RhinitisApril 10, 2006

RhinitisApril 10, 2006

THE NOSE

CT of THE NOSE

The inside of THE NOSE

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

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

Pseudoephedrine and HR

Pseudoephedrine and SBP

Pseudoephedrine and DBP

Every Patient is Different

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

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 OverviewBenefits

• 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

INS or NSA

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

LTRA in Allergic Rhinitis

All Evidence is Not the Same

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

Subcutaneous Immunotherapy (Hyposensitization)

• Mechanism of action = Unknown (may shift immune response from TH2- to TH1-response to allergen)

• Efficacy:Demonstrated in AROnly 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.html

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