1. Rhinitis April 10, 2006

2. THE NOSE

3. CT of THE NOSE

4. The inside of THE NOSE

5. 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

8. 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

10. Pseudoephedrine and HR

11. Pseudoephedrine and SBP

12. Pseudoephedrine and DBP

13. Every Patient is Different

14. 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

15. 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

16. INS or NSA

18. 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

20. LTRA in Allergic Rhinitis

21. All Evidence is Not the Same

22. 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

23. 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

24. 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