Rhinitis - Allergic (1 of 15)

Total Page:16

File Type:pdf, Size:1020Kb

Rhinitis - Allergic (1 of 15) Rhinitis - Allergic (1 of 15) 1 Patient presents w/ signs & symptoms of rhinitis 2 • Consider other classifi cations of rhinitis DIAGNOSIS No - Please see Rhinitis Is allergic rhinitis - Nonallergic disease confi rmed? management chart Yes 3 ASSESS DURATION & SEVERITY OF ALLERGIC RHINITIS A Non-pharmacological therapy • Allergen avoidance • Patient education VAS <5 VAS ≥5 B Pharmacological therapy B Pharmacological therapy • Antihistamines (oral/nasal), &/or • Corticosteroids (nasal), w/ or without • Corticosteroids (nasal), or • Antihistamines (nasal), or • Cromone (nasal), or • LTRA • Leukotriene receptor antagonists (LTRA)MIMS TREATMENT © See next page Specifi cally for patients w/ asthma Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS. B167 © MIMS Pediatrics 2020 Rhinitis - Allergic (2 of 15) Previously treated symptomatic Previously treated symptomatic patient (VAS <5) on antihistamines patient (VAS ≥5) on intensifi ed (oral/nasal) &/or corticosteroids (nasal) therapy w/ corticosteroids (nasal) w/ or without antihistamines (nasal) Intermittent Persistent symptoms, symptoms or without allergen w/ allergen exposure exposure B Pharmacological therapy B Pharmacological therapy • Step down or discontinue therapy • Continue or step up therapy Untreated REASSESS DISEASE SEVERITY VAS symptomatic patient DAILY UP TO DAY 3 (VAS <5 or ≥5) 4 CONTINUE Yes THERAPY & STEP EVALUATION VAS <5 DOWN THERAPY1 Improvement of symptoms? No VAS ≥5 B Pharmacological therapy • Step-up therapy REASSESS DISEASE SEVERITY MIMSVAS DAILY UP TO DAY 7 4 Yes EVALUATION VAS <5 Improvement of symptoms? No TREATMENT © VAS ≥5 See next page Continue therapy if symptomatic; consider step-down or discontinuation of therapy if symptoms subside Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS. B168 © MIMS Pediatrics 2020 Rhinitis - Allergic (3 of 15) PATIENTS W/ MODERATE TO SEVERE SYMPTOMS VAS ≥5 • Review diagnosis • Review compliance • Assess for infections or other causes RHINITIS - ALLERGIC Itch/sneeze major Rhinorrhea major Blockage major symptom symptom symptom B Pharmacological B Pharmacological B Pharmacological B Pharmacological therapy therapy therapy therapy • Add or increase • Add antihistamines • Add Ipratropium • Add decongestant corticosteroids (nasal) (nasal) or (nasal) short-term oral corticosteroid Improvement of symptoms? CONTINUE Yes THERAPY & C Immunotherapy No Improvement of Yes symptoms? STEP DOWN THERAPY1 No C Immunotherapy D Surgical therapy Continue therapy if symptomatic; consider step-downMIMS or discontinuation of therapy if symptoms subside. © Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS. B169 © MIMS Pediatrics 2020 Rhinitis - Allergic (4 of 15) 1 SIGNS & SYMPTOMS OF RHINITIS • Rhinitis: Infl ammation of the nasal lining membranes Major Signs & Symptoms • Nasal itching • Rhinorrhea • Nasal congestion, w/ or without obstruction • RHINITIS - ALLERGIC Sneezing Other Signs & Symptoms • Headache • Conjunctival symptoms, eye pruritus • Pruritus of the nose, palate, ears • Postnasal drainage • Impaired smell 2 DIAGNOSIS Allergic Rhinitis • IgE-mediated infl ammatory disease of the nasal mucous membrane occurring after exposure to allergens & trigger factors • Diagnosis relies primarily on the clinical history & physical exam • Most prevalent in childhood & adolescence • Careful elimination of nonallergic etiologies must be done in preschool children as allergic rhinitis is unusual in <3 years Clinical History • A family or personal history of allergic & related conditions - Asthma - Infantile eczema (atopic dermatitis) - Rhinitis, rhinosinusitis - Recurrent otitis media w/ or without eff usion • Investigate onset patterns of symptoms including triggers & seasonality, & relief w/ certain treatments • Social & environmental history - Exposure to allergens & trigger factors Physical Exam • Detect other diseases (eg asthma, atopic dermatitis, cystic fi brosis, otitis media or eustachian tube dysfunction) which may occur in relation w/ allergic rhinitis Nasal Exam • Can be carried out using a nasal speculum or by endoscopy - Endoscopy is done when symptoms persist despite treatment • May reveal the following: - Swollen nasal turbinates (note size & color) - Rhinorrhea w/ clear, cloudy or colored discharge - Viral infection, sinusitis is considered if colored discharge is noted • Patient should be referred to an ENT specialistMIMS if fi ndings are more consistent w/ a structural etiology than rhinitis (eg tumors, nasal polyps, septal deviation, etc) Other Physical Findings May Include: • Conjunctival injection & edema • Allergic shiners (dark circles under the eyes) • Morgan-Dennie lines (lower eyelid creases) • Periorbital edema • Allergic salute which gives rise to nasal crease • Dental malocclusion • Open-mouth breathing or allergic gape • Cobblestoning© (lymphoid hyperplasia) B170 © MIMS Pediatrics 2020 Rhinitis - Allergic (5 of 15) 2 DIAGNOSIS (CONT’D) Laboratory Studies Allergy Testing • Skin test: Used to diff erentiate allergic from nonallergic rhinitis & to identify the triggering agents • Allergen-specifi c IgE identifi cation corresponding to allergen exposure & symptomatic periods is confi rmatory of allergic rhinitis - Has high sensitivity & specifi city RHINITIS - ALLERGIC • Radioallergosorbent test (RAST) may also be used for the detection of allergen-specifi c IgE - Alternative for patients w/ extensive dermatitis or dermatographism, those at high-risk for anaphylaxis, patients taking drugs that may inhibit mast cell degranulation, & those who cannot tolerate skin test Nasal Smear • Eosinophils in the nasal smear usually indicate allergy; it may support the diagnosis of allergic rhinitis 3 ASSESSMENT • Stepwise treatment approach depends on severity, duration & frequency of allergic rhinitis Symptom Duration of Allergic Rhinitis is Classifi ed into the Following: Intermittent • Symptoms occur <4 days/week or symptoms last for <4 consecutive weeks/year Persistent • Symptoms occur >4 days/week & last for >4 consecutive weeks/year Symptom Severity of Allergic Rhinitis is Classifi ed into the Following: Moderate-Severe 1 or more of the following • Sleep disturbance • Problems w/ functioning at work or at school • Impairment of routine & leisure activities • Bothersome symptoms Mild • Normal sleep • Normal functioning at work & school • Normal conduct of routine & leisure activities • No bothersome symptoms Patterns of Exposure to Allergens: Seasonal • Dependent on a specifi c season Perennial • Year-round allergen exposure & usually present in everyday environment Episodic • Patient is exposed to allergens not normallyMIMS encountered in daily activities © Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS. B171 © MIMS Pediatrics 2020 Rhinitis - Allergic (6 of 15) 4 EVALUATION Evaluation of Disease Control • e following factors are considered when evaluating a patient’s response to treatment: - Symptom scores - Measures of nasal obstruction (eg peak nasal inspiratory fl ow, acoustic rhinometry, rhinomanometry) - Allergic Rhinitis & its Impact on Asthma (ARIA) severity classifi cation - Quality of Life (QOL) result - Itemized scoring - Symptom-medication scoring - VAS - A low VAS score w/ the establishment of treatment (<5) shows an amount of improvement, as indicated in Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) as well as in terms of work effi ciency, & treatment is usually maintained or continued - VAS score of <2 means well-controlled allergic rhinitis & treatment is usually stepped down - A high VAS score (≥5) shows no eff ect in symptom relief & treatment is usually stepped up MACVIA-ARIA Sentinel NetworK for Allergic Rhinitis (MASK-Rhinitis) • A clinical approach used to diagnose & classify patients based on disease severity, as well as a tool to evaluate symptom control after initiation of treatment strategies by using Information & Communications Technology (ICT) tools & a clinical decision support system (CDSS) based on ARIA guidelines • Electronic monitoring of allergic diseases include a cell phone-based VAS assessment (uses MASK aerobiology which is a simple IOS/Android app), Control of Allergic Rhinitis & Asthma Test (CARAT), an e-Allergy screening & the RhinAsthma Patient Perspective (RAPP) tool for smartphones A NON-PHARMACOLOGICAL THERAPY Patient Education • Provide general information about the disease & available treatments - Manage the patient’s & caregiver’s expectations from therapy & explain that a complete cure may not be possible • Provide educational materials as necessary • Educate both patient & caregiver about the proper use & timing of medications especially during times when allergen exposure is unavoidable - Possible side eff ects should also be advised - Concomitant medications should also be reviewed to determine if the patient is taking drugs that may cause oral or nasal dryness • Educate the caregiver & the patient, if possible, about the complications of allergic rhinitis (eg otitis media & chronic sinusitis) Allergen Avoidance • Identifi cation & avoidance of trigger allergens should be an integral part of allergic rhinitis management strategy • Removal of the allergen may result in diminished severity of the disease & decreased requirement for
Recommended publications
  • Modulation of Allergic Inflammation in the Nasal Mucosa of Allergic Rhinitis Sufferers with Topical Pharmaceutical Agents
    Modulation of Allergic Inflammation in the Nasal Mucosa of Allergic Rhinitis Sufferers With Topical Pharmaceutical Agents Author Watts, Annabelle M, Cripps, Allan W, West, Nicholas P, Cox, Amanda J Published 2019 Journal Title FRONTIERS IN PHARMACOLOGY Version Version of Record (VoR) DOI https://doi.org/10.3389/fphar.2019.00294 Copyright Statement © Frontiers in Pharmacology 2019. The attached file is reproduced here in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version. Downloaded from http://hdl.handle.net/10072/386246 Griffith Research Online https://research-repository.griffith.edu.au fphar-10-00294 March 27, 2019 Time: 17:52 # 1 REVIEW published: 29 March 2019 doi: 10.3389/fphar.2019.00294 Modulation of Allergic Inflammation in the Nasal Mucosa of Allergic Rhinitis Sufferers With Topical Pharmaceutical Agents Annabelle M. Watts1*, Allan W. Cripps2, Nicholas P. West1 and Amanda J. Cox1 1 Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, QLD, Australia, 2 Menzies Health Institute Queensland, School of Medicine, Griffith University, Southport, QLD, Australia Allergic rhinitis (AR) is a chronic upper respiratory disease estimated to affect between 10 and 40% of the worldwide population. The mechanisms underlying AR are highly complex and involve multiple immune cells, mediators, and cytokines. As such, the development of a single drug to treat allergic inflammation and/or symptoms is confounded by the complexity of the disease pathophysiology. Complete avoidance of allergens that trigger AR symptoms is not possible and without a cure, the available therapeutic options are typically focused on achieving symptomatic relief.
    [Show full text]
  • Nonpharmacological Treatment of Rhinoconjunctivitis and Rhinosinusitis
    Journal of Allergy Nonpharmacological Treatment of Rhinoconjunctivitis and Rhinosinusitis Guest Editors: Ralph Mösges, Carlos E. Baena-Cagnani, and Desiderio Passali Nonpharmacological Treatment of Rhinoconjunctivitis and Rhinosinusitis Journal of Allergy Nonpharmacological Treatment of Rhinoconjunctivitis and Rhinosinusitis Guest Editors: Ralph Mosges,¨ Carlos E. Baena-Cagnani, and Desiderio Passali Copyright © 2014 Hindawi Publishing Corporation. All rights reserved. This is a special issue published in “Journal of Allergy.” All articles are open access articles distributed under the Creative Commons At- tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Board William E. Berger, USA Alan P. Knutsen, USA Fabienne Ranc, France Kurt Blaser, Switzerland Marek L. Kowalski, Poland Anuradha Ray, USA Eugene R. Bleecker, USA Ting Fan Leung, Hong Kong Harald Renz, Germany JandeMonchy,TheNetherlands Clare M Lloyd, UK Nima Rezaei, Iran Frank Hoebers, The Netherlands Redwan Moqbel, Canada Robert P. Schleimer, USA StephenT.Holgate,UK Desiderio Passali, Italy Massimo Triggiani, Italy Sebastian L. Johnston, UK Stephen P. Peters, USA Hugo Van Bever, Singapore Young J. Juhn, USA David G. Proud, Canada Garry Walsh, United Kingdom Contents Nonpharmacological Treatment of Rhinoconjunctivitis and Rhinosinusitis,RalphMosges,¨ Carlos E. Baena-Cagnani, and Desiderio Passali Volume 2014, Article ID 416236, 2 pages Clinical Efficacy of a Spray Containing Hyaluronic Acid and Dexpanthenol after Surgery in the Nasal Cavity (Septoplasty, Simple Ethmoid Sinus Surgery, and Turbinate Surgery), Ina Gouteva, Kija Shah-Hosseini, and Peter Meiser Volume 2014, Article ID 635490, 10 pages The Effectiveness of Acupuncture Compared to Loratadine in Patients Allergic to House Dust ,Mites Bettina Hauswald, Christina Dill, Jurgen¨ Boxberger, Eberhard Kuhlisch, Thomas Zahnert, and Yury M.
    [Show full text]
  • (CD-P-PH/PHO) Report Classification/Justifica
    COMMITTEE OF EXPERTS ON THE CLASSIFICATION OF MEDICINES AS REGARDS THEIR SUPPLY (CD-P-PH/PHO) Report classification/justification of medicines belonging to the ATC group R01 (Nasal preparations) Table of Contents Page INTRODUCTION 5 DISCLAIMER 7 GLOSSARY OF TERMS USED IN THIS DOCUMENT 8 ACTIVE SUBSTANCES Cyclopentamine (ATC: R01AA02) 10 Ephedrine (ATC: R01AA03) 11 Phenylephrine (ATC: R01AA04) 14 Oxymetazoline (ATC: R01AA05) 16 Tetryzoline (ATC: R01AA06) 19 Xylometazoline (ATC: R01AA07) 20 Naphazoline (ATC: R01AA08) 23 Tramazoline (ATC: R01AA09) 26 Metizoline (ATC: R01AA10) 29 Tuaminoheptane (ATC: R01AA11) 30 Fenoxazoline (ATC: R01AA12) 31 Tymazoline (ATC: R01AA13) 32 Epinephrine (ATC: R01AA14) 33 Indanazoline (ATC: R01AA15) 34 Phenylephrine (ATC: R01AB01) 35 Naphazoline (ATC: R01AB02) 37 Tetryzoline (ATC: R01AB03) 39 Ephedrine (ATC: R01AB05) 40 Xylometazoline (ATC: R01AB06) 41 Oxymetazoline (ATC: R01AB07) 45 Tuaminoheptane (ATC: R01AB08) 46 Cromoglicic Acid (ATC: R01AC01) 49 2 Levocabastine (ATC: R01AC02) 51 Azelastine (ATC: R01AC03) 53 Antazoline (ATC: R01AC04) 56 Spaglumic Acid (ATC: R01AC05) 57 Thonzylamine (ATC: R01AC06) 58 Nedocromil (ATC: R01AC07) 59 Olopatadine (ATC: R01AC08) 60 Cromoglicic Acid, Combinations (ATC: R01AC51) 61 Beclometasone (ATC: R01AD01) 62 Prednisolone (ATC: R01AD02) 66 Dexamethasone (ATC: R01AD03) 67 Flunisolide (ATC: R01AD04) 68 Budesonide (ATC: R01AD05) 69 Betamethasone (ATC: R01AD06) 72 Tixocortol (ATC: R01AD07) 73 Fluticasone (ATC: R01AD08) 74 Mometasone (ATC: R01AD09) 78 Triamcinolone (ATC: R01AD11) 82
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2010/0221245 A1 Kunin (43) Pub
    US 2010O221245A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2010/0221245 A1 Kunin (43) Pub. Date: Sep. 2, 2010 (54) TOPICAL SKIN CARE COMPOSITION Publication Classification (51) Int. Cl. (76) Inventor: Audrey Kunin, Mission Hills, KS A 6LX 39/395 (2006.01) (US) A6II 3L/235 (2006.01) A638/16 (2006.01) Correspondence Address: (52) U.S. Cl. ......................... 424/133.1: 514/533: 514/12 HUSCH BLACKWELL SANDERS LLP (57) ABSTRACT 4801 Main Street, Suite 1000 - KANSAS CITY, MO 64112 (US) The present invention is directed to a topical skin care com position. The composition has the unique ability to treat acne without drying out the user's skin. In particular, the compo (21) Appl. No.: 12/395,251 sition includes a base, an antibacterial agent, at least one anti-inflammatory agent, and at least one antioxidant. The (22) Filed: Feb. 27, 2009 antibacterial agent may be benzoyl peroxide. US 2010/0221 245 A1 Sep. 2, 2010 TOPCAL SKIN CARE COMPOSITION stay of acne treatment since the 1950s. Skin irritation is the most common side effect of benzoyl peroxide and other anti BACKGROUND OF THE INVENTION biotic usage. Some treatments can be severe and can leave the 0001. The present invention generally relates to composi user's skin excessively dry. Excessive use of some acne prod tions and methods for producing topical skin care. Acne Vul ucts may cause redness, dryness of the face, and can actually garis, or acne, is a common skin disease that is prevalent in lead to more acne. Therefore, it would be beneficial to provide teenagers and young adults.
    [Show full text]
  • Prediction of Premature Termination Codon Suppressing Compounds for Treatment of Duchenne Muscular Dystrophy Using Machine Learning
    Prediction of Premature Termination Codon Suppressing Compounds for Treatment of Duchenne Muscular Dystrophy using Machine Learning Kate Wang et al. Supplemental Table S1. Drugs selected by Pharmacophore-based, ML-based and DL- based search in the FDA-approved drugs database Pharmacophore WEKA TF 1-Palmitoyl-2-oleoyl-sn-glycero-3- 5-O-phosphono-alpha-D- (phospho-rac-(1-glycerol)) ribofuranosyl diphosphate Acarbose Amikacin Acetylcarnitine Acetarsol Arbutamine Acetylcholine Adenosine Aldehydo-N-Acetyl-D- Benserazide Acyclovir Glucosamine Bisoprolol Adefovir dipivoxil Alendronic acid Brivudine Alfentanil Alginic acid Cefamandole Alitretinoin alpha-Arbutin Cefdinir Azithromycin Amikacin Cefixime Balsalazide Amiloride Cefonicid Bethanechol Arbutin Ceforanide Bicalutamide Ascorbic acid calcium salt Cefotetan Calcium glubionate Auranofin Ceftibuten Cangrelor Azacitidine Ceftolozane Capecitabine Benserazide Cerivastatin Carbamoylcholine Besifloxacin Chlortetracycline Carisoprodol beta-L-fructofuranose Cilastatin Chlorobutanol Bictegravir Citicoline Cidofovir Bismuth subgallate Cladribine Clodronic acid Bleomycin Clarithromycin Colistimethate Bortezomib Clindamycin Cyclandelate Bromotheophylline Clofarabine Dexpanthenol Calcium threonate Cromoglicic acid Edoxudine Capecitabine Demeclocycline Elbasvir Capreomycin Diaminopropanol tetraacetic acid Erdosteine Carbidopa Diazolidinylurea Ethchlorvynol Carbocisteine Dibekacin Ethinamate Carboplatin Dinoprostone Famotidine Cefotetan Dipyridamole Fidaxomicin Chlormerodrin Doripenem Flavin adenine dinucleotide
    [Show full text]
  • Prohibited Substances List
    Prohibited Substances List This is the Equine Prohibited Substances List that was voted in at the FEI General Assembly in November 2009 alongside the new Equine Anti-Doping and Controlled Medication Regulations(EADCMR). Neither the List nor the EADCM Regulations are in current usage. Both come into effect on 1 January 2010. The current list of FEI prohibited substances remains in effect until 31 December 2009 and can be found at Annex II Vet Regs (11th edition) Changes in this List : Shaded row means that either removed or allowed at certain limits only SUBSTANCE ACTIVITY Banned Substances 1 Acebutolol Beta blocker 2 Acefylline Bronchodilator 3 Acemetacin NSAID 4 Acenocoumarol Anticoagulant 5 Acetanilid Analgesic/anti-pyretic 6 Acetohexamide Pancreatic stimulant 7 Acetominophen (Paracetamol) Analgesic/anti-pyretic 8 Acetophenazine Antipsychotic 9 Acetylmorphine Narcotic 10 Adinazolam Anxiolytic 11 Adiphenine Anti-spasmodic 12 Adrafinil Stimulant 13 Adrenaline Stimulant 14 Adrenochrome Haemostatic 15 Alclofenac NSAID 16 Alcuronium Muscle relaxant 17 Aldosterone Hormone 18 Alfentanil Narcotic 19 Allopurinol Xanthine oxidase inhibitor (anti-hyperuricaemia) 20 Almotriptan 5 HT agonist (anti-migraine) 21 Alphadolone acetate Neurosteriod 22 Alphaprodine Opiod analgesic 23 Alpidem Anxiolytic 24 Alprazolam Anxiolytic 25 Alprenolol Beta blocker 26 Althesin IV anaesthetic 27 Althiazide Diuretic 28 Altrenogest (in males and gelidngs) Oestrus suppression 29 Alverine Antispasmodic 30 Amantadine Dopaminergic 31 Ambenonium Cholinesterase inhibition 32 Ambucetamide Antispasmodic 33 Amethocaine Local anaesthetic 34 Amfepramone Stimulant 35 Amfetaminil Stimulant 36 Amidephrine Vasoconstrictor 37 Amiloride Diuretic 1 Prohibited Substances List This is the Equine Prohibited Substances List that was voted in at the FEI General Assembly in November 2009 alongside the new Equine Anti-Doping and Controlled Medication Regulations(EADCMR).
    [Show full text]
  • 7-Nose II.Docx ( Updated F1 )
    1 [Color index: Important | Notes | Extra] Editing ​ ​ ​ ​ ​ ​ ​ ​ 2 Diseases of the nose Supernumerary nostril Midline nasal sinus: Nasal clefts: Proboscis lateralis: Incomplete fusion of the right Failure of frontal nasal Due to imperfect fusion and left medial nasal process to develop between the maxillary process prominence. appropriately results into and the lateral nasal process. two separated halves of the nose. Polyrrhinia: Arrhinia: due to bilateral Half nose: due to unilateral absence of nasal placode ​ ​ Duplication of the medial nasal absence of nasal placodes. processes. This is serious because the newborn is a nose breather. mouth breathing is a learning process. Atresia of posterior nares ❖ Types: ● Bony (most commonly) ● Membranous ● Mixed ● Complete unilateral (most commonly) ● Complete bilateral surgical emergency ​ ● Incomplete unilateral ● Incomplete bilateral ❖ Diagnosis: ● Total absence of nasal air flow ● Plastic catheter cannot be passed through the nose ● Post-rhinoscopy ● Radiographs 3 ● Emergency ● Transnasal perforation ● Trans-palatal excision ❖ Management: ﻧﻔﺘﺢ ﻓﻤﻪ ﻓﯿﻀﻄﺮ ﯾﺘﻨﻔﺲ ﻣﻦ ﻓﻤﻪ (Put something to open the mouth (oral airway ● ● Perforate it If membranous ● Surgery (endoscopic) ● In bilateral it is an emergency, in unilateral it is not an emergency and we can wait until the child gains weight then we do surgery. ● Rhinitis refers to inflammatory changes in the nasal mucosa. As the nasal mucosa is continuous ​ ​ ​ ​ ​ ​ over the nose and sinuses, there is nearly always some inflammatory change in the sinuses as 1 well. Hence Rhinosinusitis is​ a better term. ● Types: - acute rhinitis (less than 4 weeks) - chronic rhinitis (more than four consecutive weeks) ● Types based on etiology: 1) Infectious rhinitis(viral/bacterial) 2)Non-allergic Rhinitis,Non-infectious rhinitis -Eosinophilic syndromes(Nares/Nasal polyposis) -NonEosinophilic syndromes(Vasomotor rhinitis/Rhinitis medicamentosa/occupational rhinitis/Rhinitis of pregnancy/hypothyroidism/Medication(OCP).
    [Show full text]
  • For Peer Review Only
    BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-012177 on 30 November 2016. Downloaded from Commonly prescribed drugs associated with cognition: a cross-sectional study in UK Biobank ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2016-012177 Article Type: Research Date Submitted by the Author: 06-Apr-2016 Complete List of Authors: Nevado-Holgado, Alejo; University of Oxford, Psychiatry Kim, Chi-Hun; University of Oxford, Psychiatry Winchester, Laura; University of Oxford, Psychiatry Gallacher, John; University of Oxford, Psychiatry Lovestone, Simon; University of Oxford, Psychiatry <b>Primary Subject Public health Heading</b>: Secondary Subject Heading: Mental health, Pharmacology and therapeutics, Neurology Keywords: PUBLIC HEALTH, MENTAL HEALTH, Cognition, UK biobank http://bmjopen.bmj.com/ on September 26, 2021 by guest. Protected copyright. For peer review only − http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 16 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-012177 on 30 November 2016. Downloaded from 1 2 3 Commonly prescribed drugs associate with cognition: a cross-sectional study 4 in UK Biobank 5 6 7 8 Authors 9 10 Alejo J Nevado-Holgado*, Chi-Hun Kim*, Laura Winchester, John Gallacher, Simon Lovestone 11 12 13 14 15 Address For peer review only 16 17 Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK 18 19 20 21 22 23 Authors’ names and positions 24 25 Alejo J Nevado-Holgado*: Postdoctoral researcher 26 27 Chi-Hun Kim*: Postdoctoral researcher 28 29 Laura Winchester: Postdoctoral researcher 30 31 John Gallacher: Professor 32 33 Simon Lovestone: Professor 34 http://bmjopen.bmj.com/ 35 *These authors contributed equally to this work.
    [Show full text]
  • Supplementary Information
    1 SUPPLEMENTARY INFORMATION 2 ATIQ – further information 3 The Asthma Treatment Intrusiveness Questionnaire (ATIQ) scale was adapted from a scale originally 4 developed by Professor Horne to assess patients’ perceptions of the intrusiveness of antiretroviral 5 therapies (HAART; the HAART intrusiveness scale).1 This scale assesses convenience and the degree 6 to which the regimen is perceived by the patient to interfere with daily living, social life, etc. The 7 HAART intrusiveness scale has been applied to study differential effects of once- vs. twice-daily 8 antiretroviral regimens2 and might be usefully applied to identify patients who are most likely to 9 benefit from once-daily treatments. 10 11 References: 12 1. Newell, A., Mendes da Costa, S. & Horne, R. Assessing the psychological and therapy-related 13 barriers to optimal adherence: an observational study. Presented at the Sixth International 14 congress on Drug Therapy in HIV Infection, Glasgow, UK (2002). 15 2. Cooper, V., Horne, R., Gellaitry, G., Vrijens, B., Lange, A. C., Fisher, M. et al. The impact of once- 16 nightly versus twice-daily dosing and baseline beliefs about HAART on adherence to efavirenz- 17 based HAART over 48 weeks: the NOCTE study. J Acquir Immune Defic Syndr 53, 369–377 18 (2010). 19 1 20 Supplementary Table S1. Asthma medications, reported by participants at the time of survey Asthma medication n (%) Salbutamol 406 (40.2) Beclometasone 212 (21.0) Salmeterol plus fluticasone 209 (20.7) Salbutamol plus ipratropium 169 (16.7) Formoterol plus budesonide 166
    [Show full text]
  • Metered Dose Inhalers Contents
    COMMISSION OF THE EUROPEAN COMMUNITIES Brussels, 23.10.1998 COM( 1998) 603 final COMMUNICATION FROM THE COMMISSION TO THE COUNCIL AND THE EUROPEAN PARLIAMENT STRATEGY FOR THE PHASEOU-T OF CFCs IN METERED DOSE INHALERS CONTENTS Chapter 1 Introduction Page 3 Chapter2 Executive Summary Page4 Chapter 3 CFCs and MDis Page 6 Chapter4 Patient Needs Page 9 Chapter 5 Developing Alternatives to CFC-containing MD Is Page 13 Chapter 6 Approval of new products and post-authorisation surveillance Page 18 Chapter 7 Phasing out CFCs Page 25 Chapter 8 Awareness raising Page 34 Chapter 9 Exports of MD Is from the EC Page 38 Chapter 10 CFC production Issues Page 40 Chapter 11 The Essential Use Process -Overview and Timetable Page 43 2 CHAPTER 1 INTRODUCTION 1.1 Decision IX/19 of the Parties to the Montreal Protocol reqmres Parties requesting essential use nominations for chlorofluorocarbons CFCs for metered-dose inhalers (MDis) to present to the Ozone Secretariat an initial national or regional transition strategy if possible by 31 January 1998, and in any case by 31 January 1999. The European Community is a Party to the Montreal Proklc.'t>l, and this document is its transition strategy prepared in accordance with decision IX/19 of the Parties. The European Community believes that a transition strategy is necessary to set out how the transition out of CFCs in MD Is is to be managed such that the CFCs can be phased out as quickly as possible without putting in jeopardy supplies of necessary medicines to patients in need. 1.2 The European Community, on behalf of the Member States, submits a joint request every year to the Parties for the continued use of CFCs to.manufacture MDis.
    [Show full text]
  • Rhinitis (415) 833-3780
    Department of Allergy, Asthma & Immunology Kaiser Permanente San Francisco 1635 Divisadero Street, Suite 101 San Francisco, California 94115 RHINITIS (415) 833-3780 RHINITIS Nasal congestion, runny nose, sneezing, itching, post nasal drip, and sometimes headache are signs of a sensitive and inflamed nose or rhinitis. Rhinitis affects more than 40 million people in the United States. Rhinitis can be allergic or non-allergic. Allergy testing will help differentiate between allergic and non-allergic rhinitis. In addition, allergic rhinitis and non-allergic rhinitis can be present in the same person. ALLERGIC RHINITIS Allergic rhinitis is caused by allergens such as pollens, dust mite, animal dander or mold. Seasonal allergies caused by airborne pollens occur during spring, summer and fall. In contrast, allergies that can occur at any time of the year are caused by indoor allergens such as house dust mite, animals and mold. Eye symptoms, such as itching, tearing, red eye as well as asthma may be present with allergic rhinitis. Testing can be helpful in identifying both seasonal and non-seasonal allergens. For further help on controlling your allergies, please refer to the brochure, Controlling Your Airborne Allergies. Management of Allergic Rhinitis 1. Avoid allergens when possible. 2. Medical Management. The first line of medical therapy is nasal inhaled steroids. Oral medications like antihistamines and decongestants and can be helpful. If you want to use decongestants, you need to discuss their use with your provider. Other medications may be considered by your provider as well. 3. Allergy immunotherapy (shots) may be an option for some patients. NON-ALLERGIC RHINITIS If it isn’t an allergy, what is it? If it isn’t an allergy, most likely it is a condition that mimics allergic rhinitis, known as vasomotor rhinitis.
    [Show full text]
  • Patent Application Publication ( 10 ) Pub . No . : US 2019 / 0192440 A1
    US 20190192440A1 (19 ) United States (12 ) Patent Application Publication ( 10) Pub . No. : US 2019 /0192440 A1 LI (43 ) Pub . Date : Jun . 27 , 2019 ( 54 ) ORAL DRUG DOSAGE FORM COMPRISING Publication Classification DRUG IN THE FORM OF NANOPARTICLES (51 ) Int . CI. A61K 9 / 20 (2006 .01 ) ( 71 ) Applicant: Triastek , Inc. , Nanjing ( CN ) A61K 9 /00 ( 2006 . 01) A61K 31/ 192 ( 2006 .01 ) (72 ) Inventor : Xiaoling LI , Dublin , CA (US ) A61K 9 / 24 ( 2006 .01 ) ( 52 ) U . S . CI. ( 21 ) Appl. No. : 16 /289 ,499 CPC . .. .. A61K 9 /2031 (2013 . 01 ) ; A61K 9 /0065 ( 22 ) Filed : Feb . 28 , 2019 (2013 .01 ) ; A61K 9 / 209 ( 2013 .01 ) ; A61K 9 /2027 ( 2013 .01 ) ; A61K 31/ 192 ( 2013. 01 ) ; Related U . S . Application Data A61K 9 /2072 ( 2013 .01 ) (63 ) Continuation of application No. 16 /028 ,305 , filed on Jul. 5 , 2018 , now Pat . No . 10 , 258 ,575 , which is a (57 ) ABSTRACT continuation of application No . 15 / 173 ,596 , filed on The present disclosure provides a stable solid pharmaceuti Jun . 3 , 2016 . cal dosage form for oral administration . The dosage form (60 ) Provisional application No . 62 /313 ,092 , filed on Mar. includes a substrate that forms at least one compartment and 24 , 2016 , provisional application No . 62 / 296 , 087 , a drug content loaded into the compartment. The dosage filed on Feb . 17 , 2016 , provisional application No . form is so designed that the active pharmaceutical ingredient 62 / 170, 645 , filed on Jun . 3 , 2015 . of the drug content is released in a controlled manner. Patent Application Publication Jun . 27 , 2019 Sheet 1 of 20 US 2019 /0192440 A1 FIG .
    [Show full text]