rhinitis april 10, 2006. the nose ct of the nose

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