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  • Image not available. Allergic rhinitis is a common disease. Prevention measures and treatment are justified in most cases because of the potential for complications.
  • Image not available. Because an immune response to allergens results in release of inflammatory mediators that cause allergic rhinitis symptoms, patients must understand the rationale for proper timing and administration of prophylactic regimens.
  • Image not available. Avoidance of allergens is difficult and it may be impractical to expect full success.
  • Image not available. Antihistamines offer an effective option for treating both seasonal and persistent allergic rhinitis.
  • Image not available. Intranasal steroids are highly effective in patients who use them properly.
  • Image not available. While immunotherapy is the only disease-modifying treatment of allergic rhinitis, expense, potential risks, and the major time commitment required make patient selection critical.

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On completion of the chapter, the reader will be able to:

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  1. Describe how commonly allergic rhinitis is seen in the adult and pediatric populations.

  2. Assess a patient’s medical and family history to identify predisposing factors to the development of allergic rhinitis.

  3. Describe nasal physiology and how the results of sympathetic and parasympathetic stimulation.

  4. List the inflammatory mediators and their effects during an immune response.

  5. Contrast early and late phase reactions in allergic rhinitis.

  6. Describe how a diagnosis of allergic rhinitis can be differentiated from other forms of rhinitis.

  7. Construct a plan to counsel a patient about what drugs to avoid before diagnostic skin testing.

  8. Discuss the complications that may result from untreated allergic rhinitis.

  9. Recommend methods to avoid exposure to allergens.

  10. Debate the potential value of newer, peripherally selective antihistamines over older nonselective agents.

  11. Discuss the key points to make when counseling a patient on the potential side effects of antihistamines.

  12. Describe situations where intranasal and/or ophthalmic antihistamines may be useful.

  13. Prepare a strategy for a patient to overcome his reliance on nasal decongestant spray.

  14. Discuss the key points to make when counseling a patient on the use of an intranasal steroid.

  15. Recognize which allergic rhinitis patients are candidates for immunotherapy.

  16. Discuss the potential value of alternative treatment options for allergic rhinitis, such as omalixumab and probiotics.

  17. Assess the success of a patient’s allergic rhinitis treatment plan.

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Allergic rhinitis involves inflammation of the nasal mucous membrane. In a sensitized individual, allergic rhinitis occurs when inhaled allergenic particles contact mucous membranes and elicit a specific response mediated by immunoglobulin E (IgE). This acute response involves the release of inflammatory mediators and is characterized by sneezing, nasal itching, and watery rhinorrhea, often associated with nasal congestion. Itching of the throat, eyes, and ears frequently accompanies allergic rhinitis.

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Allergic rhinitis may be regarded as seasonal allergic rhinitis, commonly known as hay fever, or persistent allergic rhinitis (formerly known as perennial rhinitis). Seasonal rhinitis occurs in response to specific allergens usually present at predictable times of the year, during plants’ pollination (typically the spring or fall). Seasonal allergens include pollen from trees, grasses, and weeds. Persistent allergic rhinitis is a year-round disease caused by nonseasonal allergens, such as house dust mites, animal dander, and molds, or ...

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