Intro/Epidemiology
An immunoglobulin E (IgE)-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens.
What is allergic rhinitis
The 3 most common symptoms of allergic rhinitis.
What are rhinorrhea, sneezing, and nasal congestion.
Other symptoms include pruritis, allergic conjunctivitis
These are the five second generation antihistamines.
What are
Loratadine (Claritin)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
The first line pharmacological treatment for allergic rhinitis.
What are intranasal steroids?
This country is the largest producer of olive oil globally.
What is Spain?
These words are used to describe the frequency of allergic rhinitis.
What are frequency classifications of allergic rhinitis?
Persistent means >4 days per week AND for more than 4 weeks per year
The two most important parts of the patient's history.
What is the timing of symptoms (duration/onset) and exposure to allergen/environmental exposure
Other important things to ask include medications, hx of asthma/eczema, and other occupational exposures.
This is the most sedating second generation oral antihistamine.
What is 2 weeks?
The state in the U.S. that produces the most maple syrup.
What is Vermont?
These words are used to describe the severity of disease
What are mild and severe?
Mild - symptoms do not interfere with quality of life
Severe - symptoms impact asthma control, sleep, sports participation, or school/work performance
These are 4 common physical exam findings associated with allergic rhinitis.
What is:
Mouth breathing
watery eyes
Nasal mucosal erythema/hypertrophy
oropharyngeal cobble-stoning (post-nasal drip)
This oral medication often used in asthma is not indicated as monotherapy for the treatment of allergic rhinitis symptoms.
What is montelukast (Singulair)?
3 common side effects from the first line treatment for allergic rhinitis
Sneezing
Pain
Epistaxis
Thrush
Headache
Poor aftertaste
unpleasant smell
This automotive brand coined the term "Corinthian leather" to describe the luxurious interior of its vehicles in the 1970s.
What is Chrysler?
These are the most common environmental exposures for allergic rhinitis.
What are cigarette smoke, pets, and pollen
The main reason IgE testing may be useful for diagnosis.
What is to support symptom based diagnosis?
This class of medication has a rapid onset, but its use if often limited by cost and side effects.
What are intranasal antihistamines?
Azelastine, olopatadine - both require BID dosing and are expensive. Their effectiveness is comparable to oral antihistamines. Side effects include headache, nasal irritation, sedation, and bitter aftertaste.
Two educational points one might share with a patient to ensure maximum efficacy when prescribing a nasal steroid.
What are (any two):
Shake bottle
Prime device
Blow nose prior to use
Close one nostril
Aim at 45 degree angle laterally
These two former U.S. presidents served in the Air Force/ Army Air Forces prior to becoming president.
What are Ronald Reagan and George W. Bush.
The risk factor with the largest positive predictive value for developing allergic rhinitis.
What is family history?
Other risk factors include:
SES, positive allergy testing, and elevated serum IgE levels
The main reason IGE testing is often not warranted.
What is the cost of the test?
The cost of the test is high and likely doesn't change management. There are multiple cost effective tx options on the market currently. Empiric treatment should be attempted before testing.
The most effective treatment for allergic rhinitis.
Fluticasone propionate (Flonase) is approved for use starting at this age.
What is 4 years of age?
Fluticasone furoate (Flonase Sensimist) is approved starting at age 2
This state is home to America's only "floating post office".
What is Michigan?
The JW Westcott delivers mail from Detroit to ships along the Detroit River.