1. ALLERGIC RHNITIS - PREVALENCE n Affects 20-40 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

2. 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

3. 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

4. DISTINGUISHING ALLERGIC RHINITIS FROM THE COMMON COLD

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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)

15. 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)

16. 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)

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

18. 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

19. ALLERGIES Susan Hentz NURS 7724

20. References References –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