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ALLERGIC RHNITIS - PREVALENCE

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

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ALLERGIC RHNITIS - PREVALENCE

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  1. 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

  2. SIGNS and SYMPTOMS of ALLERGIC RHINITIS • Sneezing • Itchy nose, eyes, throat, • and/or ears • Nasal congestion • Clear rhinorrhea • Conjunctival edema, itching, • tearing, hyperemia • Subocular edema and • darkening “shiners” • Loss of taste and smell • sensations

  3. CASUSE OF ALLERGIC RHINITIS • Hypersensitivity of the immune • system • Exposure to an allergen • Triggers antibody production • Antibodies bind to cells that • contain histamine • Histamine released from cells

  4. DISTINGUISHING ALLERGIC RHINITIS FROM THE COMMON COLD

  5. Skin tests for specific IgE antibodies •Identify allergens •Antihistamine use can suppress results Serum specific IgE tests •RAST (radioallergosorbent) blood test DIAGNOSTIC TESTING

  6. COMMON ALLERGENS • Pollen • Mold • Animal dander • Dust • Dust mite • Food allergies • Insect bites • Drug allergies • Latex • Chemicals

  7. OTHER ALLERGIC REACTIONS • Cough • Asthma • Urticaria • Hives • Eczema • Atopic dermatitis • Contact dermatitis • Anaphylaxis

  8. ASTHMA and ALLERGIES • Definition: Airway hyperresponsive, exacerbated by inflammation • Symptoms • Reversible airway • obstruction • Wheezing • Cough • Dyspnea • Decreased exercise • tolerance

  9. URTICARIA • Affects 15% to 20% of the • population at some time • Most cases are acute • Duration <6 weeks • Chronic idiopathic more • frequent in elderly women • Less than 5% are chronic • Duration >6 weeks

  10. MECHANISMS FOR MAST CELL ACTIVATION IN THE SKIN • IgE immediate • hypersensitivity • Activation of complement • pathway • Drugs or chemical agents • Aggravating factors • •Heat • •Exercise • •Emotional stress

  11. DIAGNOSIS OF URTICARIA • Etiology known in <5% of • cases • Potential causes • •Foods • •Pharmaceuticals • •Sensitivity to animals, • plants, or latex • •Infections • Emotional stress often • an aggravating factor

  12. PRURITIS IN URTICARIA • Itch almost always present • varies in intensity • Pricking or burning nature • Usually worse in evening • or night • More often relieved by • rubbing than by scratching • Excoriation rare

  13. TYPE OF TREATMENT Antihistamines Intranasal steroids Cromolyn sodium Decongestants Antihistamine/decongestant combinations PRIMARY ACTION Block histamine (H1) receptor Exert local anti-inflammatory effects Stablize mast cell membrane Cause vasoconstriction Combine action of both antihistamines and decongestants PHARMACOLOGIC TREATMENT APPROACHES

  14. ANTIHISTAMINES ( H1 ANTAGONISTS) • Older Agents • Diphenhydramine (Benadryl) • Hydroxyzine (Atarax) • Clemastine (Travist) • Newer Agents • Loratadine (Claritin) • Fexofenadine (Allegra) • Cetirizine (Zyrtec) • Desloratadine (Clarinex)

  15. INTRANASAL STEROIDS • Used to control allergic • rhinitis • No systemic side effects • Common AGENTS • Fluticasone (Flonase) • Mometasone (Nasonex) • Triamcinolone (Nasacort • AQ) • Budesonide (Rhinocort)

  16. MAST CELL STABLIZERS • Adjuvant antiinflammatory • agents • Not for acute attacks • Inhibits release • •Histamines • •Leukotrienes • AGENTS • Cromolyn sodium (Intal) • Intranasal Cromolyn • (Nasalcrom) • Nedocromil (Tilade)

  17. DECONGESTANTS • Reduces nasal congestion • Avoid in patients with • hypertension • COMMON AGENT • Pseudoephedrine (Sudafed)

  18. ALLERGY IMMUNOTHERAPY • Increases IgG antibody • Decreased IgE • Decrease in histamine • release to specific allergen • Reduction in symptoms • Not indicated food allergies

  19. ALLERGIES Susan Hentz NURS 7724

  20. ReferencesReferences • American Academy of Allergy, Asthma, and Clinical Immunology (2002) Fast facts: allergies • 15 November 2002 http://www.aaaai.org/public/fastfacts/allergies.htm • Fireman P. (Ed.) (1998) Allergic rhinitis. In: Atlas of Allergies. Philadelphia: J.B. Lippincott Co. • Google Image Search 15 November 2002 http://images.google.com/images?=allergies • Patterson, R.(Ed.) (1993) Allergic Diseases Diagnosis and Management (4th ed.) • Philadelphia: J.B. Lippincott Co. • U.S. National Library of Medicine (2002) Medlineplus Medical Encyclopedia 15 November 2002 http://www.nlm.nih.gov/medlineplus/encyc/article/000812.htm

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