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Chapter 66: Allergic Rhinitis

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Which of the following is a potential adverse effect when using oral antihistamines for the management of allergic rhinitis in a 3-year-old child?

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a. HPA axis suppression

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b. Paradoxical agitation

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c. Rebound congestion

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d. Medication tolerance

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Answer b is correct. This is a potential adverse effect of oral first-generation antihistamines unique to infants and young children.

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Answer a is incorrect. It is a potential adverse effect related to intranasal corticosteroids.

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Answer c is incorrect. Rebound congestion is an adverse effect related to overuse of topical decongestants.

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Answer d is incorrect. Medication tolerance is not a concern with the use of antihistamines.

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JB is a 45-year-old man with a history of chronic nasal stuffiness nearly daily and all year round. His only other medical condition is high blood pressure. In addition to stuffiness, he has been sneezing a lot at work (which he finds very embarrassing). Also, his allergies have caused him to cancel park outings with his family. Using the ARIA guidelines, which of the following best classifies JB’s symptoms?

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a. Mild intermittent

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b. Moderate to severe intermittent

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c. Mild persistent

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d. Moderate to severe persistent

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Answer d is correct. His symptoms are severe and chronic.

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Answer a is incorrect. Because this patient’s symptoms are affecting his quality of life, they are not mild. Also, because his symptoms are more than 4 days per week and more than 4 consecutive weeks, they are persistent.

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Answer b is incorrect. His symptoms are year round.

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Answer c is incorrect. His symptoms affect his quality of life.

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Which therapeutic option would be best for JB?

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a. Oral decongestant

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b. Nonselective antihistamine

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c. Intranasal corticosteroid

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d. Intranasal decongestant

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Answer c is correct. An intranasal corticosteroid is highly effective for congestion and sneezing.

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Answer a is incorrect. This patient suffers from high blood pressure and an oral decongestant can cause it to increase even more. Also, decongestants are only useful for nasal congestion and not sneezing.

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Answer b is incorrect. A nonselective antihistamine is not the best option due to its sedative and anticholinergic effects, but can be a good ...

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