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
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