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Chapter 64. Allergic Rhinitis

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?

a. HPA axis suppression

b. Paradoxical agitation

c. Rebound congestion

d. Medication tolerance

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

Answer a is incorrect. HPA axis suppression is a potential adverse effect related to intranasal corticosteroids.

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

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

MH is a 37-year-old man with a history of chronic nasal stuffiness. He reports symptoms 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. Which of the following best classifies MH’s symptoms?

a. Mild intermittent

b. Moderate-to-severe intermittent

c. Mild persistent

d. Moderate-to-severe persistent

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

Answer a is incorrect. Since this patient’s symptoms are affecting his quality of life, they are not mild. Also, since his symptoms are >4 d/wk and >4 consecutive weeks, they are persistent.

Answer b is incorrect. His symptoms are year round.

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

Which therapeutic option would be best for MH?

a. Oral decongestant

b. First-generation antihistamine

c. Intranasal corticosteroid

d. Intranasal decongestant

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

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

Answer b is incorrect. A first-generation antihistamine is not the best option due to its sedative and anticholinergic effects, but can be a good additional agent should the intranasal corticosteroid not provide significant relief of symptoms.

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