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Allergic Disorders
Anne-Marie Irani, MDVirginia Commonwealth University
Immediate and Late Reactions in IgE-mediated Hypersensitivity
Adapted from Hadley JA. Med Clin North Am. 1999;83(1):13-25.Dykewicz MS, et al. Ann Allergy Asthma Immunol. 1998;81:478-518.Squillance SP. Otolaryngol Head Neck Surg. 1992;107:831-834.Urval KR. Primary Care. 1998;25:649-662.Adapted from American Academy of Allergy, Asthma, and Immunology. The Allergy Report. Vol 1. Milwaukee, Wis: 2000.
– = provides no benefit+/– = provides little or minimal benefit+ = provides modest benefit++ = provides substantial benefitAmerican Academy of Allergy, Asthma, and Immunology. The Allergy Report. Vol 1. Milwaukee, Wis: 2000. 22
Intranasal Corticosteroids in Allergic Rhinitis: An Overview
• Require careful patient instruction to ensure proper use
• May cause nasal dryness, irritation, and/or bleeding
• Reports of nasal septal perforation and limited suppression of bone growth
• Most effective medication class for controlling symptoms of allergic rhinitis
• Relieve sneezing, rhinorrhea, and mucosal edema leading to nasal congestion
• Associated with minimal side effects
DrawbacksBenefits
Physicians should routinely monitor the growth of children taking nasal corticosteroids and weigh the benefits of corticosteroid therapy against the possibility of effects on growth velocity.
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Total Systemic Exposure
LiverLiver
Post First-Pass Metabolism
GI Tract Absorption
NASAL CORTICOSTEROIDNasal Absorption
Excretion
Adapted from Pedersen S, et al. Allergy. 1997;52(suppl 39):1-34. 24
First and Second generation H1 Histamine Receptor Antagonists
• Minimal effect on rhinorrhea
• Higher costs
• Reduce itching, sneezing, rhinorrhea
• Some effect on nasal congestion
• Non-sedating• Minimal
anticholinergicactivity
• Once daily dose
Second Second GenerationGeneration
• Have little effect on nasal congestion
• Can cause sedation• Anticholinergic activity• Short duration of action
• Reduce itching, sneezing, rhinorrhea
• Lower costs
First First GenerationGeneration
DrawbacksBenefits
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Immunotherapy for Allergic Rhinitis: An Overview
• Must be administered in facilities equipped to handle adverse reactions (urticaria, laryngeal edema, bronchospasm, and anaphylaxis)
• Requires high level of patient compliance
• Especially effective for grass pollen, ragweed pollen, and house-dust mites
• Improvement of childhood allergies in children
• May prevent progression of rhinitis to asthma
• May reduce need for symptomatic pharmacotherapy
DrawbacksBenefits
Report of BSACI Working Party. Clin Exp Allergy. 1993;23(suppl 3):1-44.Canonica GW, et al. Allergy. 1998;53(suppl 41):7-31. Report of BSACI Working Party. Clin Exp Allergy. 1993;23(suppl 3):1-44.Canonica GW, et al. Allergy. 1998;53(suppl 41):7-31. 26
• physician supervised• open, single blind, double-blind, placebo-
controlled
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Treatment
• Skin hydration & moisturizers• Avoidance of irritants• Avoidance of allergens• Topical corticosteroids• Topical calcineurin inhibitors
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Incidence of different types of atopy. AD peaks in the first years of life and declines after that time. Asthma and allergic rhinitis increase over time as sensitization develops.