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Allergic
Rhinitis
By: Kristine Charisse V.Tanedo
BSN III MSU-IIT
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what is
Allergic Rhinitis? -Inflammation of mucous membranes of the
nose
-reactions in nasal mucosa from repeated
allergen exposure that causes hypersensitivity
-may be seasonal or perennial
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Causes:
InhaledInhaled Pollens
Grasses
Weeds
House dust Dust mite
Animal dander
Feathers
IngestedIngested Wheat
Eggs
Milk nuts
Seasonal
Perennial
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Seasonal Rhinitis
\ CommonCommon Allergens:Allergens: pollens
Symptoms:Symptoms:
Watery nasal drainage
Nasal congestion
Repetitive sneezing
Itchy eyes, ears, nose and throat
Nose rubbing
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Pathophysiology
-allergic reaction is an exaggerated orinappropriate immune reaction that causesdamage to host
-Type I immediate hypersensitivity reaction
-mediated by IgEIgE antibodiesantibodies which triggermast cells and basophils to releasepharmacogically active agents.
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How are symptoms caused?
ItchingItching and sneezingand sneezing irritation of free nerveendings
RhinorrheaRhinorrhea-increase mucus production
CongestionCongestion-vasodilation
OedemaOedema-increase vascular permeability
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Other Symptoms:
Weakness
Discomfort or uneasiness Irritability
Fatigue
Difficulty concentrating Decrease appetite
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Nursing Management:
Educate
Avoid exposure to allergens
Saline nasal sprays
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Anti-histamines
-prevent histamine from binding to H1
receptors
-control sneeze , itch and rinorrhea
-ineffective in relieving nasal blockage
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Anti-histamines
1st generation anti-histamines:
ChlorpheniramineChlorpheniramine
DiphenylhydramineDiphenylhydramine
2nd generation anti-histamines:
CetrizineCetrizine
AzelastineAzelastine
FexotenadineFexotenadine
LoratidineLoratidine
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Topical Nasal Corticosteroids-reduce mucosal inflammation and all nasal symptoms
-use with persistent rhinitis of the lowest effectivedose BudesonideBudesonide
Side-effects:
Immunosuppressant
Salt and water retention
Non-steroidal nasal sprays:
CromolynCromolyn ((nasalcromnasalcrom)) very safe
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Sinusitis
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Sinuses
FrontalFrontal-above eyes in forehead bone
MaxillaryMaxillary-cheek
SphenoidSphenoid-center skull, behind eyes and nose
EthmoidEthmoid-eyes and nose
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What is Sinusitis?
-follows after rhinitis
-may be viral or allergic
-result of abrupt pressure changes -inflammation of edema of mucous membranes
-provides opportunistic bacteria invasion
-inflammation produces mucoid drainage -postnasal drainage causes obstruction of nasal
passages and inflamed throat
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Etiology
70% is caused by bacteria:
StreptococcusStreptococcus pneumoniapneumonia
HaemophilusHaemophilus influenzainfluenza
MoraxellaMoraxella catarrhaliscatarrhalis
Others:
StaphylococcusStaphylococcus aureusaureus
StreptococcusStreptococcus pyogenespyogenes GramGram--negativenegative bacillibacilli
Respiratory virusesRespiratory viruses
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Predisposing factors:
-allergies, nasal deformities, cystic fibrosis,nasal polyps, HIV infection
-cold weather
-high pollen places
-exposure to smoke/smoking
-reinfection from siblings
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Clinical Manifestations:
-Maxillary and anterior ethmoidal sinuses
-Facial pain or pressure on affected area
-Nasal obstruction
-Fatigue-Purulent nasal discharge
-Fever, headache, ear pain
-Decrease sense of smell
-Sore throat-Early morning periorbital edema
-Cough that worsens in supine position
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Complications:
Meningitis (Brudzinskis, Kernigs)
Brain abscess
Ischemic brain infarction
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Diagnostic Tests:
Sinus radiographs
Ultrasonograms
CT Scan if unresponsive to 48 hours
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Medical Management:
Antibiotics:
AmoxicillineAmoxicilline
AmpicillineAmpicilline
ErythromycinErythromycin TM 2:TM 2: SeptraySeptray BactivaBactiva
2nd line:
CephalosporinCephalosporin cefuroximecefuroxime axetilaxetil ((CeftrinCeftrin))
AmoxicillinAmoxicillin clavulanateclavulanate ((augmentinaugmentin)
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NewerDrugs
Macrolides
ClarithromycinClarithromycin ((biaxinbiaxin))
AzithromycinAzithromycin ((ZithromaxZithromax))
Quinolones
LevofloxacinLevofloxacin ((LevaquinLevaquin))
LevofloxacinLevofloxacin ((LevaquinLevaquin)) Side effect:
Nephrotoxic
Hepatotoxic
2-3 liters water
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Nasal decongestants:
PseudophedrinePseudophedrine hydrochloride (hydrochloride (Sudafed)Sudafed)
Other:
Oral topical decongestants
Antihistamines BenadrylBenadryl
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Nursing Management:
Educate
Steam inhalation
Avoid: (during acute infection)
Swimming Diving
Air travel
Explain to patient fever, severe headache, nuchal rigidity, signs of
potential complications
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