PowerPoint Presentation

Allergic Rhinitis

OTC 20151ReferencesPractice guideline for the treatment of allergic rhinitis. American Academy of OtolaryngologyHead and Neck Surgery Feb.2015, Vol. 152(1S) S1S43Treatment of Allergic Rhinitis. Am Fam Physician. 2010;81(12):1440-1446.

Allergic rhinitis management pocket reference 2008. Allergy 2008: 63: 990996.

Pharmacotherapy: A pathophysiologic Approach. 7th Edition 2008.

Safety of Antihistamines in Children. Drug Safety 2001; 24 (2): 119-147.

Second-Generation Antihistamines Actions and Efficacy in the Management of Allergic Disorders. Drugs 2005; 65 (3): 341-3842Allergic Rhinitis-OverviewThe most common atopic diseaseThe hallmark of ~: a temporal relationship between the exposure to allergens & the development of nasal symptomsIt takes at least 2 years of exposure to aeroallergens (airborne environmental allergens) to develop AR (thus, very rare in children 50%) environment found in most homesMites feed on human skin scales and their own faeces.Mite itself is not allergen, the main allergen is the glycoprotein that coats their faeces.Dust mite remain airborne for about 30 minutes after being disturbedMolds: grow best in warm, moist environmentCat-derived allergens: light small proteins secreted through the sebaceous glands in the skin. May remain airborne for up to 6 hrs. Can be detected at home even 6 months after removal of the cat.

16mitesAny arthropod of the order acarina except the ticks. They are minute animals related to the spiders, usually having transparent or semitransparent bodies. They may be parasitic on man and domestic animals, producing various irritations of the skin (acariasis or mite infestations). Many mite species are important to human and veterinary medicine as both parasite and vector. Seasonal Allergic RhinitisCaused by wind-borne plant pollens (e.g. tree, grass. etc)hay fever, and rose fever are terms related to seasons associated grass pollinosis and NOT associated with FEVER! 17Symptoms of perennial allergic rhinitis are similar but less severe than those associated with seasonal ARSymptoms maybe associated with: (1) specific activities (e.g. vaccuming the carpet) (2) certain environments (e.g. cigarette smoke)

18ComplicationsSinusitisRecurrent otitis media & hearing lossPatients who develop: fever,purulent nasal discharge, frequent HA, earacherefer to Dr. for evaluation and treatment

19Chronic obstruction around the sinus ostia and eustachian tube increases the risk of sinusitis, recurrent otitis media and eustachian tube dysfunctionSymptoms of Allergic RhinitisOcular: itching, lacrimation, mild soreness, puffiness & conjuctival erythemaNasal: congestion, watery rhinorrhea, itching, sneezing, postnasal drip and nasal pruritusHead & Neck: loss of taste and smell, mild sore throat due to postnasal drip, earache, sinus HA, itching of the palate and throatSystemic: malaise & fatigue:

20malaiseA vague feeling of bodily discomfort. Physical Assessmentallergic shiners venous/lymphatic congestionChronic mouth breathing highly arched palateA horizontal crease across the lower third of the nose (in patients repeatedly rub their noses upward) called nasal saluteNasal mucosa: pale & swollenNasal secretions: clear & wateryEyes: watery with scleral & conjuctival erythema and periorbital edema21

Allergic shiners

Arched palate because of mouth breathing

Periorbital edema22

23

24Uncomplicated allergic rhinitis does not cause fever, significant sore throat, vomiting or diarrhoea these symptoms suggest viral or bacterial infection refer to doctor

24

25

26

28

32

33

34

35

36

37

41Update: April 2013The US Food and Drug Administration (FDA) has approved carbinoxamine maleate extended-release (Karbinal ER, Tris Pharma), the first liquid, sustained-release histamine-H1 receptor blocker indicated for the treatment of seasonal and perennial allergic rhinitis in children aged 2 years and older.

The drug will be available in a 4 mg/5 mL oral suspension.It is dosed once every 12 hours, "making it an attractive treatment option" for allergy sufferers who do not respond to second-generation antihistamines and are not satisfied with dosing schedules associated with the first-generation antihistamines.

Carbinoxamine is a mildly sedating antihistamine. Before 2006, it was widely used in carbinoxamine-containing combination products. However, most of these older drugs had not gone through the FDA's approval process.