Rhinitis April 10, 2006

THE NOSE

CT of THE NOSE

The inside of THE NOSE

Therapeutic Options Allergic Rhinitis AAAAI. The Allergy Report 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 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 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): Suonpaa J. Ann Med. 1996;28: Dykewicz MS, Fineman S. Ann Allergy Asthma Immunol. 1998;81: 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

INS or NSA

Therapeutic Options Allergic Rhinitis AAAAI. The Allergy Report 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 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 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 Available at:

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