Allergic Rhinitis

Question 1

What is allergic rhinitis?

Answer 1

Inflammation of the nose that occurs when the immune system overreacts to allergens in the air

Question 2

How can allergic rhinitis be further categorised?

Answer 2

• Seasonal allergic rhinitis
• Perennial rhinitis
• Occupational rhinitis

Question 3

When does seasonal allergic rhinitis occur?

Answer 3

Only at certain times of the year

Question 4

If seasonal allergic rhinitis is due to pollen or grass what is it known as?

Answer 4

Hay fever

Question 5

When does perennial rhinitis occur?

Answer 5

Throughout the year

Question 6

What are some common allergens in perennial rhinitis?

Answer 6

• House dust mites

- Domestic pets

Question 7

What causes occupational rhinitis?

Answer 7

Exposure to allergens at work

Question 8

What occupational allergens can cause rhinitis?

Answer 8

• Flour
• Wood dust
• Latex

Question 9

What immunoglobulin mediates allergic rhinitis?

Answer 9

IgE

Question 10

What does IgE cause in response to allergen exposure?

Answer 10

Release of inflammatory mediators from mast cells in the nasal mucosa leading to migration of inflammatory cells

Question 11

What is the most important inflammatory mediator in allergic rhinitis?

Answer 11

Histamine

Question 12

Does allergic rhinitis have a genetic or environmental underlying cause?

Answer 12

Mixture of factors

Question 13

What are the risk factors for allergic rhinitis?

Answer 13

• History of atopy
• Family history of atopy
• Exposure to common allergens
• Air pollution
• Reduced exposure to infection
• Exposure to cigarette smoke

Question 14

What are the typical symptoms of allergic rhinitis?

Answer 14

• Sneezing
• Rhinorrhoea and nasal congestion
• Itchy nose and/or palate
• Eye symptoms

Question 15

What colour is the rhinirrhoea usually in allergic rhinitis?

Answer 15

Clear

Question 16

What does yellow rhinorrhoea suggest?

Answer 16

Allergy or infection

Question 17

What does green rhinorrhoea suggest?

Answer 17

Infection

Question 18

What does blood tinged rhinorrhoea raise concern of?

Answer 18

Tumour

Question 19

Is rhinorrhoea in allergic rhinitis bilateral or unilateral?

Answer 19

Bilateral

Question 20

What are the eye symptoms of allergic rhinitis?

Answer 20

• Watering
• Itching
• Redness
• Swelling

Question 21

How is allergic rhinitis usually diagnosed?

Answer 21

Clinically

Question 22

What additional test may be helpful in determining the causative allergen in allergic rhinitis?

Answer 22

Allergy testing

Question 23

What allergy testing methods are used in allergic rhinitis?

Answer 23

• Skin prick testing

- Blood assays

Question 24

What are the advantages of skin prick testing?

Answer 24

• Reliable

- Immediate results

Question 25

What can suppress response and obscure results of skin prick testing?

Answer 25

- Antihistamines - Topical corticosteroids - TCAs

Question 26

What is involved in allergy testing blood assays for allergic rhinitis?

Answer 26

Total allergen-specific IgE concentrations are determined

Question 27

What are the differentials for allergic rhinitis?

Answer 27

- Non-allergic rhinitis - Infective rhinitis - Nasal polyps - Sinusitis - Adenoidal hypertrophy - CF - SLE - Granulomatous conditions

Question 28

What are the main lines of treatment for allergic rhinitis?

Answer 28

- Education - Allergen avoidance - Anti-histamines - Topical steroids

Question 29

What are the first line 'as-required' treatments for allergic rhinitis?

Answer 29

Nasal anti-histamines

Question 30

What are the advantages of nasal anti-histamines in treating allergic rhinitis?

Answer 30

- Equal efficacy to oral anti-histamines for treating rhinitis symptoms - Fast acting (less than 15 minutes)

Question 31

What is the disadvantage of nasal histamines in treating allergic rhinitis?

Answer 31

Do not reduce symptoms at other sites unlike oral anti-histamines

Question 32

Who should nasal anti-histamines not be used in for allergic rhinitis?

Answer 32

Under 5's

Question 33

When are oral anti-histamines advised in allergic rhinitis?

Answer 33

When sneezing or nasal discharge are predominant and regular preventer therapy is required

Question 34

What types of oral anti-histamines are recommended in allergic rhinitis?

Answer 34

Once-daily, non sedating

Question 35

Give an example of a once-daily, non-sedating anti-histamine?

Answer 35

Cetirizine

Question 36

When are topical intranasal steroids more useful than anti-histamine for treating allergic rhinitis?

Answer 36

When nasal blockage is predominant or polyps are present

Question 37

What symptoms of allergic rhinitis are intranasal steroids effective at treating?

Answer 37

All symptoms

Question 38

Are intranasal steroids faster or slower in onset than anti-histamines?

Answer 38

Slower

Question 39

How long may intranasal steroids take to develop maximum efficacy when used to treat allergic rhinitis?

Answer 39

Days to weeks

Question 40

When may surgery be an indicated treatment for allergic rhinitis?

Answer 40

When drugs fail and structural abnormalities are present

Question 41

What surgeries may improve the airway or entry of topical medications in allergic rhinitis?

Answer 41

- Reduction of inferior turbinates | - Correction of deviated septum

Question 42

What does immunotherapy for allergic rhinitis involve?

Answer 42

Exposure to increasing amounts of allergens to develop tolerance

Question 43

What are the complications of allergic rhinitis?

Answer 43

- Poor quality of life - Poor asthma control - Sinusitis - Nasal polyps - Chronic otitis media