1 / 17

Allergic Rhinitis

Allergic Rhinitis. By Alex Pearce-Smith. Scenario . A 12 yr old boy comes into see you with his mum in June. He complains of a persistant runny nose and sore eyes for the last 3 wks. You suspect seasonal rhinitis. What other points would you want to know from the history?

judd
Download Presentation

Allergic Rhinitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Allergic Rhinitis By Alex Pearce-Smith

  2. Scenario • A 12 yr old boy comes into see you with his mum in June. He complains of a persistant runny nose and sore eyes for the last 3 wks. You suspect seasonal rhinitis. • What other points would you want to know from the history? • What examination would you perform? • How would you manage this?

  3. What are these examples of?

  4. Pathophysiology

  5. Sub-types • Seasonal (hayfever) • Grass, Tree pollen allergens, same time each year. • Perennial • House dust mites, feathers, animal danders – throughout the year. • Occupational • Workplace – e.g. flour allergy in bakers.

  6. Epidemiology • Approximately 25% of UK population • Age Matters • Seasonal more common in children • Perennial more common in adults • Increasing age a negative risk factor • Seasonal rhinitis more predisposition to itch, sneezing and diurnal symptoms. • Perennial – catarrh more prevelant and more likely to be diagnosed with asthma.

  7. What to look for….. • Which of these are typical symptoms of Allergic Rhinitis? • Facial pain • Post nasal drip • Persistent runny nose • Unilateral Symptoms • Nasal obstruction • Nosebleeds • Nasal itch • Violent sneezing in bouts • Conjunctivitis

  8. Classification

  9. Treatment • Mild and Intermittent • Topical (rapid relief) – e.g. Azelastine. • Oral – e.g. Cetirizine, Loratadine, Fexofenadine. • Or LTRA (e.g. Montelukast – esp. in asthmatics). • Mild but persistent/ Moderate-Severe but Intermittent. • Trial of above +/- decongestant (max 2/52) • Nasal Corticosteroids – e.g.Fluticasone, Budesonide, Mometasone. • Review after a month • If improved continue for 1/12 • if not then step up treatment.

  10. Treatment • Moderate/Severe and Persistent. • 1) Nasal corticosteroids, 2)Antihistamines, 3) LTRAs • Review after 2-4 wks • If improved continue for further month • If not rv diagnosis and compliance and consider: • Increase corticosteroid • Add antihistamine (if itch and sneeze) • Add Ipratropium (if rhinorrhoea) • Add decongestant/ oral steroids …….. refer

  11. Consider Asthma • Strong link between allergic rhinitis and asthma. • If known asthmatic then review asthma control. • If no diagnosis of asthma try these 4 Qus. • Have you had an attack/recurrent wheeze? • Do you have a troublesome cough esp. at night? • Do you cough or wheeze after exercise? • Does your chest feel tight? • If yes to any of these then review asthma.

  12. Allergen Avoidance….Can you think of 3? • Allergen impermeable covers fo matresses and pillows. • Wash bedding in hot water regularly. • Remove animals, teddys and carpets from bedrooms. • Air-conditioning. • Air Filters in bedroom • Dehumidifier • Vented drier to dry clothes • Minimize upholstered furniture.

  13. Pollen Avoidance…. Can you think of 3 measures….. • Stay indoors and shut windows! • Wear sunglasses. • Wash hair and change clothes after returning from exposure to high pollen count. • Avoid drying clothes outdoors. • Pollen filters in cars. • Avoid grassy places. • Take a holiday by the sea when sx at worst! • Vasaline around nostrils • Pets carry pollen……

  14. Testing? • Not usually necessary – but may be useful if struggling to isolate allergen or has suffered a severe reaction. • Skin Prick testing • Skin Prick Testing • RAST (specific IgE) • If skin prick inappropriate due to severe previous reaction/ on antihistamine.

  15. Referral? • Referral should be considered if either: • refractory to treatment e.g. 6 weeks with nasal steroids • unilateral nasal symptoms • nasal perforation, ulceration or collapse • sero-sangionous discharge • high nasal cavity crusting • recurrent cellulitis • urgent referral required for periorbital cellulitis

  16. Scenario • A 12 yr old boy comes into see you with his mum in June. He complains of a persistant runny nose and sore eyes for the last 3 wks. You suspect seasonal rhinitis. • What other points would you want to know from the history? • What examination would you perform? • How would you manage this?

  17. Questions? • References • GP notebook • CKS • ARIA guidelines • Allergyuk.org • Patient.co.uk

More Related