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Natural History of AR
Onset is common in childhood, adolescence and early adulthood Symptoms often wane in older adults, but may develop or persist at any age No apparent gender selectivity or predisposition for developing allergic rhinitis May contribute to other conditions such as Sleep disorders Fatigue Learning problems
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Causes of AR
Rhinorrhoea
Oedema
Role Of Leukotrienes In AR
Dilatation of nasal blood vessels, increase vascular permeability with edema formation congestion Increase mucus production Recruitment of inflammatory cells into the tissue Promote inflammation by enhancing the activity of inflammatory cells 5000 times more potent than histamine
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Clinical Manifestations
Others Repetitive sneezing Watery rhinorrhea Nasal pruritus Nasal congestion Eye symptoms Ear symptoms Postnasal drainage
ARIA Classification
Intermittent
< 4 days per week or < 4 weeks
Persistent
4 days per week and 4 weeks
Mild
normal sleep & no impairment of daily activities, sport, leisure & normal work and school & no troublesome symptoms
ModerateModerate-severe
one or more items abnormal sleep impairment of daily activities, sport, leisure abnormal work and school troublesome symptoms
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10
Symptoms inflammation
Diagnosis of AR
History Physical / Nasal Examination Laboratory Testing - Skin Prick Test - Peak Nasal Inspiratory Flow Rate - Rhinomanometry
Physical Examination
Allergic shiner Dennie Morgan line Allergic crease Allergic salute Nasal mucosa may appear normal or pale bluish, swollen with watery secretions but only if patient is symptomatic Exclude structural problems (polyps, deflected nasal septum)
Others: Others: nasal voice, constant mouth breathing, frequent snoring, coughing, repetitive sneezing, chronic open gape of the mouth, weakness, malaise, irritability
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Management of AR
Allergen Avoidance Pharmacotherapy Immunotherapy
Pharmacotherapy
Medications used to treat allergic rhinits: rhinits: Antihistamines Decongestants AH-D combinations AHCorticosteroids Mast Cell stabilizers Anticholinergics Antileukotrienes
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AntiAnti-Histamines
Act by preventing histamine from binding to the H1-receptors Primarily helpful in controlling Sneezing, itching & rhinorrhoea; ineffective in releiving nasal blockage 1st generation anti-histamines anti- chlorpheniramine - diphenylhydramine 2nd generation anti-histamines anti- cetrizine - azelastine - fexofenadine - loratadine
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Role Of Montelukast In AR
It belongs to that class of drug which specifically blocks leukotrienes, leukotrienes, an underlying cause of allergy symptoms Blocks LTC4 which is approximately 10 times as potent as histamine Blocks LTD4 which was shown to be 5000 times as potent as histamine Offers relief from congestion and stuffiness Gives day-time as well as night-time symptom relief daynightProvided as a service by CiplaMed
The Ideal Drug For Allergic Rhinitis Should Have The Following Features:
Inhibit both early and late phases Be an H1 blocker Counter effects of other mediators FastFast-acting, to control the early phase DosingDosing-od or bd for compliance No side effects Manage all symptoms Intranasal administration
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Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis
Otolaryngol Head Neck Surg 1992, 107, 855-60 855-
ModerateModerate-severe
Oral H1 blocker and/or LTRA Intranasal H1 blocker and/or decongestant Intranasal CS
ModerateModerate-severe
Intranasal CS If nose very blocked add oral CS or decongestant or LTRA