allergic rhnitis - prevalence
DESCRIPTION
ALLERGIC RHNITIS - PREVALENCE. Affects 20-40 million Americans 10% - 30% of adults Up to 40% of children More common young boys but little sex difference after adolescence No impact of race or socioeconomic status. SIGNS and SYMPTOMS of ALLERGIC RHINITIS. Sneezing - PowerPoint PPT PresentationTRANSCRIPT
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