allergic rhinitis

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allergic rhinitis allergic rhinitis mikael d. jones, pharm.d., bcps university of kentucky college of pharmacy college of nursing objectives explain pathologic and pathophysiologic characteristics of allergic rhinitis discuss the pharmacokinetics, pharmacology, side effects, drug interactions, and proper dosing of commonly used medications for allergic rhinitis given a patient case, select an appropriate treatment regimen, monitoring parameters and patient related consultation recommendations considering the patient's diagnosis and unique characteristics assess a patient’s pharmacotherapeutic regimen for safety and efficacy using clinical signs, symptoms and laboratory data counsel patients on the appropriate use of nasal preparations allergic rhinitis inflammation of the nasal mucosa in response to inhaled allergenic materials in a sensitized individual seasonal (intermittent ) specific allergens responsible (pollen) acute symptoms predictable occurrence (fall & spring) perennial (persistent) non-seasonal allergens responsible chronic, subtle symptoms year-round occurrence many patients suffer seasonal exacerbations * prevalence of hay fever adults 18-74 national health interview survey …

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ng to development of allergic rhinitis mucus layer traps foreign particles in air during inspiration cilia moves mucus layer toward posterior nasopharynx mucus is swallowed and removed via gi & lymphatic systems * anatomy and physiology of the nasal passages nasal vascular bed contains both resistance and capacitance vessels extensive capillary system necessary for warming and humidifying inhaled air fenestrations in arterioles and capillaries allow fluid to pass into nasal passages venous sinusoids are controlled by sphincters (erectile tissue) * anatomy and physiology of the nasal passages autonomic nervous system controls blood flow pns (muscarinic) causes vasodilation airway narrowing secretory glands sensation of itching & sneezing olfactory nerve stimulation → salivation, gastric & pancreatic gland secretion sns (α-adrenergic) causes vasoconstriction airway widening inflammation of the nasal mucous membranes leads to: nasal mucosal edema, discharge, sneezing, conjunctival itching * allergic rhinitis: immune response allergen sensitization nasal mucosa exposed to allergenic materials …

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duration of 12-24 hours linked to chronic disease typified by nasal congestion * the allergic response presentation sneezing rhinorrhea congestion scratchy throat nasal itching conjunctivitis * presentation allergic salute allergic shiners adenoidal breathing periorbital edema * fever or cold? allergic rhinitis nasal discharge thin, watery, clear fever none itching in ears, nose, throat sneezing often violent, prolonged spells duration weeks to months common cold or uri nasal discharge thick, yellow to green fever low grade itching rare sneezing occasional duration 7-10 days diagnosis skin tests scratch test (epicutaneous) make superficial wound on outermost layer of the skin a drop of antigen is then placed in the wound intradermal diluted allergen injected between layers of the skin * diagnosis (con’t) positive result both tests wheal and flare reaction within 15 to 30 minutes patient history physical exam laboratory tests * general management principles avoid factors that cause symptoms use appropriate treatments …

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ical nasal corticosteroid and: oral nonsedating h1-antihistamine (with or without a decongestant combination). consider: topical nasal antihistamine; nasal cromolyn sodium for children. and, if needed: a short course (3- to 10-day) of oral corticosteroids. if there are prominent eye symptoms: topical ocular antihistamine, vasoconstrictor, mast cell stabilizer, and/or topical ocular nsaid. treatment: antihistamines first line agents antihistamines histamine h1 receptor competitive antagonists ↓ itching, sneezing, rhinorrhea, conjunctivitis prevention > reversal of symptoms drying action responsible for efficacy metabolism primarily liver dosing 1-2 hours prior to exposure tolerance change to an agent in a different chemical class * antihistamines h1 receptor antagonists are most appropriate against seasonal and perennial rhinitis block nasal vasodilation, edema, sneezing and itching also appear to block histamine release from mast cells mechanism and clinical significance is unclear 3 generations of antihistamines available second and third generation antihistamines are highly specific for h1 receptor do not cross …

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d aftertaste newer agents do not exhibit fatal drug interactions earlier 2nd generation drugs [astemizole (hismanal) and terfenadine (seldane)] were associated with life-threatening arrhythmias (prolongation of qt interval) resulted from mutual inhibition of metabolism in presence of other p450 substrates, overdose, or hepatic dysfunction half-life of nonmetabolized agents (zyrtec, allegra) is 10-12 hr cetirizine is excreted unchanged by kidneys fexofenadine is excreted in bile unchanged loratidine, azelastine, desloratadine are metabolized by p450 3a4 and 2d6, and perhaps other p450s the metabolites of these drugs are active, resulting in long half-lives (22-54 hr) antihistamines safety 1st generation agents causes sedation use in caution in patients with angle-closure glaucoma pyloroduodenal obstruction urinary tract obstruction hyperthyroidism caution in eldery because of sedation and anticholinergic effects antihistamines safety 1st generation agents adverse effects hypotension, palpitation, tachycardia sedation, nervousness children can get paradoxical excitation n/v, dry mouth, weight gain urinary retention antihistamines safety 2nd/3rd generation …

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allergic rhinitis allergic rhinitis mikael d. jones, pharm.d., bcps university of kentucky college of pharmacy college of nursing objectives explain pathologic and pathophysiologic characteristics of allergic rhinitis discuss the pharmacokinetics, pharmacology, side effects, drug interactions, and proper dosing of commonly used medications for allergic rhinitis given a patient case, select an appropriate treatment regimen, monitoring parameters and patient related consultation recommendations considering the patient's diagnosis and unique characteristics assess a patient’s pharmacotherapeutic regimen for safety and efficacy using clinical signs, symptoms and laboratory data counsel patients on the appropriate use of nasal preparations allergic rhinitis inflammation of the nasal mucosa in r...

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