PHRM 514 Allergic Rhinitis Fall '12 (2)

Accessed september 2009 diagnosis o thorough history

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Accessed September 2009.
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Diagnosis o Thorough history o Historical identification of causative allergens o Physical examination (typically more noticeable in children) n Allergic shiners n Transverse nasal crease n Adenoidal breathing n Pale, bluish, edematous nasal turbinates coated with thin, clear secretions n Tearing, periorbital swelling o Nasal scrapings o Allergy testing May JR, Smith PH. Allergic rhinitis. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:1649-1652.
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Allergy Testing o Percutaneous (aka skin tests) n Diluted allergen is pricked or scratched into the skin surface n Use a positive control (histamine) and negative control n 15 minutes after allergen application site is examined for positive reaction o Wheal-and-flare reaction n Reaction is evidence of the presence of mast cell bound IgE to the specific allergen tested o Intradermal n Small volume (0.01 to 0.05 mL) of diluted allergen is injected between the layers of the skin o Radioallergosorbent test (RAST) n Detect IgE antibodies in the blood that are specific for a specific allergen May JR, Smith PH. Allergic rhinitis. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:1649-1652.
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Wheal-and-flare Reaction o Interfering medications: n 1st generation antihistamines—stop 3 to 5 days before test n 2nd generation antihistamines—stop 10 days before test n Medications with antihistamine properties and H2 receptor antagonists— stop before test May JR, Smith PH. Allergic rhinitis. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:1649-1652. Wheal and flare responses. Clinical Molecular Allergy. http://www.clinicalmolecularallergy.com/content/4/1/1/figure/F2. Published 2006. Accessed October 10, 2011.
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Case o Chief complaint: “She seems to get the same cold every fall.” o HPI: Patient is a 4 year old female who presents to her pediatrician’s office. Her mother states that the patient has been sneezing, has a runny nose, and is constantly rubbing her nose upward. She has noticed that she has had these same symptoms the last three years at the beginning of fall.
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Case o PMH: Eczema o FH: Mom, age 30, CEO, with allergic rhinitis; Dad, age 32, movie star, with asthma; 1 pet dog o Allergies: NKDA o Medications: fexofenadine 30mg PO BID and hydrocortisone 0.25% lotion, thin film applied twice daily PRN eczema o Immunizations: up to date
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Which of the following is least likely to be a symptom consistent with a diagnosis of allergic rhinitis? 1. Nasal congestion 2. Pruritic eyes 3. Allergic conjunctivitis 4. Yellow rhinorrhea 5. Sneezing
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What are this patient’s predisposing risk factors for allergic rhinitis?
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Since this patient’s symptoms reoccur only during the fall, she is most likely allergic to… 1. Dogs 2. Tree pollen 3. Cats 4. Mold 5. Weed pollen
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On physical exam the patient is found to have venous pooling and dark circles under her eyes. What is this referred to as? 1. Allergic salute 2. Allergic black eyes 3. Allergic shiners 4. Allergic eyes 5. Allergic crease
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The doctor would like to do skin testing on the patient. How many days prior to the skin testing should the child stop receiving fexofenadine (2nd generation antihistamine)? 1. 1 to 2 days 2. 3 to 5 days 3. 6 to 8 days 4. 10 days 5. 14 days
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Questions o Email: [email protected] o Office hours: By appointment
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Accessed September 2009 Diagnosis o Thorough history o...

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