atopy, environmental exposures, and lifestyle factors. Treatment involves allergen avoidance, pharmacotherapy with antihistamines, intranasal corticosteroids, leukotriene receptor antagonists and immunotherapy for selected patients.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. • Allergic rhinitis is a clinical hypersensitivity of
the nasal mucosa to foreign substances
mediated through IgE antibodies .
• type I, IgE-dependent, mast cell–mediated
immune reaction, whereby the release of mast
cell or basophil mediators creates responses to
sensitizing allergens.
3. Genetics and family history
The best established is family history
of allergy especially of allergic
rhinitis
(13% , 29% , 47%)
Environment
More common in developed
countries
Pollution (immigrants)
Hygeine hypothesis (early exposure
to animals and nursery attendance
reduce atopy)
Risk Factors
4. • prevalence of between 10% and 20% and
affects 20 to 40 million individuals in the
United States annually.
• higher in children and adolescents than
in adults.
• In childhood, boys outnumber girls; the
gender ratio becomes approximately
equal in adults.
• In one study, the mean total productivity
losses per employee per year were $593
for allergic rhinitis, which was more
costly than all other prevalent and
chronic disorders.
7. Hypersensitivity reactions
• Type I :mast cell mediated reactions
• Type II, cytotoxic, antibody-mediated reactions
(IgG-, IgM-mediated , opsonization,
complement activation, penicillin-induced
autoimmune hemolytic anemia).
IgE-dependent IgE-independent
8. • Type III, immune complex–mediated reactions.
(serum sickness)
• Type IV, delayed hypersensitivity (DTH)
reactions (T cell–mediated) (PPD)
9. Pathophysiology of Allergic Rhinitis
The reaction can be considered in four phase:
1. Sensitization
2. Early phase reaction
3. Late phase reaction
4. Systemic activation
• Initial stage :
low-dose exposure production of specific IgE antibodies.
10. TH2
CD4
IgE ,
Recruitment
and survival of
eosinophils
Antigen-specific IgE then
attaches to high-affinity
receptors on mast cells
and basophils
subsequent exposure
IgE
Mast
cell
11. Early Response to Antigen
• Within minutes after exposure
of an allergic patient to
antigen, an inflammatory
response occurs. The patient
first senses tingling and
pruritus, followed by sneezing,
rhinorrhea, and, last, nasal
congestion.
• increases are noted in the
levels of several mediators,
including histamine, kinins,
tryptase, PGD2, leukotriene C4
(LTC4), leukotriene B4 (LTB4),
major basic protein (MBP) and
platelet-activating factor (PAF).
12. • Histamine is preformed in
Granules
• Histamine causes rhinorrhea
(By action on vascular
endothelial cells and glandular
secretions), sneezing, pruritis
(By action on sensory nerves)
and nasal obstruction (Not
marked and of short duration)
• The major mediator of the
early phase reaction.
• Histamine also possesses
proinflammatory and
immunomodulatory
properties
13. • Prostaglandins are
manufactured by AAA
metabolism by COX pathway
after its break-down form cell
membrane by Ph-Lip-A2.
• PG D2 is the predominant
prostanoid released following
mast cell degranulation.
• It induces a sustained nasal
obstruction and is ten times
more potent than histamine.
14. Eicosanoids are Manufactured
by AAA metabolism by LOX
pathway after its break-down
form cell membrane by
Phospholipase A2.
Formally known as the slow
reacting substance of
anaphylaxis (SRS-A), play an
essential role in asthma and
rhinitis.
They induce vascular
permeability and oedema in
the nose and are also involved
in eosinophil recruitment.
LTB4 induces neutrophil
recruitment.
Leukotrienes
15. Late phase reaction
• The response to allergen exposure is not
limited to the acute events that occur minutes
after exposure. Hours after antigen challenge,
some patients experience a recurrence of
symptoms, most notably nasal congestion.
• striking characteristic of the late-phase
response is cellular inflammation.
16. • suggesting that nasal secretions and the nasal
mucosa are two separate compartments with
different inflammatory cellular predominance
during allergic inflammation.
• polymorphonuclear cells and eosinophils
predominating in nasal secretions , and
mononuclear cells predominating in the nasal
mucosa.
17. • examination of nasal mucosal scrapings or
biopsy specimens which sample deeper layers,
showed that most metachromatic cells in
these compartments were mast cells.
18. • Langerhans cells : large
mononuclear dendritic
cells that are important in
antige presentation.
• In a study involving
patients with perennial
allergic rhinitis, a
significant decrease in
numbers of Langerhans
cells in the epithelium was
seen after 3 months of
treatment with fluticasone
propionate.
19. Adhesion Molecules and Cellular
Recruitment
• Mechanisms exist for the
migration and accumulation of
these effector cells during
allergic inflammation.
• Recruitment of cells are
mediated, by interactions
between adhesion molecules
on the cells themselves and
those on vascular endothelial
cells.
• Adhesion molecules on the
vascular endothelial cell
surface include ICAM-1
(CD54), ICAM-2, E-selectin, P-
selectin (granule membrane
protein VCAM-1.
20.
21. Neuronal Contribution
• Unilateral intranasal antigen
challenge experiments have
supported the role of the nervous
system in amplifying the allergic
response as challenge.
• an increase in rhinorrhea, secretion
weights, and PGD2 contralateral to
the challenge. The contralateral
secretory response was rich in
glandular markers and was inhibited
by atropine, an anticholinergic,
suggesting that the efferent limb was
cholinergically mediated.
• Histamine’s action on nasal afferent
nerves initiates this reflex.
• increases in the levels of substance P,
calcitonin gene–related peptide, and
vasoactive intestinal peptide
immediately after antigen challenge
in allergic individuals.
22. Hyperresponsiveness
• One of the hallmarks of allergic rhinitis is the
hyperresponsiveness .
Hyperresponsiveness
SpecificHyperresponsiveness(PRIMING ) NonspecificHyperresponsiveness
25. History
• The classic symptoms of seasonal allergic rhinitis
are recurrent episodes of sneezing, pruritus,
rhinorrhea, nasal congestion, and lacrimation
that occur after exposure to the offending
allergen.
• Itching is the symptom most suggestive of an
allergic etiology and involves not only the nose
but also the palate, throat, eyes, and ears.
• Systemic symptoms that may accompany allergic
rhinitis include general malaise, fatigue,
irritability, snoring, and sleep problems.
• family history of allergic diseases such as allergic
rhinitis, asthma, and atopic dermatitis.
26. classification of allergic rhinitis
• Classification of allergic rhinitis is
seasonal, perennial, or episodic .
Seasonal allergic rhinitis is defined by
symptoms that occur during exposure
to seasonal allergens
Perennial allergic rhinitis, defined as
nasal symptoms for more than 2
hours per day for more than 9 months
of the year.
Episodic rhinitis refers to symptoms
on exposure to allergens that are not
normally present in the environment.
27. • newer classification was proposed in 1999, during
the ARIA (Allergic Rhinitis and its Impact on Asthma)
Intermittent
Symptoms
• < 4 days / week
• or < 4 weeks
Persistent
Symptoms
• > 4 days / week
• or > 4 weeks
Mild
• Sleep: normal
• Daily activities (incl. sports):
normal
• Work-school activities: normal
• Severe symptoms: no
Moderate- severe
• Sleep: disturbed
• Daily activities: Restricted
• Work and school activities:
disrupted
• Severe symptoms: yes
28. Physical Examination
• A complete ear, nose, and throat examination is
essential in the workup of every patient suspected of
having allergic rhinitis and is useful in identifying other
problems rather than in confirming the diagnosis.
• The patient should be looked at generally to assess any
obvious external features, such as an allergic crease or
allergic salute.
• Atopic dermatitis or conjunctivitis should be sought
and the patient's respiratory state noted.
29. • Examination of the face
:
• allergic shiners .
• Adenoid facies
• allergic salute .
• Dinnie’s lines.
• Injection of bulbar
conjunctiva
30. Nose and throat
• Inferio turbinate Mucosal edema, pale,
bluish, and edematous, and coated with thin,
clear secretions.
2. Cobblestoning of posterior pharyngeal wall
32. Allergy skin prick testing
(SPT)
• A drop of a standardized allergen extract is
placed on the volar aspect of the forearm
and then pricked into the skin using a
lancet
• A positive control (histamine) and a
negative control (saline or diluent) should
be included
• A separate lancet is used for each test
which is read as the mean wheal diameter
at 15 minutes
• Reactions greater than 2 mm in under fives
and 3 mm in older subjects are regarded as
positive
• Invalid results in +ve negative control and in
–ve positive control (RAST should be
employed)
33. • A positive skin prick test is not indicative of clinical allergy
unless supported by the relevant history.
• Positive skin prick tests occur in 25-30 percent of adults,
only 10-15 percent develop symptoms.
• The risk of clinical allergy increases with the size of the
skin reaction.
• Patients who have positive skin prick tests and no
symptoms are sensitized: approximately half of these will
go on to develop clinical allergic disease.
Sensitivity and specificity of SPT
34. • Skin testing should not routinely be performed in
patients
• 1- who are at high risk for an anaphylactic
reaction to testing (poorly controlled asthma)
• 2- have experienced a recent anaphylactic event
• 3- are taking medications that may interfere with
the treatment of anaphylaxis (TCAs,
Antihistamine) (BBs)
• 4- have certain skin conditions (dermatographism
or skin mastocytosis)
35. • RAST tests are more
expensive, delayed, take
longer and no more
sensitive or specific than
skin prick tests.
• They should be used where
there are contraindications
to skin prick tests, where
skin prick tests are
unavailable or difficult to
interpret. There is usually
good correlation between
RAST and SPT
Specific IgE (RAST study)
Radioallergosorbent Test
36.
37. Immunoassay
• Not influenced by
medication
• Not influenced by
skin disease
• Does not require
expertise
• Quality control
possible
• Expensive
Skin test
• Higher sensitivity
• Immediate results
• Requires expertise
• Cheaper
Immunoassay vs skin test for
diagnosis of allergy
38. • Management of allergic
rhinitis includes allergen
avoidance,
pharmacotherapy,
education and possibly
immunotherapy.
• Treatment strategies
should involve both the
upper and lower airway
where the latter is also
affected.
Treatment
39. Secondary measures
- Major indoor allergens
include house dust mite,
domestic pets, cockroach and
moulds.
- In sensitized symptomatic
individuals, allergen
avoidance is desirable &
complementary
However, allergen avoidance
measures are frequently
expensive, time-consuming,
impracticable or, in the case
of pollens, not feasible
Primary prevention
- Early uses of antibiotics
and vaccinations (↑)
- High allergenic foods
during early life (↑)
- Smoking during
pregnancy (↑)
- Obsessional house dust
mite avoidance (↑)
Allergen avoidance and environmental
control
41. Antihistamines: These rapidly
relieve running, itching and
sneezing, but have little or no
effect on blockage
First-generation antihistamines,
should be avoided because of
sedation, psychomotor
retardation and learning (Cross
BBB acting on central H
receptors)
Cetirizine, fexofenadine and
desloratadine do not appear to
block potassium channels even
at supranormal doses. (No effect
on K+ reuptake and so on
arrhythmias)
Antihistamines
42. • These are the most effective
treatment for rhinitis, especially if
started prior to allergen
exposure. Regular treatment is
necessary.
• Side effects are minor and include
epistaxis and nasal irritation in 5-
10 % patients.
• Nasal steroids reduce
inflammation and consequent
hyperreactivity, reduce nasal
symptoms, eye symptoms and
improve the sense of smell.
Topical Glucocorticosteroids
43. • Their onset of action is slow with
some improvement after 6-12 hours
and maximum effects occurring
only after several days.
• No difference in efficacy between
various preparations, but lowest
bioavailability is seen with
fluticasone and mometasone.
• In three large retrospective studies,
topical corticosteroids reduced the
relative risk of asthma exacerbation
by 50% if used with antihistamines
Topical Glucocorticosteroids
44. • Stabilize mast cell membrane (prophylactic
use)
• This spray is weakly effective against all
rhinitis symptoms.
• Needs to be used three to four times daily
and this limits compliance.
• Its safety means that it is useful for small
children (less than 4 years) for whom a
topical corticosteroid is not available.
Sodium Cromoglicate
45. • Used topically, these reduce
nasal obstruction, but increase
rhinorrhoea.
• Regular use for more than a few
days can result in rhinitis
medicamentosa
• Very short-term use (for flying,
OME, and rhinosinusitis) is
therefore recommended.
• Systemic decongestants are
relatively ineffective and have
side effects such as hyperactivity
and insomnia in children and
hypertension in adults.
Decongestants
46. • This atropine-like nasal spray is
useful against watery rhinorrhoea
and may, if regularly used, be
curative.
• Occasionally it is helpful in patients
with allergic rhinitis who do not
respond to topical corticosteroids
alone.
• Side effects can include worsening of
glaucoma or prostatism and dry
mouth and eyes.
Ipratropium Bromide
47. • These can be used to unblock the
nose at the start of treatment or
provided for very severe symptoms
during the hayfever season.
• Regular use is associated with
significant systemic side effects and
therefore only occasional
intermittent use for a few days at a
time is sensible.
• They should be combined with
topical corticosteroid and the usual
precautions apply.
Systemic Corticosteroids
48. • They are effective against congestion
and mucus production, with efficacy
similar to that of loratadine, but less
than topical corticosteroids.
• Combination of an antileukotriene
plus an antihistamine was superior to
either alone in one study, but in a
second study did not show much
clinically significant added benefit.
Antileukotriens
49. Allergen immunotherapy involves the
repeated administration of an allergen
extract in order to induce a state of
immunological tolerance, with a reduction
in clinical symptoms and requirements for
medication during subsequent natural
allergen exposure.
indicated in those patients with allergic
rhinitis with severe symptoms who fail to
respond adequately to usual treatment
with antihistamines and topical nasal
corticosteroids
Immunotherapy is more effective in
patients with a limited spectrum of
allergies.
Immunotherapy
50. • Up-dosing phase involves weekly injections for 8-16 weeks
followed by Maintence injections at 4-8 weekly intervals for
3-5 years
• Hospital based clinics and full observation for 60 minutes
following injections
• Mechanism is blunting of seasonal increases in allergen
specific IgE by an increase in blocking IgG antibodies and
inhibition of recruitment and activation of inflammatory
cells. (Deviation from Th2-type in favor of protective Th1-
type).
• The sublingual route can be an alternative in view of side
effects of subcutaneous immunothearapy.
51.
52. • Nasal surgery may be needed where
there is a marked septal deviation
or bony turbinate enlargement
which makes topical nasal sprays
usage difficult.
• Mucosal hypertrophy is preferably
dealt with medically if possible,
since after surgery the problem
tends to recur within months.
• Endoscopic sinus surgery may also
be needed to relieve symptoms of
rhino sinusitis
Surgery
53. • Few treatments are available for small children
• Sedating antihistamines should be avoided because they
impair cognitive function.
• The only intranasal formulation licensed for younger children is
sodium cromoglicate.
• Saline drops or spray may also be useful in children under two.
• Topical corticosteroid nasal sprays differ in their lower age
limit.
• Fluticasone propionate is licensed for children from 4 years, for
others the age limit is 5 or 6 years (beclomethasone or
mometasone)
• Budesonide is not licensed for paediatric use
Special Considerations: Pediatric
Rhinitis
54. • Existing rhinitis may be
exacerbated by pregnancy and
rhinitis can occur de novo in
pregnancy, probably due to high
circulating estrogen.
• Usually allergic rhinitis in
pregnancy is resistant to
treatment.
• The least absorbed topical nasal
corticosteroids would seem a
sensible option for the treatment
of existing rhinitis
Special Considerations: Pregnancy