Allergic rhinitis

Question 1

What are the causes of allergic rhinitis?

Answer 1

• An inflammatory response involving the release of histamine, initiated by allergens being deposited on the nasal and respiratory tract mucosa.
• Allergens responsible for seasonal allergic rhinitis include grass/tree pollens and fungal mould spores.
• Perennial allergic rhinitis occurs when symptoms are present all year
  ¬> Commonly caused by dust mites, animal dander and feathers.
  ¬> Patients may suffer from a form of perennial rhinitis that becomes worse in the summer months.
• Allergic rhinitis is associated with asthma and eczema.

Question 2

What are the signs and symptoms of allergic rhinitis?

Answer 2

• Rhinorrhoea (runny nose)
• Nasal congestion
• Nasal itching
• Watery eyes
• Irritated eyes
• Discharge from the eyes
• Sneezing

Question 3

What are the referral symptoms of allergic rhinitis?

Answer 3

• Tightness of the chest
• Wheezing
• Shortness of breath
• Painful ear
• Painful sinuses
• Purulent conjunctivitis
• Severe symptoms only partially relieved by OTC preparations

Question 4

What are the OTC treatments of allergic rhinitis?

Answer 4

• Antihistamines
• Nasal corticosteroids
• Sodium cromoglicate
• Decongestants

Question 5

What is the general advice for allergic rhinitis?

Answer 5

• Allergen avoidance is recommended but not always possible.
• For seasonal allergic rhinitis (hay-fever):
  ¬> Car windows and air vents should be kept closed while driving, to reduce amount of pollen/allergens entering the car
  ¬> House windows should be kept closed when the pollen count is high.
• For perennial allergic rhinitis:
  ¬> Regular cleaning of the house to keep dust levels at a minimum.

Question 6

What are the non-sedating antihistamines for allergic rhinitis?

Answer 6

• Acrivastive
• Cetrizine
• Loratadine
• Fexofenadin

Question 7

What is the sedating antihistamine for allergic rhinitis?

Answer 7

Chlophenamine

Question 8

What is antihistamines for and how are they given?

Answer 8

• First-line treatment for mild to-moderate.
• Effective in reducing sneezing and rhinorrhoea (runny nose).
• Usually given orally.

Question 9

What are some examples of intranasal corticosteroids?

Answer 9

• Beclometasone
• Fluticasone
• Mometasone

Question 10

What is intranasal corticosteroids for and how are they given?

Answer 10

• Treatment of choice for moderate-to-severe nasal symptoms that are continuous.
• Acts to reduce inflammation that has occurred as a result of the allergen’s action
• Regular use is essential for full benefit to be obtained and treatment should be continued throughout the hay Fever season.
• Can take several days to be effective

Question 11

What is sodium cromoglicate for and how are they given?

Answer 11

• Highly effective for the treatment of eye symptoms.
• Work within an hour
• Should be used continuously to obtain full benefit.

Question 12

What is decongestants for and how are they given?

Answer 12

• May be used short term to reduce nasal congestion alone or in combination with an antihistamine.
• Can be useful in patients starting to use a preventer such as a nasal corticosteroid.