Brianna Parker allergic rhinitis
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Brianna ParkerALLERGIC RHINITIS
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OutlineAllergic Rhinitis:1. Signs and Symptoms2. Physical Exam Findings3. Diagnostic Criteria
•Distinguishing Allergic Rhinitis and Alternative Diagnoses
4. Severity Classification•Mild, Moderate, Severe, Intermittent, Persistent
5. Treatment Guidelines• Irritant avoidance, OTC, Prescription
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Allergic Rhinitis •Inflammation of the nasal mucosa, occurring when the immune system overreacts to allergens in the air•Signs and symptoms:•Nasal Congestion•Sneezing•Red, itchy, watery eyes•Rhinorrhea
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Physical Exam
Findings
•External Nose:• Erythema•Nasal salute
•Nasal mucosa:• Pale, bluish hue• Boggy, swollen turbinates
•Conjunctiva:• Edematous• Cobblestone- appearance
•Eyes:•Dark circles under eyes
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Recognizing Allergic Rhinitis• Alternative Diagnosis:
2. Do you have any of the following symptoms?• Symptoms on one side of your nose• Thick, green or yellow discharge• Facial pain• Recurrent nose bleeds• Loss of smell
• Allergic Rhinitis:
1. Do you have any of the following symptoms for at least one hour on most days?•Watery, runny nose• Sneezing•Nasal obstruction•Nasal itching• Conjunctivitis
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Diagnostic Guide
• Clinical findings of physical exam• Allergic salute• Allergic shiners• Transverse crease on nose
• Trial of therapy:• Antihistamines• Intranasal corticosteroids
• Allergy testing:• Positive findings on: • Skin IgE testing• Serum allergen specific IgE testing
• Sinonasal Imaging:• Should not be preformed routinely due to
increased risk of radiation
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Severity Classifications
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Practice Guidelines:First Line Treatment:
• Avoidance of allergens:• Smoke, chemicals, pets
• Assess for chronic conditions and comorbidities:• Asthma, atopic dermatitis, sleep apnea
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First Line Pharmacologic Treatments:
For Mild Intermittent: First line medication:Oral Antihistamine (2nd generation):• Loratadine (Claritin) • Cetirizine (Zyrtec)• Fexofenadine (Allegra)
Benefits: Rapid onset of action, oral administration, relief of symptoms, over-the-counter availability, potential cost saving (generic brand), relief of eye symptoms
Risks, harms, costs: Systemic side effects such as sedation, dry eyes, urinary retention
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For Moderate/Severe Intermittent and Persistent: First line medication:Intranasal corticosteroids• Fluticasone (Flonase)• Triamcinolone acetonide (Nasacort)
Benefits: Improved symptom control, improved quality of life, better sleep, targeted local effect
Risks, harms, costs: epistaxis, potential growth concerns in children, septal perforation,
Differences of opinions: Some believe that this medication should be the first line treatment for all severities of allergic rhinitis while others feel oral antihistamines may be adequate therapy for mild intermmitent patients.
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Additional Pharmacologic Treatments:Intranasal AntihistaminesSecond-line therapy after failure of nasal steroids or oral antihistamines • Benefits: Rapid onset, increased effectiveness for nasal congestion• Risks, harms, costs: Increased cost, sedation, poor taste, more frequent
dosing, epistaxis.• Differences of opinion: Some believe that these should be recommended
at the same level as oral antihistamines, while the majority believe they are second line.
Oral Leukotriene Receptor Antagonists (LTRAs) • Ineffective or less effective therapy at an increased cost; however,
patient’s with dual diagnosis with asthma may benefit from oral LTRAs as a first-line therapy.
Combination Therapy • Combination pharmacologic therapy appropriate when inadequate
response to pharmacologic monotherapy
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Alternative Interventions• Immunotherapy• For patients with inadequate response to pharmacologic
therapy
• Inferior Turbinate Reduction • Surgeon can perform inferior turbinate reduction with nasal
airway turbinate obstruction who have failed medical management.
• Acupuncture
• Herbal Therapy
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Questions?
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•Global Primary Care Education. (2007). Allergic Rhinitis and its impact on Asthma, p 1-5.
• Ryan, D. (2016). How to identify and manage seasonal allergic rhinitis. Journal Of Community Nursing, 30(2), 54-59 6p.
• Scullion, J., & Holmes, S. (2015). Assessing and treating allergic rhinitis. Practice Nursing, 26(5), 224-230 7p.
References: