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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Describe two different systems for categorizing allergic rhinitis (AR).

  2. Describe the basic pathophysiology of AR.

  3. List the four most typical symptoms of AR and identify the usual single most troublesome one.

  4. List at least three of the reasons for referral to an allergy specialist.

  5. Discuss the categories of pharmacotherapy choices for treatment of AR.

  6. Rank the pharmacotherapy choices for efficacy in treating the usual single most troublesome symptom of AR.

  7. Describe an approach for treatment of mild AR with over-the-counter (OTC) drugs.

  8. Create a therapy plan for treatment of moderate–severe AR.

  9. Describe how to monitor patients treated for AR.

  10. Identify the differences in approach to the treatment of AR for children, pregnant women, and the elderly compared with the routine approach in adults.

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KEY CONCEPTS

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  • Image not available. Allergic rhinitis (AR) is an allergen-induced and immunoglobulin E (IgE)-mediated inflammatory condition of the lining of the nose and upper respiratory tract.

  • Image not available. AR can be categorized in different ways.

  • Image not available. AR is a common disorder that can negatively impact quality of life to a significant degree, yet it has been trivialized in the past.

  • Image not available. The goals of treatment of AR are to reduce or minimize the frequency and severity of symptoms, prevent comorbid disorders and complications, improve the patient's quality of life, improve work attendance and productivity and/or school attendance and performance, and minimize adverse effects of therapy.

  • Image not available. The general approach for treatment of AR is fourfold: avoidance of allergen triggers, pharmacotherapy, immunotherapy, and patient/family education.

  • Image not available. Routine first-line agents for the treatment of AR are intranasal corticosteroids and oral and/or intranasal antihistamines. Adjunctive or secondary choice agents, each of which may have a first-line role in selected patients, include decongestants, cromolyn, montelukast, ipratropium, and intranasal saline irrigation.

  • Image not available. Intranasal corticosteroids are the most effective therapy for AR, especially for nasal congestion. They are first-line agents for severe manifestations and are also used for those with moderate disease not controlled with oral and/or intranasal antihistamines. Their anti-inflammatory mechanism of action probably contributes to this superiority.

  • Image not available. Second-generation antihistamines are first-line agents, especially for mild or intermittent AR. They are preferred over first-generation antihistamines because of their improved side-effect profile. Although effective for most symptoms of AR, they are less effective than intranasal corticosteroids for nasal congestion. Intranasal administration of an antihistamine is more effective than oral administration for nasal congestion.

  • Image not available. The best applications of decongestants in AR are in short-term use to overcome severe nasal congestion and to facilitate improved efficacy of intranasal agents. The intranasal administration of decongestants should usually not exceed 3 consecutive days.

  • Image not available. Generally speaking, the treatment of AR in children is the same as it is for adults, except for limitations in terms of FDA-approved products for some age groups and route of administration issues with some products.

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INTRODUCTION

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Rhinitis is inflammation of the lining of the nose and ...

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