Allergic Rhinitis

Etiology: Disease Process: Signs and Symptoms:

Predisposing factors
Allergen Exposure
• Red itchy swollen eyes
• Genetics ↓
• Sneezing
• Age
• Runny nose
• Sex Allergy Sensitization
• Nasal congestion
• Female Gender ↓
• Family History
Increase IgE
• Birth during the pollen Allergic rhinitis can affect
season ↓ quality of life by also
Mast Cells producing fatigue, loss of
↓ sleep, and poor concentration.
Precipitating factors
• Exposure to Inflammatory
environmental Mediators Laboratory/
allergen Diagnostics:
(pollen,dust,animal
hair, molds spores) • Nasal smears,
Local Increase
• Presence of allergens
Trigeminal
of mucous • RAST
Inflammation Nerve
IgE glands (Radioallergo
• Exposure to smoking secretion sorbent test)
• Bacterial or viral • peripheral
infection blood counts,
• Food allergy If not treated: If treated: • total serum
IgE,
• epicutaneous
Prognosis: Nursing Management: and
intradermal
If left untreated, many • Improving breathing testing,
complications may result, such pattern • food
as allergic asthma, chronic nasal • Promoting elimination
obstruction, chronic otitis media understanding of allergy and
with hearing loss, anosmia and allergy control challenge,
(absence of the sense of smell), • Coping with a chronic • and nasal
and, in children, orofacial dental disorder provocation
deformities. Early diagnosis and • Monitoring and tests.
adequate treatment are essential managing potential
to reduce complications and complications
relieve symptoms. • Promoting home and
community based care
• Identify the patient’s
known allergens (eg,
medications,foods,
insects, environmental
allergens).
• • Describe the patient’s
typical allergic reaction
and its severity.

Management:
Medical Management
The goal of therapy is to
provide relief of symptoms.
Therapy may include one or all
of the following interventions:
Avoidance therapy use of air
conditioners, air cleaners,
humidifiers, removal of dust
catching furnishings, carpets
and window coverings, removal
of pets from the home or
bedroom use of pillow and
mattress covers that are
impermeable to dust mites and a
smoke free environment
Pharmacotherapy:
Antihistamines are the major
class of medications prescribed
for the symptomatic relief of
allergic rhinitis.
Adrenergic agents:
Adrenergic agents,
vasoconstrictors of mucosal
vessels, are used topically (nasal
and ophthalmic formulations) in
addition to the oral route.
Mast cell stabilizers:
Intranasal cromolyn sodium
(NasalCrom) is a spray that acts
by stabilizing the mast cell
membrane, thus reducing the
release of histamine and other
mediators of the allergic
response.
Corticosteroids:
Intranasal corticosteroids are
indicated in more severe cases
of allergic and perennial rhinitis
that cannot be controlled by
more conventional medications
such as decongestants,
antihistamines, and intranasal
cromolyn.
• Document the patient’s
allergies (eg, medications,
foods, insects, environmental
allergens) in the patient’s
medical record.
• Post allergy alerts
appropriately.
• Encourage the patient to wear
a medical alert band and to
carry information about
allergies at all times.
• Monitor the patient closely
after administration of new
medications and exposure to
new foods, contrast agents,
latex, and other allergens.
• Investigate potential for
allergic reactions with all new
medications through
consultation with the
pharmacist.
• Instruct the patient to question
all medications and new foods.
• Identify early manifestations
of allergic reactions.
• Administer emergency
treatment for allergic reactions.
• Monitor the patient’s response
and status for
12–14 hours after a severe
allergic reaction.
• Instruct the patient and family
about emergency home
management of allergic
reaction.
• Instruct the patient and family
about avoidance measures to
reduce risk of exposure to
allergens.
Leukotriene Modifiers: Prioritized Problem/Nursing
Diagnosis:
As previously discussed,
leukotrienes have many effects Ineffective breathing pattern
on the inflammatory cycle. related to allergic reaction
Leukotriene modifiers, such as
zileuton
(Zyflo), zafirlukast (Accolate),
and montelukast (Singulair),
block the synthesis or action of
leukotrienes and prevent the
signs and symptoms associated
with asthma
And Immunotherapy:
Allergen desensitization
(allergen immunotherapy,
hyposensitization) is primarily
used to treat IgE-mediated
diseases by injections of
allergen extracts.
Immunotherapy,also referred to
as allergy vaccine therapy,
involves the administration of
gradually increasing quantities
of specific allergens to the
patient until a dose is reached
that is effectivein reducing
disease severity from natural
exposure