Rhinitis April 10, 2006
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Transcript of Rhinitis April 10, 2006
RhinitisApril 10, 2006
RhinitisApril 10, 2006
THE NOSE
CT of THE NOSE
The inside of THE NOSE
Therapeutic Options Allergic Rhinitis
AAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518.
• Antihistamines
• Decongestants
• Anticholinergics
• Corticosteroids
Cromones/mast cell stabilizers
Leukotriene receptor antagonists
Immunotherapy
Therapeutic Options Allergic Rhinitis
AAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518.
• Antihistamines
• Decongestants
• Anticholinergics
• Corticosteroids
Cromones/mast cell stabilizers
Leukotriene receptor antagonists
Immunotherapy
Pseudoephedrine and HR
Pseudoephedrine and SBP
Pseudoephedrine and DBP
Every Patient is Different
Therapeutic Options Allergic Rhinitis
AAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518.
• Antihistamines
• Decongestants
• Anticholinergics
• Corticosteroids
Cromones/mast cell stabilizers
Leukotriene receptor antagonists
Immunotherapy
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.
Intranasal Corticosteroids in Allergic Rhinitis: An OverviewBenefits
• Are first-line therapy for persistent allergic rhinitis
• Relieve all symptoms
– Sneezing
– Nasal itching
– Rhinorrhea
– Nasal congestion
• Minimal side effects
Drawbacks
• May cause nasal irritation and/or bleeding
• Patient compliance
• Patient concerns about steroids
INS or NSA
Therapeutic Options Allergic Rhinitis
AAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518.
• Antihistamines
• Decongestants
• Anticholinergics
• Corticosteroids
Cromones/mast cell stabilizers
Leukotriene receptor antagonists
Immunotherapy
LTRA in Allergic Rhinitis
All Evidence is Not the Same
Therapeutic Options Allergic Rhinitis
AAAAI. The Allergy Report. 2000.Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518.
• Antihistamines
• Decongestants
• Anticholinergics
• Corticosteroids
Cromones/mast cell stabilizers
Leukotriene receptor antagonists
Immunotherapy
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 AR
• Usage: In patients who do not respond adequately to pharmacotherapy
• Side effects: local reactions, anaphylaxis
AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html
Types of Rhinitis
• Allergic– Seasonal or Perennial– Intermittent or Persistent
• Non Allergic– Vasomotor– Infectious
• Viral or Bacterial
– Drug induced• Antihypertensives, Afrin
– Hormonal• Pregnancy, Hypothyroid
– NARES, Atrophic, Anatomic