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Source: May JR, Smith PH. Allergic Rhinitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7998284. Accessed June 23, 2012.

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  • Hay fever
  • Pollinosis

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  • Inflammation of nasal passages caused by allergic reaction to airborne substances.

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  • Seasonal: Occurs in response to specific allergens (pollen from trees, grasses, and weeds) present at predictable times of year (spring and/or fall blooming seasons).
  • Perennial: Occurs year-round in response to nonseasonal allergens (e.g., dust mites, animal dander, and molds).
  • Many patients have both types, with symptoms year-round and seasonal exacerbations.

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  • Airborne allergens inhaled into nose processed by lymphocytes, producing immunoglobulin E (IgE).
    • On nasal reexposure, IgE bound to mast cells interacts with airborne allergens, triggering release of inflammatory mediators.
  • Within seconds to minutes, rapid release of mediators (histamine, leukotrienes, prostaglandin, tryptase, kinins) causes:
    • Vasodilation
    • Increased vascular permeability
    • Nasal secretions
  • Histamine produces:
    • Rhinorrhea
    • Itching
    • Sneezing
    • Nasal obstruction
  • Late-phase reaction 4–8 hours after initial exposure may cause chronic symptoms, including nasal congestion.

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  • Affects about 50 million Americans of all ages.
  • Prevalence of seasonal rhinitis between 1–40%; perennial rhinitis prevalence ranges from 1–13%.

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  • Allergen avoidance important to prevent episodes but often difficult to accomplish.

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  • Genetics
  • Allergen exposure

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Signs and Symptoms

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  • Clear rhinorrhea; sneezing; nasal congestion; postnasal drip (occasionally with cough or hoarseness); allergic conjunctivitis; and pruritic eyes, ears, or nose.
  • May be loss of smell or taste, with sinusitis or polyps underlying cause in many cases.
  • Untreated rhinitis may lead to:
    • Insomnia
    • Malaise
    • Fatigue
    • Poor work or school performance
  • Complications include recurrent and chronic sinusitis and epistaxis.

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Means of Confirmation and Diagnosis

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  • Medical history for:
    • Description of symptoms
    • Environmental factors and exposures
    • Results of previous therapy
    • Use of medications
    • Previous nasal injury or surgery
    • Family history

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Laboratory Tests

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  • Radioallergosorbent test (RAST) to detect IgE antibodies in blood specific for given antigen.
  • Peripheral blood eosinophil count may be elevated but is nonspecific finding.

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Diagnostic Procedures

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  • Percutaneous allergy testing can help determine whether rhinitis caused by immune response to allergens.
  • Microscopic examination of nasal scrapings typically reveals numerous eosinophils.

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Differential Diagnosis

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  • Viral rhinitis (common cold)
  • Viral conjunctivitis
  • Vasomotor rhinitis
  • Acute or chronic sinusitis
  • Rhinitis medicamentosa
  • Nasal polyposis
  • Foreign body

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  • Minimize or prevent symptoms with minimal side effects and reasonable medication expense.
  • Maintain normal lifestyle, including participation in outdoor activities and interaction with pets.

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  • Figure 1: Treatment algorithm for allergic rhinitis

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Figure 1.
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Treatment algorithm for allergic rhinitis. Reprinted with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy Handbook. 8th ed. New York: McGraw-Hill, 2012.

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  • Allergen avoidance
    • Reduce household mold growth by keeping humidity below 50% and removing obvious growth with bleach or disinfectant.
    • Remove pets that cause symptoms from home, if ...

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