Rhinitis April 10, 2006

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Rhinitis April 10, 2006. THE NOSE. CT of THE NOSE. The inside of THE NOSE. Therapeutic Options Allergic Rhinitis. Antihistamines Decongestants Anticholinergics Corticosteroids. Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy. - PowerPoint PPT Presentation

Transcript of Rhinitis April 10, 2006

  • RhinitisApril 10, 2006

  • THE NOSE

  • CT of THE NOSE

  • The inside of THE NOSE

  • Therapeutic Options Allergic RhinitisAAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478518.AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene receptor antagonistsImmunotherapy

  • Therapeutic Options Allergic RhinitisAAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478518.AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene receptor antagonistsImmunotherapy

  • Pseudoephedrine and HR

  • Pseudoephedrine and SBP

  • Pseudoephedrine and DBP

  • Every Patient is Different

  • Therapeutic Options Allergic RhinitisAAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478518.AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene receptor antagonistsImmunotherapy

  • Intranasal Corticosteroids in Allergic Rhinitis: An OverviewBenefitsAre first-line therapy for persistent allergic rhinitisRelieve all symptomsSneezingNasal itchingRhinorrheaNasal congestionMinimal side effectsDrawbacksMay cause nasal irritation and/or bleeding Patient compliancePatient concerns about steroids

    Urval KR. Primary Care. 1998;25(3):649-662.Suonpaa J. Ann Med. 1996;28:17-22.Dykewicz MS, Fineman S. Ann Allergy Asthma Immunol. 1998;81:463-468.

  • INS or NSA

  • Therapeutic Options Allergic RhinitisAAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478518.AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene receptor antagonistsImmunotherapy

  • LTRA in Allergic Rhinitis

  • All Evidence is Not the Same

  • Therapeutic Options Allergic RhinitisAAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478518.AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene receptor antagonistsImmunotherapy

  • Subcutaneous Immunotherapy (Hyposensitization)Mechanism of action = Unknown (may shift immune response from TH2- to TH1-response to allergen)Efficacy:Demonstrated in AROnly disease-modifying therapy for ARUsage: In patients who do not respond adequately to pharmacotherapySide effects: local reactions, anaphylaxisAAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html

  • Types of RhinitisAllergicSeasonal or PerennialIntermittent or PersistentNon AllergicVasomotorInfectiousViral or BacterialDrug inducedAntihypertensives, AfrinHormonalPregnancy, HypothyroidNARES, Atrophic, Anatomic

    Therapeutic Options in the Management of ARThe classes of agents available to help manage AR include AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene antagonistsImmunotherapy

    [AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html; Dykewicz M, et al. Ann Allergy Asthma Immunol. 1998;81:478518]

    Therapeutic Options in the Management of ARThe classes of agents available to help manage AR include AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene antagonistsImmunotherapy

    [AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html; Dykewicz M, et al. Ann Allergy Asthma Immunol. 1998;81:478518]

    Therapeutic Options in the Management of ARThe classes of agents available to help manage AR include AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene antagonistsImmunotherapy

    [AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html; Dykewicz M, et al. Ann Allergy Asthma Immunol. 1998;81:478518]

    Benefits and drawbacks of intranasal corticosteroid therapy in allergic rhinitis.Intranasal Corticosteroids in Allergic Rhinitis: An OverviewTherapeutic Options in the Management of ARThe classes of agents available to help manage AR include AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene antagonistsImmunotherapy

    [AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html; Dykewicz M, et al. Ann Allergy Asthma Immunol. 1998;81:478518]

    Therapeutic Options in the Management of ARThe classes of agents available to help manage AR include AntihistaminesDecongestantsAnticholinergicsCorticosteroidsCromones/mast cell stabilizers Leukotriene antagonistsImmunotherapy

    [AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html; Dykewicz M, et al. Ann Allergy Asthma Immunol. 1998;81:478518]

    Subcutaneous Immunotherapy (Hyposensitization)Immunotherapy, also known as hyposensitization, requires sequential subcutaneous introduction of increasing dosages of specific allergens to which the patient is sensitive. Although the mechanism of action is currently unknown, it has been hypothesized that immunotherapy shifts the immune response to allergens from a TH2-mediated to a TH1-mediated response.Immunotherapy has been demonstrated to be effective in clinical studies in children with AR, allergic conjunctivitis, allergic asthma, and/or hypersensitivity to stinging insects. Moreover, early intervention with immunotherapy may modify the course of the disease.Immunotherapy should be used in combination with pharmacotherapy, because few patients respond completely to immunotherapy alone. The benefits of immunotherapy must be weighed against potential risks, including anaphylaxis.Immunotherapy may be administered by subcutaneous injection or by sublingual tablet.

    [AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html]