Allergic Rhinitis

(Hay Fever, Seasonal Allergic Rhinitis)

Prepared by: Nicarose Mela U. Gerona

Atopic Disorders
It is caused by hereditary predisposition that causes or leads to hypersensitivity reactions. e.g. Asthma, allergic rhinitis, etc.

Background
A most common respiratory allergy Mediated by an immediate (type 1 hypersensitivity) immunologic reaction. Symptoms are similar to viral rhinitis Caused by an allergic specific IgEmediated immunologic response Induced by airborne pollens or molds

Occurence
Early spring Early summer Early fall *each attack begins and ends at the same time of the year. The airborne mold spores require a warm, damp weather to live.

Clinical Manifestations
Sneezing Nasal Congestion: Clear, Watery nasal discharge Nasal itching Itching of the throat and soft palate Excessive Tearing and eye irritation

Dry cough or hoarseness Headache Pain in Paranasal sinuses Epistaxis Fatigue Loss of Sleep Poor concentration

Assessment and Diagnostics

Diagnosis is based on History and Physical Examination Nasal Smears Peripheral blood counts Total serum IgE Epicutaneous and intradermal testing Food elimination

 RAST (radioallergosorbent test) Nasal Provocation

Medical Management
Avoidance Therapy: Remove allergens (eg. Carpet) Pharmacologic Therapy Antihistamines (eg. Claritin) Adrenergic Agents Mast Cell Stabilizers (NasalCrom)

Corticosteroids (eg. Rhinocort) Leukotriene Modifiers (eg. Accolate, Zyflo) Immunotherapy Allergen desensitization Allergy Vaccine therapy

Nursing Interventions
Health Teaching: Improving Breathing Pattern Allergy Control

Atopic Dermatitis
(Eczema)

Background
Type 1 immediate hypersensitivity disorder. Characterized by hyperreactivity and inflammation of the skin. It includes both allergic and nonallergic disorders.

Clinical Manifestations
Pruritus and hyperirritability of the skin Excessive dryness Redness (due to itching) Maculopapulr lesions contain exudates secondary to trauma May be accompanied by manifestations of asthma, hay fever or dermatitis

Medical Management
Decreasing itching through wearing cotton fabrics. Avoiding animals, dust and perfume sprays. Using a mild detergent Topical Moisturizers Topical Corticosteroids Use of Immunosuppressive agents (Neoral, Sandimmune)

 Antihistamines Antibiotics *There is actually no TRUE CURE. Treatment is mostly palliative.

Nursing Management
Key strategy is to minimize allergen exposure and physical stimuli. Maintain skin hydration by bathing in lukewarm water. Use gentle soaps Applying lubricants (Petroleum) Avoid scratching Trim fingernails

Dermatitis Medicamentosa
(Drug Reactions)

Background
Type 1 Hypersensitivity disorder Skin rash associated with medications. Can be systemic or generalized in symptoms

Clinical Manifestations
To be particularly vivid in color Characteristics of rash are more intense

Medical and Nursing Mgt.

STOP the drug Physician will order a new drug that will work for client Monitor vital signs Avoid scratching of skin

Urticaria and Angioneurotic Edema

(Hives)

Background (Urticaria) Also known as hives Type 1 hypersensitive allergic reactions

Clinical Manifestations
Pink edematous elevations (hives) varying in centimeters Pruritus causing local discomfort Hive remains up to several hours and dries up. If it continues to more than 6 weeks it is then called chronic urticaria.

Background (Angioneurotic Edema)

It involves the deep layers of the skin resulting in a more diffuse swelling.

Clinical Manifestations
Reddish hue on site Skin does not pit when pressured unlike other edema The eyelids, lips, cheeks, genitalia, hands, hands, tongue, feet, mucous membranes of the larynx and GI canal may be affected.

 Swellings may appear suddenly, or slowly in 1 to 2 hours. Often preceded by burning and itching sensations Lesions may last up to 24- 36 hours

Medical & Nursing Mgt

Antihistamines Doxepin (TCA) Corticosteroids (short-term only) Dont use: ACE inhibitors Penicillin Precaution: NSAIDs, aspirin Dont wear tight clothing and dont rub skin.