Term
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Definition
| Inflammation of the nasal mucous membrane |
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Term
| What are the three types of Rhinitis? |
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Definition
1. Allergic
2. Non-allergic
3. Rhinitis medicamentosa |
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Term
| What are the three types of Allergic Rhinitis |
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Definition
1. Seasonal (intermittent)
2. Perennial (persistent)
3. Episodic (when occasionally exposed to a particular allergen) |
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Term
| What are the two types of Non-allergic Rhinitis? |
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Definition
1. Infectious
2. Idiopathic or vasomotor |
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Term
True or False:
Antihistamines work well to treat non-allergic rhinitis |
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Definition
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Term
| What are the three types of Rhinitis medicamentosa? |
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Definition
1. Drug-induced
2. Hormonal
3. Anatomical |
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Term
True or False:
You should start to treat your seasonal allergic rhinitis patients when they show up to your office and their allergies are killing them. |
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Definition
False:
You should begin treatment a couple of weeks before their allergies normally start with antihistamines and/or intranasal corticosteroids. |
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Term
True or False:
It is a good idea to prescribe intranasal corticosteroids to control allergic rhinits symptoms. |
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Definition
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Term
| In addition to treating patients with allergic rhinitis with medication you should to what? |
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Definition
| Educate patients about avoidance activities. |
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Term
| When should you suggest immunotherapy to your allergic rhinitis patients? |
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Definition
| When optimal avoidance measures and medication therapy are insufficient to control their symptoms. (Esp. consider it if they are younger patients.) |
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Term
True or False:
Rhinitis is one of the top 5 reasons for patients to see their primary care clinicians. |
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Definition
False:
It's one of the top 10 reasons. |
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Term
| How much of the population is affected by Rhinitis? |
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Definition
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Term
True or False:
Rhinitis is often associated with exposure to allergens and persists as long as exposure to that allergen occurs. |
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Definition
False:
It is often self limited and associated with a viral URI. |
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Term
| With chronic symptoms, what guides therapy? |
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Definition
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Term
| What are the major separations in Rhinitis and the percentages of each? |
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Definition
Allergic 43%
Non-allergic 23%
Mixed rhinitis 34% |
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Term
| What are the major separations in Rhinitis and the percentages of each? |
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Definition
Allergic 43%
Non-allergic 23%
Mixed rhinitis 34% |
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Term
| Which age group has the highest incidence of AR? |
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Definition
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Term
| What percentage of patients are symptomatic >4 mo/yr? |
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Definition
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Term
| 20% of patients are symptomatic how many months of the year? |
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Definition
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Term
Pure AR -- 43%
Pure non-AR -- 23%
Mixed -- 34%
What is the percentage of the allergic component and the non allergic component of Rhinitis? |
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Definition
Non-allergic component is 57%
Allergic component is 77%
(the mixed rhinitis is counted twice) |
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Term
| What are 6 predisposing factors for AR? |
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Definition
1. Asthma (can present like allergies)
2. Atopic dermatitis
3. FHx of allergy
4. Exposure to 2nd hand smoke
5. Occupational/environmental exposures
6. Early introduction of formula and foods (like honey) |
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Term
| What is the progression of the atopic march? |
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Definition
Infancy/Early childhood - Atopic Eczema/Food allergies
School years - Asthma/Perennial rhinitis
Teenage Years - Seasonal rhinitis/Conjunctivitis |
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Term
| Definition of Allergic Rhinitis |
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Definition
| Symptomatic disorder of the nose induced by IgE-mediated inflammation after allergen exposure. |
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Term
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Definition
| rhinorrhea, nasal obstruction, nasal itching, sneezing |
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Term
| Possible comorbidities of AR |
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Definition
| asthma, conjunctivitis, rhinosinusitis |
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Term
| What causes sensitization to the allergens? |
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Definition
| Mast cells in the mucosa produce IgE which binds the allergen protein. |
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Term
| How does exposure to an allergen cause an allergic response? |
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Definition
1. inhalation of the allergen protien
2. allergens elute & cross the mucous membrane
3. The protein binds the IgE on the mast cells triggering an allergic response. |
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Term
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Definition
| Protein components of airborne pollen grains. |
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Term
| What pollen is most likely to cause allergies in the Spring? |
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Definition
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Term
| What pollen is most likely to cause allergies in the Spring to late Summer? |
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Definition
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Term
| What pollen is most likely to cause allergies in late Summer to early Fall? |
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Definition
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Term
| If a patient has overlapping seasonal allergies how will they present? |
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Definition
| They will present with perennial allergic rhinitis |
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Term
| What are common causes of perennial allergies? |
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Definition
-dust mite fecal proteins
-animal dander
-cockroaches
-mold |
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Term
| What inherited predisposition may be found in persons with allergies? |
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Definition
| Predisposition to phenotype 2 helper TH2 cells |
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Term
True or False:
Atopic patients are less likely to exhibit exaggerated responses to normal substances than the average patients. |
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Definition
False:
They exhibit exaggerated responses |
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Term
| What is the process of sensitization in a genetically predisposed host? |
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Definition
1. Immune system identifies an allergen as foreign
2. Airborn allergens are processed by TH2 cells which produce antigen specific IgE antibodies
3. Sensitizing of genetically predisposed hosts |
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Term
| What is released in mast cell degranulation? |
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Definition
| histamine, chemical modulators, arachidonic acid metabolites (leukotrienes & prostaglandins) are synthesized de novo following cell activation |
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Term
| How is the early phase response in an allergic reaction initiated? |
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Definition
| Allergen protein cross links two IgE molecules causing a secondary response inside the mast cell. |
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Term
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Definition
| release of the contents of granules into the extracellular space |
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Term
| What are symptoms of the early phase response of an allergic reaction? |
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Definition
stimulation of irritant receptors (sneezing), puritis (itching), vascular permeability (inc bld flow), mucosal permeability, smooth muscle contraction (feels like "obstruction),
influx of inflammatory cells, mucous secreation, chemotaxis, airway permeability (can't breathe) |
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Term
| When does the late phase response of the allergic reaction begin? |
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Definition
| 4-8 hrs after allergen exposure |
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Term
| What cytokines are released by mast cells in the late phase allergic reaction? |
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Definition
| IL 3,4,5,6,8 which promote chemotaxis |
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Term
| What is the affect of the infiltration and activation of migrating cells? |
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Definition
-obstruction
-histamine released primarily by basophils
-hyperrsponsive inflammed mucosa (respond to lower levels of allergen) |
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Term
| What are diagnosis signs of the eyes? |
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Definition
Allergic shiners
-Darkness (low sensitivity, high specificity)
-Little correlation between symptoms and area
Watery eyes (and possibly itchy) |
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Term
| What are diagnosis signs of the nose? |
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Definition
Transverse nasal crease (allergic salute)
Pale blue, edematous turbinates
Clear, watery nasal discharge (bilateral)
Nasal scrapings under microscope - eosinophils |
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Term
True or False:
Lymphoid hyperplasia indicates a bacterial infection. |
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Definition
False:
Lymphoid hyperplasia can occur in allergic rhinitis as well |
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Term
| What are other (non-diagnostic) signs of Allergic Rhinitis? |
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Definition
blockage of the eustachian tubes (possibly causing nausea)
cough
pain on deep palpation of the sinuses (typically bilaterally) |
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Term
| What are the 4 indications for allergy testing? |
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Definition
1. Identification of allergens
2. Chronic or recurrent symptoms
3. Symptoms not controlled by avoidance and medication
4. Need for immunotherapy (med not tolerated, decrease cost of med) |
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Term
True or False:
Both positive and negative controls should be used in allergy testing. |
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Definition
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Term
| How long do you wait to read the positive control? the allergen response? |
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Definition
| Read positive control in 10 min and the allergen response in 15-20 min. |
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Term
| In allergy testing how big must the wheal be to be considered positive? |
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Definition
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Term
| In allergy testing if your negative control (phenolated glycerol/saline) is positive, what could be the cause? |
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Definition
| dermagraphism/physical urticaria |
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Term
| In allergy testing if your positive control (histamine hydrochloride) is negative, what could be the cause? |
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Definition
| use of anti-histamine prior to testing or hypoactive skin |
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Term
| What is the grading scale of allergy multi-testing? |
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Definition
0 = no reaction (1-3mm wheal)
1+ = erythema w/ 3mm wheal
2+ = erythema w/ 5mm wheal
3+ = erythema w/ 7-10 mm wheal
4+ = erythema w/ >10 mm wheal
5+ = erythema w/ >10 mm wheal and pseudopods |
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Term
| What are the general categories of treatment for AR? |
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Definition
-Avoidance of identified allergens
-Pharmacotherapy
-Immunotherapy
-Surgery if severe |
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Term
| How can you avoid dust mite allergens? |
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Definition
Controls: plastic covers, frequent vacuuming of carpet
Avoid: overstuffed chairs, curtains, stuffed animals, dust-collecting boxes under bed |
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Term
| How ca you avoid cockroach allergens? |
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Definition
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Term
| What percentage of people respond positively to a skin prick allergy test to cats, dogs, and dust mites? |
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Definition
Cats 72% of atopic patients
Dust mite 61% response
Dogs 36% |
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Term
| What is the size of animal dander? |
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Definition
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Term
| Why does animal dander cause so many allergies? |
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Definition
| It stays airborne for several hours and is stirred up by vacuuming and walking on carpeted areas. |
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Term
True or False:
It is unreasonable to expect cat or dog owners to get rid of their pets because of their allergies. |
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Definition
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Term
| What are some realistic steps to reducing animal dander in households allergic to their pets? |
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Definition
Pets out of the house.
Dogs in the yard.
Cats - out of the bedroom - confine to non-carpeted area with HEPA filter
(Washing cats not effective - return to baseline values in 3 hrs) |
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Term
| Is it better for animals to be on carpeted or non-carpeted areas? |
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Definition
| non-carpeted w/ HEPA filter |
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Term
| How much allergen does carpet accumulate? |
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Definition
| 100x more than polished floors |
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Term
| How hot should clothes be washed to remove dander? |
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Definition
| 60 degrees w/ one rinse or any temp with 2 rinses or steam washing machine |
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Term
| How can you prevent breathing allergens when cleaning the house or litter box? |
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Definition
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Term
| To capture dander is it better for bedding to be loosely or tightly woven? |
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Definition
| tightly woven (ex: mattress covers) |
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Term
True or False:
Fabric covered furniture helps cut down on dander by absorbing it from the air. |
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Definition
False:
You should limit or remove fabric covered furniture |
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Term
True or False:
Male pets put out more dander than female pets. |
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Definition
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Term
True or False:
Neutered males have more dander than not neutered males. |
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Definition
False:
Neutered males put out an amount closer to a female (less than male) |
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Term
| How can you prevent others from bringing dander into the house? |
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Definition
| Request/require guests to change clothes before entering or exposing patient. |
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Term
| What are the ineffective allergen avoidance strategies? |
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Definition
1. HEPA vacuum (it still stirs up dust and dander)
2. Washing pets w/ water or shampoo (they return to baseline in 3 hrs)
3. Steam cleaning carpet or upholstery
4. Oral agents/sprays to reduce animal shedding |
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Term
| Name some strategies that may be effective in reducing pet related allergies. |
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Definition
1. after petting animal, wash hands before touching face
2. MERV 12 filter on HVAC system
3. HEPA free-standing unit
4. 6 air exchanges per hour in the home
5. Tannic acid spray for carpeting and upholstery
6. use a multiple intervention approach |
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