ALLERGIC RHNITIS - PREVALENCE n Affects million Americans n 10% - 30% of adults n Up to 40% of children n More common young boys n but little sex difference after n adolescence n No impact of race or n socioeconomic status
SIGNS and SYMPTOMS of ALLERGIC RHINITIS n Sneezing n Itchy nose, eyes, throat, n and/or ears n Nasal congestion n Clear rhinorrhea n Conjunctival edema, itching, n tearing, hyperemia n Subocular edema and n darkening “shiners” n Loss of taste and smell n sensations
CASUSE OF ALLERGIC RHINITIS n Hypersensitivity of the immune n system n Exposure to an allergen n Triggers antibody production n Antibodies bind to cells that n contain histamine n Histamine released from cells
DISTINGUISHING ALLERGIC RHINITIS FROM THE COMMON COLD
DIAGNOSTIC TESTING n Skin tests for specific IgE n antibodies n Identify allergens n Antihistamine use can n suppress results n Serum specific IgE tests n RAST (radioallergosorbent) n blood test
COMMON ALLERGENS n Pollen n Mold n Animal dander n Dust n Dust mite n Food allergies n Insect bites n Drug allergies n Latex n Chemicals
OTHER ALLERGIC REACTIONS n Cough n Asthma n Urticaria n Hives n Eczema n Atopic dermatitis n Contact dermatitis n Anaphylaxis
ASTHMA and ALLERGIES n Definition: Airway hyperresponsive, exacerbated by inflammation n Symptoms n Reversible airway n obstruction n Wheezing n Cough n Dyspnea n Decreased exercise n tolerance
URTICARIA n Affects 15% to 20% of the n population at some time n Most cases are acute n Duration <6 weeks n Chronic idiopathic more n frequent in elderly women n Less than 5% are chronic n Duration >6 weeks
MECHANISMS FOR MAST CELL ACTIVATION IN THE SKIN n IgE immediate n hypersensitivity n Activation of complement n pathway n Drugs or chemical agents n Aggravating factors n Heat n Exercise n Emotional stress
DIAGNOSIS OF URTICARIA n Etiology known in <5% of n cases n Potential causes n Foods n Pharmaceuticals n Sensitivity to animals, n plants, or latex n Infections n Emotional stress often n an aggravating factor
PRURITIS IN URTICARIA n Itch almost always present n varies in intensity n Pricking or burning nature n Usually worse in evening n or night n More often relieved by n rubbing than by scratching n Excoriation rare
PHARMACOLOGIC TREATMENT APPROACHES n TYPE OF TREATMENT n Antihistamines n Intranasal steroids n Cromolyn sodium n Decongestants n Antihistamine/decongestan t n combinations n PRIMARY ACTION n Block histamine (H1) n receptor n Exert local anti- inflammatory n effects n Stablize mast cell membrane n Cause vasoconstriction n Combine action of both n antihistamines and n decongestants
ANTIHISTAMINES ( H1 ANTAGONISTS) n Older Agents n Diphenhydramine (Benadryl) n Hydroxyzine (Atarax) n Clemastine (Travist) n Newer Agents n Loratadine (Claritin) n Fexofenadine (Allegra) n Cetirizine (Zyrtec) n Desloratadine (Clarinex)
INTRANASAL STEROIDS n Used to control allergic n rhinitis n No systemic side effects n Common AGENTS n Fluticasone (Flonase) n Mometasone (Nasonex) n Triamcinolone (Nasacort n AQ) n Budesonide (Rhinocort)
MAST CELL STABLIZERS n Adjuvant antiinflammatory n agents n Not for acute attacks n Inhibits release n Histamines n Leukotrienes n AGENTS n Cromolyn sodium (Intal) n Intranasal Cromolyn n (Nasalcrom) n Nedocromil (Tilade)
DECONGESTANTS n Reduces nasal congestion n Avoid in patients with n hypertension n COMMON AGENT n Pseudoephedrine (Sudafed)
ALLERGY IMMUNOTHERAPY n Increases IgG antibody n Decreased IgE n Decrease in histamine n release to specific allergen n Reduction in symptoms n Not indicated food allergies
ALLERGIES Susan Hentz NURS 7724
References References –American Academy of Allergy, Asthma, and Clinical Immunology (2002) Fast facts: allergies –15 November –Fireman P. (Ed.) (1998) Allergic rhinitis. In: Atlas of Allergies. Philadelphia: J.B. Lippincott Co. –Google Image Search 15 November –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