Alesandra Dawn H.
Payot
BS Pharmacy 3rd year
Clinical Pharmacy 2
ALLERGIC RHINITIS & ASTHMA
Definition:
 Allergic rhinitis is inflammation of the inside of
the nose caused by an allergen. lgE mediated
hypersensitivity disease of mucous
membranes of nasal airways characterized by
sneezing, watery nasal discharge, itching, and
nasal obstruction. (Durham, 1999).
o Allergen – substance that cause
allergy such as dust, mould, or flakes
of skin from certain animal. They also
can reach the lungs and trigger
asthma.
o lgE – it is immunoglobulin E a an
antibodies produced by the immune
system. If the lgE has higher amounts,
it can be a sign that the body
overreacts to allergens which can lead
to an allergic reaction. lgE levels can
be high when the body is fighting an
infection from a parasite and from
some immune system conditions.
o If mataas ang lgE level meaning
there are allergens in our body,
the lgE is responsible with the
allergens that enters our body.
 Asthma is a chronic (long-term) condition that
affects the airways in the lungs. The airways
are tubes that carry air in and out of your
lungs.
o Bronchiole – a tiny branch of air
tubes in the lungs
- If meron tayong asthma, the airways can
become inflamed and narrowed at times kaya
nahihirapan tayong huminga dahil ang
airways are swollen.
- Normal lungs – muscle is relaxed then
normal lining and normal amount of mucous.
- Asthmatic – the line is swollen and there are
excess mucous and the muscles are
tightened.
Epidemiology:
 Allergic rhinitis
- It is reported to affect approximately 25 and
40% of children and adults globally,
respectively. Approximately 80% of Allergic
Rhinitis symptoms develop before the age of
20 years (12) and peak at age 20-40 before
gradually declining.
 Asthma
- Around 9.8% of female adults have asthma,
compared to 6.1% of male adults. It is a
leading chronic disease in children. Currently,
there are about 5.1 million children under the
age of 18 with asthma. Black children are
nearly three times more likely to have asthma
compared to white children.
Etiology:
 Asthma occurs in families which suggest that
it is an inherited disorder. Allergy is the
strongest predisposing factor for asthma.
Chronic exposure to airway irritants or
allergens also increases the risk for
developing asthma. Common allergens can
be seasonal (eg. Grass, tree and weed
pollens, mold, dust, or animal dander).
Precipitating factors (specific event that triggers the
problem)
 Aerobiological flora – came from airborne
materials such as viruses, pollen, pollutants
 House dust and dust mites
 Feathers
 Tobacco smoke
 Industrial chemicals
 Animal dander
Predisposing factors (conditions/activities that can
lead to development of disease)
 Psychological
 Focal sensitivity states
 Infections
 Physical
 Degree of pollution in the air
 Humidity and temperature differences
 Temperature changes
 Age & sex
 lgA deficiency
Alesandra Dawn H. Payot
BS Pharmacy 3rd year
Clinical Pharmacy 2
Pathophysiology of Allergic Rhinitis
 Immunoglobulin (lg) E mediated type 1
hypersensitivity response to an antigen
(allergen) in a genetically susceptible person.
 Type 1 hypersensitivity causes local
vasodilation and increased capillary
permeability.
Pathophysiology of Asthma
 Airways Muscle: the thin layer of muscle
within the wall of an airway can contract to
make it tighter and narrower. In people with
asthma, this muscle is often “twitchy” and
contracts more easily and more strongly than
in people who do not have asthma.
 Inflammation/Swelling: the inside walls of
the airways are often swollen and inflamed,
leaving less space inside. Preventer or
controller medicines work by reducing the
inflammation that causes the swelling.
Symptoms:
Allergic Rhinitis
 Sneezing
 An itchy nose
 A runny or blocked nose.
 Itchy, red and watery eyes
 A cough
 The roof of your mouth being itchy
Asthma
 Wheezing, coughing and chest tightness
becoming severe and constant
 Being too breathless to eat, speak or sleep
 Breathing faster
 A fast heartbeat
 Drowsiness, confusion, exhaustion or
dizziness
 Blue lips or fingers
 Fainting
 Mucus: mucus production is usually a
protective response, but in severe asthma, it
is excessive and can block the inside of the
airways – preventer medicines also reduce
mucus.
 Fibrosis or scarring: ongoing inflammation in
the airways can lead to the development of
scar tissue and “tissue remodeling”. This
results in thickened airway walls and
increased smooth muscle.
TYPES OF ALLERGIC RHINITIS
 Seasonal – symptoms can occur in spring,
summer, and early fall.
 Perennial – symptoms can occurs year-round
and are generally caused by sensitivity to dust
mites, pet hair or, cockroaches or mold.
TYPES OF ASTHMA
Step 1: Mild intermittent asthma
- Symptoms may occur about 2 days a week or
less often.
- Severity: symptoms will not interfere with
regular activities.
- Inhaler use: a person will need to use a short-
acting beta agonist (SABA) inhaler to control
symptoms on 2 or fewer days each week.
When we say short-acting beta 2-agonists
(SABAs) quickly open your airways to stop
asthma symptoms. People sometimes refer to
SABAs as “reliever” or “rescue”
Step 2: Mild persistent asthma
- Symptoms may have a minor impact on
regular activities.
Step 3: Moderate
- Symptom frequency: symptoms will occur on
a daily basis.
- Severity: symptoms will limit regular activities
somewhat.
Step 4: Severe
- Symptom frequency: symptom will arise
throughout the day.
- Severity: symptoms will significantly limit
regular activities.
Alesandra Dawn H. Payot
BS Pharmacy 3rd year
Clinical Pharmacy 2

INVESTIGATIONS  Anticholinergics: Ipratropium bromide

For Allergic Rhinitis:
 Histamine test – confirm that a person has
had an anaphylactic reaction, blood pressure
drops suddenly and the airways narrow
blocking breathings.
 Nasal smear
 Skin tests
 Subcuticular test
For Asthma:
 History
 Physical examination
 Pulmonary function tests (PFT)
 Chest x-ray
 Allergy skin testing
 Blood level of eosinophils and lgE.
MANAGEMENT
Non-Drug Treatment:
 Environmental control measures (avoidance
of allergens)
Drug Treatment:
 Antihistamines cetirizine
- Antihistamines are most commonly used by
people who have allergic reactions to pollen
and other allergens. They are also used to
treat a variety of other conditions such as
stomach problems, colds, anxiety and more.
- Cetirizine via selective inhibition of peripheral
H1 receptors.
- People who should not take cetirizine HCL are
people who have glaucoma, increased
pressure in the eye, liver problems, decreased
kidney function and an inability to complete
empty the bladder.
 Nasal decongestants
- Oxymetazoline: it works by narrowing the
blood vessels in the nasal passages.
Contraindications include overactive thyroid
gland, diabetes, closed angle glaucoma, high
blood pressure.
nasal spray
- Ipratropium: is an acetylcholine antagonist
via blockade of muscarinic cholinergic
receptors, meaning increase airflow in
asthma.
- Anticholinergic drugs: these drugs can treat
a variety of conditions from overactive bladder
to chronic obstructive pulmonary disorder.
Contraindications include person with
hypersensivity.
 Corticosteroids: Beclomethasone
 Leukotriene receptor antagonists
- Montelukast: is a leukotriene receptor
antagonist used as part of an asthma therapy
regimen.
o Leukotriene receptor antagonists
help prevent breathing problem.
- Montelukast is contraindicated in patients with
a history of hypersensitivity to the drug or its
components. It helps stop airways from
narrowing (caused by inflammation). This
makes breathing easier and prevents asthma
attacks.
Non-Drug/Drug Treatment:
 Reassure the patient as anxiety worsens
respiratory distress.
 Keep the patient in an upright position
Drug Treatment:
 Nebulized with salbutamol for immediate
relief
 Hydrocortisone for all severe cases
- Hydrocortisone: a steroid (corticosteroid)
medicine. Reduces inflammation, reduce
mucus secretion and suppress the immune
system. It works by calming down body’s
immune response to reduce pain, itching and
swelling (inflammation).
- The most common side effects of
hydrocortisone tablets are dizziness,
headaches, swollen ankles and feeling weak
or tired.
 Antibiotic if there is evidence of infection
Alesandra Dawn H. Payot
BS Pharmacy 3rd year
Clinical Pharmacy 2

 Antihistamines – effectively block histamine

effects (runny nose and watery eyes)
CASE STUDY cetirizine or loratadine.
A 39-year-old Indian female residing in the United  Nasal decongestants – oxymetazoline
States (USA) suffering with Allergic Rhinitis took  Inj. Hydrocortisone 200 mg IV start routinely
online consultation. The patient complains of given to all severe cases than 6 hourly.
continuous sneezing, running nose, nasal irritation
Monitoring:
and blockage, watery eyes with irritation, palate
itching with sore throat and mild headache with Post  Changes in diet
Nasal Drip from past 3 consecutive years. The  Follow up check up
symptoms usually present seasonally during spring to  Minimize contact with offending allergens
fall, usually worsen from June-July. During wake-up
 Reduce dust mite exposure by encasing bed
time in the morning, there is continuous sneezing for
pillows and matress in allergen proof covering
1-2 hours which is suggestive of temperature change
 Take medication as prescribed.
intolerances. As per patient’s clinical history, she is
also having symptoms related to acute sinusitis and
allergic asthma with shortness of breath occasionally

Findings:

 Continuous sneezing
 Runny nose, nasal irritation and blockage
 Watery eyes with irritation
 Palate itching with sore throat and mild
headache

Assessment:

 Physical examination
 Allergy testing
 Sinus examination
 Skin-prick testing
 Blood level of eosinophils and lgE

Resolution:

Non-Pharmacologic

 Eating light and easily digestible food

 Frequent intake of small amounts of lukewarm
water
 Fresh curd in the mid-noon only with black
pepper

Pharmacologic