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Allergic Rhinitis PowerPoint Presentation

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Published on : Mar 14, 2014
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Slide 1 - Allergic Rhinitis Kirk H. Waibel CPT, MC Walter Reed Army Medical Center
Slide 2 - Objectives Understand importance of allergic rhinitis Recognize variation in allergic symptoms Apply appropriate treatment strategies
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Slide 7 - My child has allergies! Pathophysiology History Physical Exam
Slide 8 - Allergen
Slide 9 - History Onset of symptoms Infant less than 3 years old Older child Symptoms Headache - Ocular Nasal - Oral Pruritis Sneezing Congestion Postnasal drip Rhinorrhea
Slide 10 - History Frequency Perennial (cat, dog, dust mite, cockroach, molds) Seasonal (trees, grass, weeds) Severity School absence Loss of smell Behavioral changes Comorbid conditions
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Slide 12 - Physical Exam Eyes Ears Nose Oropharynx Lungs
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Slide 18 - Differential Diagnosis Upper respiratory infection Chronic sinusitis Anatomical nasal obstruction Concha bullosa - Nasal polyps Deviated nasal septum - Adenoidal hypertrophy GERD
Slide 19 - Should you refer for skin testing? YES Poor response to therapeutic trial Drastic environmental changes are considered Strong desire for immunotherapy NO Hx suggestive for AR Trial of appropriate therapy successful Symptoms mild and easily managed Mechanical, anatomical, or infectious causes
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Slide 21 - Agent Sneezing Itching Congestion Rhinorrhea Eye OA +++ +++ +/- ++ ++ NA + + +/- + - ICS ++ ++ +++ ++ + OD - - ++ - - ND - - +++ - - MCS + + + + - IND - - - ++ - Pharmacologic Management
Slide 22 - Antihistamines 1st generation: Hydroxyzine (Atarax®) Diphenhydramine (Benadryl®) Chlorphenarimine (CTM®) 2nd generation: Certirizine (Zyrtec®) Loratidine (Claritin®) Fexofenadine (Allergra®) Desloratadine (Clarinex®)
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Slide 24 - Nasal sprays Nasal steroids Cromolyn (Nasocrom®) Oxymetolazone (Afrin®) Nasal saline (Ocean®)
Slide 25 - Nasal steroids Mometasone (Nasonex®) Fluticasone (Flonase®) Budesonide (Rhinocort®) Vancenase (Beclomethasone®) Flunisolide (Nasalide®)
Slide 26 - Immunotherapy Rise in IgG “blocking” antibodies Reserved for patients who find it difficult to avoid allergens but do not respond adequately to pharmacologic therapy Children > 7 years old
Slide 27 - Allergist Referral Symptoms should exceed 6 weeks and present for at least 2 years in a row Inadequate relief after one month of continuous treatment Intolerable side effects Complications of allergy Patients moving into the area already on immunotherapy
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Slide 31 - Age (yrs) 2 18 100 % of adult A B C 1. IQ 2. Weight 3. Lymph nodes 4. OFC 5. Length 6. Emotional stability MATCH