Allergic Rhinitis

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Slide 1 :

Allergic Rhinitis

Slide 2 :

Statistics 2 million school days lost in 1996 Allergic rhinitis in up to 40% of children Recent study showed: 73% of classrooms contained 4 or more allergens 87% of classroom contained irritants 10% of classrooms had live pets 23% of classrooms had cockroaches ©caj

Slide 3 :

Definition of Allergic Rhinitis Rhinitis is an inflammation of the mucous membranes of the nose. Allergic rhinitis involves reactions in the nasal mucosa from repeated allergen exposures that causes hypersensitivity. These reactions may be seasonal or perennial.

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Seasonal Rhinitis Common allergens: Grass pollens Tree pollens Weed pollens Mold spores Symptoms include: Watery nasal drainage Nasal congestion Repetitive sneezing Itchy eyes, nose, ears, and throat Nose rubbing Allergic salute

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Perennial Allergic Rhinitis Show little or no seasonal variation Symptoms are intermittent or continuous throughout the year Watery nasal drainage and sneezing are less prominent than seasonal allergic rhinitis Nasal congestion is often the primary symptom

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Chronic nasal congestion may produce…. Dry irritated or sore throat Snoring Pain around eyes Mouth breathing Orthodontic disturbances Frontal headaches/sinusitis Chronic cough

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Chronic nasal congestion may produce ... Otitis media/possible hearing loss Altered smell and/or taste Sleep disturbance, with or without daytime fatigue Asthma exacerbation

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Systemic Symptoms of Allergic Rhinintis Some patients with allergic rhinitis experience: Weakness Discomfort or uneasiness Irritability Fatigue Difficulty concentrating Decreased appetite

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Allergic triggers Dust mites Carpeting, upholstered furniture Animals Furry or feathered Pollens PE, recess

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Allergic Triggers II Cockroaches Molds Water damage, leaking roofs, poorly maintained heating/cooling systems Can be encountered outdoors as well as indoors Foods Uncommon for chronic symptoms

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Environmental Triggers At School Indoors: Chalk dust Dust/dust mites Insufficient airflow Cockroaches Second hand smoke Paints Magic markers Glue/paste Pets Cleaning agents Molds New furnishings or equipment

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Environmental Triggers At School Outdoors: Pollens (grass, trees, weeds) Molds Pesticides

Slide 13 :

Allergic Rhinitis Therapy Avoidance of triggers Medications Allergy shots

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Avoidance of Triggers No carpeting or upholstered furniture No furry or feathered pets Perform maintenance chores requiring use of irritating chemicals/cleaners when children not present Maintain heating/cooling systems No smoking

Slide 15 :

Medications Antihistamines Decongestants Nonsteroidal nasal sprays Steroid nasal sprays Anticholinergic nasal sprays Antileukotrienes

Slide 16 :

Medications, con’t Non Sedating Antihistamines: (H1 Receptor Blockers) Prevent action of histamine receptors, relieves runny nose,sneezing, itching. Does not control inflammation. Very small effect on nasal congestion. Allegra® Claritin ® Reditabs and syrup Clarinex ® Medication brand names are examples only, and are not all inclusive.

Slide 17 :

Medications, con’t Less Sedating Antihistamine: Oral -- Cetirizine (Zyrtec®) Topical nasal spray -- Azelastine (Astelin®) Medication brand names are examples only, and are not all inclusive.

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Medications, con’t Decongestants Sudafed® Work well for congestion, some for runny nose No effect on itching or sneezing Side effects: insomnia, increased activity, irritability Medication brand names are examples only, and are not all inclusive.

Slide 19 :

Medications, con’t Oral non-sedating antihistamine-decongestant: May be more effective than either product alone. Only indicated for children over age 12. Fexofenadine/Pseudoephedrine (Allegra® D) Loratadine/Pseudoephedrine (Claritin® D 12/24 hour) Cetirizine/pseudoephedirne (Zyrtec® D)

Slide 20 :

Medications, con’t Non-steroid nasal sprays Cromolyn (Nasalcrom®) Non-prescription Very safe Has to be used several times daily Good for prevention of symptoms if given before exposure Medication brand names are examples only, and are not all inclusive.

Slide 21 :

Medications, con’t Topical Nasal Corticosteroids: Reduce mucosal inflammation and all nasal symptoms. Use with persistent rhinitis at the lowest effective dose Beclomethasone diproprionate Aqueous (Beconase®) Budesonide (Rhinocort®, Rhinocort Aqua®) Flunisolide (Nasarel®) Fluticasone proprionate (Flonase®) Mometasone (Nasonex®) Triamcinolone acetonide (Nasacort® AQ, Nasacort®, Trinasal ®)

Slide 22 :

Other Medications Anticholinergic nasal spray (Atrovent®) Good for runny nose Antileukotrienes (Singulair®) Helpful for runny nose and congestion Not first line therapy

Slide 23 :

Stepwise Approach to Medicines for Allergic Rhinitis Avoidance of allergic factors and irritants is the first step in management. Mild intermittent symptoms: Non-sedating antihistamine and/or decongestants as needed

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Stepwise Approach to Medicines for Allergic Rhinitis, con’t Persistent mild to moderate symptoms: Intranasal steroid starting therapy 1-2 weeks prior to season Non-sedating antihistamine and or decongestant as needed Topical ocular (eye) antihistamine with or without vasonconstrictor or topical eye mast cell stabilizer

Slide 25 :

Stepwise Approach to Medicines for Allergic Rhinitis con’t. Severe symptoms: Topical nasal corticosteroids Non-sedating antihistamine and/or decongestant if needed Short term burst of oral corticosteroids If inadequate response, consider allergy immunotherapy

Slide 26 :

Allergy Injections When medications and avoidance don’t work Usually prescribed by a specialist Most effective for dust mites, pollen allergy When history confirms skin test results May also be effective for cat, mold allergy

Slide 27 :

Additional Resources Allergy & Asthma Network/Mothers of Asthmatics, Inc. -- http://www.aanma.org American Academy of Allergy, Asthma, and Immunology -- http://www.aaaai.org American Academy of Pediatrics -- http://www.aap.org American College of Allergy, Asthma, and Immunology -- http://www.allergy.mcg.edu Asthma & Allergy Foundation of America -- http://www.aafa.org/home US Environmental Protection Agency -- http://www.epa.gov/iaq

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