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Rhinitis April 10, 2006
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THE NOSE
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CT of THE NOSE
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The inside of THE NOSE
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Therapeutic Options Allergic Rhinitis AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Antihistamines Decongestants Anticholinergics Corticosteroids Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy
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Therapeutic Options Allergic Rhinitis AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Antihistamines Decongestants Anticholinergics Corticosteroids Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy
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Pseudoephedrine and HR
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Pseudoephedrine and SBP
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Pseudoephedrine and DBP
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Every Patient is Different
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Therapeutic Options Allergic Rhinitis AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Antihistamines Decongestants Anticholinergics Corticosteroids Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy
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Urval KR. Primary Care. 1998;25(3):649-662. Suonpaa J. Ann Med. 1996;28:17-22. Dykewicz MS, Fineman S. Ann Allergy Asthma Immunol. 1998;81:463-468. Intranasal Corticosteroids in Allergic Rhinitis: An Overview Benefits Are first-line therapy for persistent allergic rhinitis Relieve all symptoms –Sneezing –Nasal itching –Rhinorrhea –Nasal congestion Minimal side effects Drawbacks May cause nasal irritation and/or bleeding Patient compliance Patient concerns about steroids
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INS or NSA
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Therapeutic Options Allergic Rhinitis AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Antihistamines Decongestants Anticholinergics Corticosteroids Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy
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LTRA in Allergic Rhinitis
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All Evidence is Not the Same
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Therapeutic Options Allergic Rhinitis AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Antihistamines Decongestants Anticholinergics Corticosteroids Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy
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Subcutaneous Immunotherapy (Hyposensitization) Mechanism of action = Unknown (may shift immune response from TH2- to TH1-response to allergen) Efficacy: Demonstrated in AR Only disease-modifying therapy for AR Usage: In patients who do not respond adequately to pharmacotherapy Side effects: local reactions, anaphylaxis AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.htmlhttp://www.theallergyreport.org/reportindex.html
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Types of Rhinitis Allergic –Seasonal or Perennial –Intermittent or Persistent Non Allergic –Vasomotor –Infectious Viral or Bacterial –Drug induced Antihypertensives, Afrin –Hormonal Pregnancy, Hypothyroid –NARES, Atrophic, Anatomic
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