ALLERGIC RHNITIS - PREVALENCEALLERGIC RHNITIS - PREVALENCE

Affects 20-40 million Affects 20-40 million AmericansAmericans

10% - 30% of adults10% - 30% of adults Up to 40% of childrenUp to 40% of children More common young boysMore common young boys but little sex difference but little sex difference

afterafter adolescenceadolescence No impact of race or No impact of race or socioeconomic statussocioeconomic status

SIGNS and SYMPTOMS of ALLERGIC RHINITISSIGNS and SYMPTOMS of ALLERGIC RHINITIS

SneezingSneezing Itchy nose, eyes, throat,Itchy nose, eyes, throat, and/or earsand/or ears Nasal congestionNasal congestion Clear rhinorrheaClear rhinorrhea Conjunctival edema, Conjunctival edema,

itching,itching, tearing, hyperemiatearing, hyperemia Subocular edema andSubocular edema and darkening “shiners”darkening “shiners” Loss of taste and smellLoss of taste and smell sensationssensations

CASUSE OF ALLERGIC RHINITISCASUSE OF ALLERGIC RHINITIS

Hypersensitivity of the Hypersensitivity of the immuneimmune

systemsystem Exposure to an allergenExposure to an allergen Triggers antibody Triggers antibody

productionproduction Antibodies bind to cells Antibodies bind to cells

thatthat contain histaminecontain histamine Histamine released from Histamine released from

cellscells

DISTINGUISHING ALLERGIC RHINITIS FROM THE DISTINGUISHING ALLERGIC RHINITIS FROM THE COMMON COLDCOMMON COLD

Allergic Rhinitis Common Cold

Symptoms Rhinorrhea,congestion, sneezing,watery, itchy eyes

Same as allergicrhinitis, can also havefever, aches, andpains

Warning time Symptoms beginalmost immediatelyafter exposure

Symptoms mostsevere after a fewdays

Duration Last as long asexposure continuesand until the reactiontriggered by theallergen ends

Symptoms resolvewithin several days toweek

a

DIAGNOSTIC TESTINGDIAGNOSTIC TESTING

Skin tests for specific Skin tests for specific IgEIgE

antibodiesantibodies • •Identify allergensIdentify allergens • •Antihistamine use can Antihistamine use can suppress resultssuppress results Serum specific IgE Serum specific IgE

teststests • •RAST RAST

(radioallergosorbent)(radioallergosorbent) blood testblood test

COMMON ALLERGENSCOMMON ALLERGENS

PollenPollen MoldMold Animal danderAnimal dander DustDust Dust miteDust mite Food allergiesFood allergies Insect bitesInsect bites Drug allergiesDrug allergies LatexLatex ChemicalsChemicals

OTHER ALLERGIC REACTIONSOTHER ALLERGIC REACTIONS

CoughCough AsthmaAsthma UrticariaUrticaria HivesHives EczemaEczema Atopic dermatitisAtopic dermatitis Contact dermatitisContact dermatitis AnaphylaxisAnaphylaxis

ASTHMA and ALLERGIESASTHMA and ALLERGIES

Definition: Airway Definition: Airway hyperresponsive, hyperresponsive, exacerbated by exacerbated by inflammationinflammation

SymptomsSymptoms Reversible airway Reversible airway obstructionobstruction WheezingWheezing CoughCough DyspneaDyspnea Decreased exerciseDecreased exercise tolerancetolerance

URTICARIAURTICARIA

Affects 15% to 20% of Affects 15% to 20% of thethe

population at some timepopulation at some time Most cases are acuteMost cases are acute Duration <6 weeksDuration <6 weeks Chronic idiopathic moreChronic idiopathic more frequent in elderly frequent in elderly

womenwomen Less than 5% are Less than 5% are

chronicchronic Duration >6 weeksDuration >6 weeks

MECHANISMS FOR MAST CELL ACTIVATION IN MECHANISMS FOR MAST CELL ACTIVATION IN THE SKINTHE SKIN

IgE immediateIgE immediate hypersensitivityhypersensitivity Activation of Activation of

complementcomplement pathwaypathway Drugs or chemical Drugs or chemical

agentsagents Aggravating factorsAggravating factors • •HeatHeat • •ExerciseExercise • •Emotional stressEmotional stress

DIAGNOSIS OF URTICARIADIAGNOSIS OF URTICARIA

Etiology known in <5% Etiology known in <5% ofof

casescases Potential causesPotential causes • •FoodsFoods • •PharmaceuticalsPharmaceuticals • •Sensitivity to animals,Sensitivity to animals, plants, or latexplants, or latex • •InfectionsInfections Emotional stress oftenEmotional stress often an aggravating factoran aggravating factor

PRURITIS IN URTICARIAPRURITIS IN URTICARIA

Itch almost always Itch almost always presentpresent

varies in intensityvaries in intensity Pricking or burning Pricking or burning

naturenature Usually worse in Usually worse in

eveningevening or nightor night More often relieved byMore often relieved by rubbing than by rubbing than by

scratchingscratching Excoriation rareExcoriation rare

PHARMACOLOGIC TREATMENT APPROACHESPHARMACOLOGIC TREATMENT APPROACHES

TYPE OF TREATMENTTYPE OF TREATMENT AntihistaminesAntihistamines

Intranasal steroidsIntranasal steroids

Cromolyn sodiumCromolyn sodium DecongestantsDecongestants Antihistamine/Antihistamine/

decongestantdecongestant combinationscombinations

PRIMARY ACTIONPRIMARY ACTION Block histamine (H1)Block histamine (H1) receptorreceptor Exert local anti-Exert local anti-

inflammatoryinflammatory effectseffects Stablize mast cell Stablize mast cell

membranemembrane Cause vasoconstrictionCause vasoconstriction Combine action of bothCombine action of both antihistamines andantihistamines and decongestantsdecongestants

ANTIHISTAMINES ( H1 ANTAGONISTS)ANTIHISTAMINES ( H1 ANTAGONISTS)

Older AgentsOlder Agents Diphenhydramine Diphenhydramine

(Benadryl)(Benadryl) Hydroxyzine (Atarax)Hydroxyzine (Atarax) Clemastine (Travist)Clemastine (Travist) Newer AgentsNewer Agents Loratadine (Claritin)Loratadine (Claritin) Fexofenadine (Allegra)Fexofenadine (Allegra) Cetirizine (Zyrtec)Cetirizine (Zyrtec) Desloratadine Desloratadine

(Clarinex)(Clarinex)

INTRANASAL STEROIDSINTRANASAL STEROIDS

Used to control allergicUsed to control allergic rhinitisrhinitis No systemic side No systemic side

effectseffects Common AGENTSCommon AGENTS Fluticasone (Flonase)Fluticasone (Flonase) Mometasone (Nasonex)Mometasone (Nasonex) Triamcinolone Triamcinolone

(Nasacort (Nasacort AQ)AQ) Budesonide (Rhinocort)Budesonide (Rhinocort)

MAST CELL STABLIZERSMAST CELL STABLIZERS

Adjuvant Adjuvant antiinflammatoryantiinflammatory

agentsagents Not for acute attacksNot for acute attacks Inhibits releaseInhibits release • •HistaminesHistamines • •LeukotrienesLeukotrienes AGENTSAGENTS Cromolyn sodium (Intal)Cromolyn sodium (Intal) Intranasal CromolynIntranasal Cromolyn (Nasalcrom)(Nasalcrom) Nedocromil (Tilade)Nedocromil (Tilade)

DECONGESTANTSDECONGESTANTS

Reduces nasal Reduces nasal congestioncongestion

Avoid in patients withAvoid in patients with hypertensionhypertension COMMON AGENTCOMMON AGENT Pseudoephedrine Pseudoephedrine

(Sudafed)(Sudafed)

ALLERGY IMMUNOTHERAPYALLERGY IMMUNOTHERAPY

Increases IgG antibodyIncreases IgG antibody Decreased IgE Decreased IgE Decrease in histamine Decrease in histamine release to specific release to specific

allergenallergen Reduction in symptomsReduction in symptoms Not indicated food Not indicated food

allergiesallergies

ALLERGIESALLERGIES

Susan HentzSusan Hentz

NURS 7724NURS 7724

ReferencesReferences

ReferencesReferences

– American Academy of Allergy, Asthma, and Clinical Immunology (2002) American Academy of Allergy, Asthma, and Clinical Immunology (2002) Fast Fast facts: allergiesfacts: allergies

– 15 November 2002 http://www.aaaai.org/public/fastfacts/allergies.htm15 November 2002 http://www.aaaai.org/public/fastfacts/allergies.htm

– Fireman P. (Ed.) (1998) Fireman P. (Ed.) (1998) Allergic rhinitis. Allergic rhinitis. In: In: Atlas of AllergiesAtlas of Allergies. Philadelphia: . Philadelphia: J.B. Lippincott Co.J.B. Lippincott Co.

– Google Image Search 15 November 2002 http://images.google.com/images?Google Image Search 15 November 2002 http://images.google.com/images?=allergies=allergies

– Patterson, R.(Ed.) (1993) Patterson, R.(Ed.) (1993) Allergic Diseases Diagnosis and Management Allergic Diseases Diagnosis and Management (4th (4th ed.)ed.)

– Philadelphia: J.B. Lippincott Co.Philadelphia: J.B. Lippincott Co.

– U.S. National Library of Medicine (2002) U.S. National Library of Medicine (2002) Medlineplus Medical Encyclopedia Medlineplus Medical Encyclopedia 15 November 2002 15 November 2002 http://www.nlm.nih.gov/medlineplus/encyc/article/000812.htmhttp://www.nlm.nih.gov/medlineplus/encyc/article/000812.htm