Non-Allergic Rhinitis

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NON- Contact Us Phone: (843) 863-1188 Fax: (843) 863-8286 ALLERGIC Website: www.lowcountryent.com RHINITIS _______________________________________________ OVERVIEW: Low Country ENT Non-Allergic Rhinitis EAR, NOSE & THROAT · HEAD & NECK involves chronic SURGERY · HEARING AIDS · BALANCE TESTING· ALLERGY TESTING & sneezing or having a IMMUNOTHERAPY congested, drippy nose with no apparent cause. This disease is Both annoying and inconvenient. LOW COUNTRY ENT 2580 Tricom St. N. Charleston, SC 29406 The most common symptoms of taking over-the-counter or prescription nonallergic rhinitis are: medications. • Stuffy nose Triggers of persistent non- • Runny nose allergic rhinitis • Sneezing • Postnasal drip • Irritation of the nose by smoke, strong smells, fumes, chemicals, • Unlike the allergic form, nonallergic changes in temperature or humidity. rhinitis rarely causes itchy nose, eyes Hormonal changes during pregnancy or throat. • and puberty, which can sometimes cause nose symptoms. Diagnosis and Treatment • Food and drink – mainly hot, spicy It is important to have an accurate diagnosis food, or alcohol. Sensitivity to so you can manage your condition certain food coloring or appropriately. Because the symptoms are so preservatives may be a cause. similar. • Emotion such as stress or sexual arousal can sometimes affect the • Your doctor can diagnose non-allergic nose. rhinitis after ruling out other causes of your symptoms. • If you have symptoms of non-allergic Nonallergic rhinitis (vasomotor rhinitis, your doctor will first perform tests to see if an allergy or other health problem rhinitis) is a condition that causes chronic is causing your rhinitis. To determine if you sneezing, congestion, or runny nose. While have an allergy, your doctor may order a these symptoms are like those of allergic skin test to identify allergies you have, or a rhinitis(hay fever), nonallergic rhinitis is blood test. • Your doctor may also order tests to see if different because, unlike an allergy, it doesn’t you have any sinus problems that may be involve the immune system. An allergic reaction causing your rhinitis. Tests may include a occurs when the immune system overreacts to nasal endoscope to look inside your nose an otherwise harmless substance known as an or a CT scan of your sinuses. allergen. • If your doctor can’t find any underlying cause for your rhinitis, they’ll make a diagnosis of vasomotor rhinitis (non- Symptoms allergic rhinitis) Airborne pollutants or odors, certain foods or • Nonallergic rhinitis cannot be cured, beverages, some medications, changes in the but many people find weather or underlying chronic health problems • relief by avoiding triggers, using can all trigger symptoms of nonallergic rhinitis. a saline rinse solution or by These symptoms can come and go, or be constant. .

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Khan CV 9-4-20
CURRICULUM VITAE DAVID A. KHAN, MD University of Texas Southwestern Medical Center 5323 Harry Hines Boulevard Dallas, TX 75390-8859 (214) 648-5659 (work) (214) 648-9102 (fax) [email protected] EDUCATION 1980 -1984 University of Illinois, Champaign IL; B.S. in Chemistry, Magna Cum Laude 1984 -1988 University of Illinois School of Medicine, Chicago IL; M.D. 1988 -1991 Good Samaritan Medical Center, Phoenix AZ; Internal Medicine internship & residency 1991-1994 Mayo Clinic, Rochester MN; Allergy & Immunology fellowship PROFESSIONAL EXPERIENCE 1994 -2001 Assistant Professor of Internal Medicine, UT Southwestern 1997 -1998 Co-Director, Allergy & Immunology Training Program 1998 - Director, Allergy & Immunology Training Program 2002- 2008 Associate Professor of Internal Medicine, UT Southwestern 2008-present Professor of Medicine, UT Southwestern AWARDS/HONORS 1993 Allen & Hanburys Respiratory Institute Allergy Fellowship Award 1993 Von Pirquet Award 2001 Outstanding Teacher 2000-2001 UTSW Class of 2003 2004 Outstanding Teacher 2003-2004 UTSW Class of 2006 2005 Outstanding Teacher 2004-2005 UTSW Class of 2007 2006 Daniel Goodman Lectureship, ACAAI meeting 2007 Most Entertaining Teacher 2006-2007 UTSW Class of 2009 2008 Stanislaus Jaros Lectureship, ACAAI meeting 2009 Outstanding Teacher 2007-2008 UTSW Class of 2010 2011 John L. McGovern Lectureship, ACAAI meeting 2012 I. Leonard Bernstein Lecture, ACAAI meeting 2014 Distinguished Fellow, ACAAI meeting 2015 Elliot F. Ellis Memorial Lectureship, AAAAI meeting 2015 Bernard Berman Lectureship,
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NUR 6325 Family Primary Care I Fall Semester 2021 Course Information
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Respiratory Drug Guidelines ______
Respiratory Drug Guidelines ______________________________________________ First Edition 2008 Ministry of Health Government of Fiji Islands 2008 "This document has been produced with the financial assistance of the European Community and World Health Organization. The views expressed herein are those of the Fiji National Medicine & Therapeutics Committee and can therefore in no way be taken to reflect the official opinion of the European Community and the World Health Organization.” Disclaimer The authors do not warrant the accuracy of the information contained in these guidelines and do not take responsibility for any deaths, loss, damage or injury caused by using the information contained herein. Every effort had been made to ensure the information contained in these guidelines is accurate and in accordance with current evidence-based clinical practice. However, if the evidence in the medical literature is either limited or not available, the recommendations in these guidelines are based on the consensus of the members of the subcommittee. In view of the dynamic nature of medicine, users of these guidelines are advised that independent pr ofessional judgment should be exercised at all times. ii Preface The publication of the Respiratory Drug Guidelines represents the culmination of the efforts of the National Medicines and Therapeutics Committee to publish clinical drug guidelines for common diseases seen in Fiji. These guidelines are targeted for health care settings. It sets the gold standards for the use of respiratory drugs in Fiji. These guidelines have taken into account the drugs available in the Fiji Essential Medicines List (EML) in recommending treatment approaches. All recommended drug therapies are either evidence-based or universally accepted standards.
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Respiratory Guidelines
RESPIRATORY GUIDELINES Medicines Used in Respiratory Diseases Introduction This chapter contains brief summaries of the major drugs used in the management of respiratory disease and are recommended in these guidelines. The summaries do not contain comprehensive accounts of the pharmacology of these compounds. The reader is advised to consult standard textbooks and/or the industry product information for more details. It is important to consider the risks and benefits of drugs (particularly corticosteroids) that are used to treat respiratory diseases. As a general principle, the lowest drug doses that achieve best control should be used. For example: Patient adherence to asthma treatment is better if regimens have: fewer devices and drugs fewer adverse effects been understood and agreed between patient and health care professional. Beta2 receptor stimulating drugs (Beta2 agonists) Introduction Stimulation of beta2-receptors on airway smooth muscle relaxes the muscle resulting in bronchodilation. All beta2 agonists may also stimulate beta1-receptors; however, the effects of beta1-receptor stimulation (eg tachycardia) are more likely to occur following systemic absorption or following inhalation of relatively large doses. Under almost all circumstances, the preferred route of administration for beta2 agonists is by inhalation. Administration by inhalation causes bronchodilation with low doses thus minimising systemic adverse effects. Adverse effects: Dose-limiting adverse effects of the beta2 agonists are most commonly tachycardia (which can also lead to paroxysmal tachyarrhythmias, such as atrial fibrillation or paroxysmal supraventricular tachycardia), tremor, headaches, muscle cramps, insomnia, and a feeling of anxiety and nervousness. In high doses (eg tablets,intravenous and emergency nebulisation) all beta2 agonists can cause hypokalaemia and hyperglycaemia.
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YMAI10627 Proof 1..27
All abstracts are strictly embargoed until the date of presentation at the 2014 Annual Meeting. J ALLERGY CLIN IMMUNOL Abstracts AB1 VOLUME 133, NUMBER 2 A Rare Presentation Of Surfactant Deficiency In a Term Neonate Therapeutic Equivalence Of Budesonide/Formoterol (BUD/FM) 1 Dr. Nisha N. Shah, MD1, Dr. Heena Shah, MD2, Dr. Kenneth Paris, 3 Breath-Actuated Inhaler (BAI) Compared With Bud/FM Pressurized MD, MPH3; 1LSU Health Sciences Center New Orleans, New Orleans, Metered-Dose Inhaler (pMDI) In Adults and Adolescents With LA, 2Louisiana State University, New Orleans, LA, 3LSU Health Sciences Moderate To Severe Asthma Center, New Orleans, New Orleans, LA. Kevin R. Murphy, MD1, Rajiv Dhand, MD2, Frank Trudo, MD3,Tom RATIONALE: It is important to consider non infectious, and non allergic Uryniak, MS3, Ajay Aggarwal, MD3; 1Boys Town National Research causes of chronic pulmonary inﬂammation in a term neonate. We describe Hospital, Boys Town, NE, 2Department of Medicine, University of a rare case of surfactant deﬁciency in a term neonate. Tennessee Graduate School of Medicine, 3AstraZeneca LP. METHODS: Surfactant protein C gene sequencing done at Johns Hopkins RATIONALE: To assess the therapeutic equivalence of BUD/FM DNA laboratory. 160/4.5mg delivered by BAI versus BUD/FM delivered by pMDI. RESULTS: A 5 week old full term female with a history of failure to METHODS: Adults and adolescents >_12 years of age with asthma and >_3 thrive, formula intolerance, intermittent tachypnea, hypoxia, and leuko- months daily use of inhaled corticosteroids were randomized to receive either cytosis presented to our hospital. The patient was born full term via BUD/FM BAI 2x160/4.5mg bid, BUD/FM pMDI 2x160/4.5mgbid,orBUD Cesarean section without complication.
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Vasomotor Rhinitis)
Nonallergic Rhinitis (Vasomotor Rhinitis) If it isn’t an allergy, what is it? Nasal congestion, runny nose, postnasal drip, and sinus headache are signs of a sensitive and infamed nose (rhinitis . These symptoms for both conditions are very similar. However, the substances that cause them, and the way we test for and treat the two conditions are very different. When an immune reaction in the nose is causing the symptoms, the condition is called allergic rhinitis, and the offending substance is called an allergen. Common allergens include pollen, animal dander, and dust mites. Itching is usually one of the most bothersome symptoms of allergic rhinitis. When a nerve ending reaction in the nose is causing the symptoms, the condition is called nonallergic rhinitis vasomotor rhinitis). In this case, the offending substance is called an irritant. Common irritants include smoke, perfumes, weather changes, and any strong chemical fumes or odors. (Even the aroma from certain fowers and trees can act as irritants. Nasal congestion, sinus headache, and postnasal drip are usually the most bothersome symptoms of nonallergic rhinitis (vasomotor rhinitis . Why don’t the tests show reactions? Allergy tests only detect immune reactions (by skin test or blood test . Because there is no immune reaction involved in nonallergic rhinitis (vasomotor rhinitis , tests can’t identify the troublesome irritants. People usually know the obvious irritants well from personal experience! How does a person develop this condition? We don’t know. Allergic rhinitis tends to run in families and typically starts in childhood or adolescence. Nonallergic rhinitis (vasomotor rhinitis doesn’t usually run in families and can start at any age.
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REVIEW Rhinitis: The Osteopathic Modular Approach Shan Shan Wu, DO; Kelsey Graven, DO; Michelle Sergi, OMS IV; Robert Hostoffer, DO From the Department of Historically, osteopathic principles have focused on the appropriate drainage Pulmonary and Critical Care of cranial structures to relieve symptoms of rhinitis, which include nasal con- Medicine at University Hospitals-Cleveland Medical gestion, anterior/posterior rhinorrhea, sneezing, and itching. Allergic rhinitis is Center in Ohio (Drs Wu and primarily an aberrant immunologic reaction caused by cytokines secreted from Hostoffer); the University Hospitals-St John Medical lymphocytes that traverse the lymphatic pathway throughout the body. Several Center in Westlake, Ohio studies have documented that, when manipulated, the lymphatic system (Dr Graven); the Ohio enhanced the motion of these lymphocytes to important immune structures in University Heritage College of Osteopathic Medicine in both human and animal models. Additionally, modulation of both sympathetic Cleveland (Student Doctor and parasympathetic outﬂow has been found either to inhibit or enhance secre- Sergi and Dr Hostoffer); the tion and/or drainage of important allergic sites. Osteopathic approaches to Lake Erie College of Osteopathic Medicine in Erie, rhinitis play an effective role in the comprehensive management of rhinitis, and Pennsylvania (Dr Hostoffer); techniques based on these approaches are therapeutic options for rhinitis. and the Allergy/Immunology This article provides an up-to-date literature review about the management Associates, Inc, in Mayﬁeld Heights, Ohio (Dr Hostoffer). of rhinitis using the 5 models of osteopathic medicine: biomechanical, respira- Financial Disclosures: tory-circulatory, metabolic, neurologic, and behavioral. None reported. J Am Osteopath Assoc. 2020;120(5):351-358 doi:10.7556/jaoa.2020.054 Support: None reported.
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Phenotypes and Endotypes of Rhinitis and Their Impact on Management: a PRACTALL Report N
Allergy POSITION PAPER Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report N. G. Papadopoulos1,2, J. A. Bernstein3, P. Demoly4, M. Dykewicz5, W. Fokkens6, P. W. Hellings7, A. T. Peters8, C. Rondon9, A. Togias10 & L. S. Cox11 1Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK; 2Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece; 3Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA; 4Allergy Department, University Hospital of Montpellier, Montpellier, France; 5Section of Allergy and Clinical Immunology, Saint Louis University School of Medicine, Saint Louis, MO, USA; 6Otorhinolaryngology Department, Academic Medical Centre, Amsterdam, The Netherlands; 7Otorhinolaryngology Department, University Hospitals Leuven, Leuven, Belgium; 8Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 9Servicio de Alergologia, Hospital Carlos Haya, Malaga, Spain; 10National Institute of Allergy and Infectious Diseases, National institute of Health, Bethesda, WA; 11Nova Southeastern University, Davie, FL, USA To cite this article: Papadopoulos NG, Bernstein JA, Demoly P, Dykewicz M, Fokkens W, Hellings PW, Peters AT, Rondon C, Togias A, Cox LS. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy 2015; 70: 474–494. Keywords Abstract classiﬁcation; endotypes; phenotypes; rhini- Rhinitis is
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Nonallergic Rhinitis Causes of Rhinitis Three Major Evaluation and Treatment Allergic Types of Rhinitis Charity C
Overlap in Common Nonallergic Rhinitis Causes of Rhinitis Three major Evaluation and Treatment Allergic types of Rhinitis Charity C. Fox, M.D. chronic rhinitis Clinical Assistant Professor Allergy and Immunology Non Allergic Infection Department of Internal Medicine Rhinitis (Sinusitis) The Ohio State University Medical Center Nonallergic Rhinitis Nonallergic Rhinitis • A Diagnosis of Exclusion • Little prevalence data for nonallergic • Candidates have rhinitis syndromes 9 Negative allergy skin tests or RAST tests • 52% of patients seen in an allergy clinic were found to have nonallergic rhinitis 9 No infectious process • No definitive diagnostic test • Female>male in a few studies looking at epidemiology • Diagnosis based primarily on clinical features and associated conditions Mullarkey et al J Allergy Clin Immunol 65: 122, 1980. Sibbald et all. Thorax 6:895, 1991. 1 Overlap in Non-Infectious Mechanistic Classification of Rhinitis Causes of Rhinitis Inflammatory Non Inflammatory Pure Allergic (Leukocytes) (No Leukocytes) Allergic 43% Eosinophil Neutrophil Mixed Epithelial Neural Hormonal Structural Mixed Rhinitis Dysplasia 34% Allergy Bacterial Viral Atrophic Nociceptive Thyroid Tumors Combined Sinusitis NARES Para Nonallergic Vasculitis Sjogrens Pregnancy Non Ciliary sympathetic 57% CESS Allergic Dysfunction Anatomic/ Polyps Oxidants Sympathetic Rhinitis Immune Glandular Trauma Deficiency Sinusitis Mucosal Olfactory Pure NSAID Dentogenic disruption Nonallergic Sensitivity 23% Allergic Foreign Occupational Meltzer et al. J Allergy Fungal
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Journal of Clinical Medicine Review Review of Rhinitis: Classification, Types, Pathophysiology Georgia A. Liva, Alexander D. Karatzanis and Emmamuel P. Prokopakis * Department of Otorhinolaryngology, Medical School, University of Crete, 71500 Heraklion, Crete, Greece; [email protected] (G.A.L.); [email protected] (A.D.K.) * Correspondence: [email protected] Abstract: Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dys- function of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with considerable morbidity and financial burden on health care systems worldwide. Its economic impact is further emphasized by the fact that it represents a risk factor for other conditions such as sinusitis, asthma, learning disabilities, behavioral changes, and psychological impairment. Rhinitis may be associated with many etiologic triggers such as infections, immediate-type allergic responses, inhaled irritants, medications, hormonal disturbances, and neural system dysfunction. It is basically classi- fied into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). However, this subdivision may be considered as an oversimplification because a combined (mixed) phenotype exists in many individuals and different endotypes of rhinitis subgroups are overlapping. Due to the variety of pathophysiologic mechanisms (endotypes) and clinical symptoms (phenotypes), it is difficult to develop clear guidelines for diagnosis and treatment. This study aims to review the types of allergic and non-allergic rhinitis, providing a thorough analysis of the pathophysiological background, diagnostic approach, and main treatment options. Citation: Liva, G.A.; Karatzanis, Keywords: rhinitis; review; allergic; non-allergic; occupational; gustatory; idiopathic; atrophic A.D.; Prokopakis, E.P.
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1 1 Rhinitis 2020: A Practice Parameter Update 2 3 Authors: Dykewicz MS, Wallace DV, Amrol D, Baroody F, Bernstein J, Craig T, Dinakar C, Ellis A, Finegold I, Golden 4 DBK, Greenhawt M, Hagan J, Horner C, Khan DA, Lang D, Larenas-Linnemann D, Lieberman J, Meltzer E, 5 Oppenheimer J, Rank M, Shaker M, Shaw J, Steven G, Stukus D, Wang J 6 7 Chief Editor(s): Dykewicz MS and Wallace DV 8 Workgroup Contributors: Dykewicz MS, Wallace DV, Amrol D, Baroody F, Bernstein J, Craig T, Finegold I, Hagan J, 9 Larenas-Linnemann D, Meltzer E, Shaw J, Steven G 10 Joint Task Force on Practice Parameters Reviewers: Wallace DV, Golden DBK, Bernstein JA, Dinakar C, Ellis A, 11 Greenhawt M, Horner C, Khan DA, Lang D, Lieberman J, Oppenheimer J, Rank M, Shaker M, Stukus D, Wang J 12 13 Reprints: Joint Task Force on Practice Parameters (JTFPP) liaison: Peris Flagg (American Academy of Allergy, 14 Asthma, and Immunology, 555 E. Wells Street, Suite 1100, Milwaukee, WI 53202, [email protected]); 15 [email protected] 16 17 Previously published practice parameters and guidelines of the JTFPP are available at 18 http://www.allergyparameters.org.; http://www.AAAAI.org, and http://www.ACAAI.org. 19 20 Resolving conflict of interest: 21 The Joint Task Force on Practice Parameters (JTFPP) is committed to ensuring that all guidelines are based on the 22 best scientific evidence at the time of publication, and that such evidence is free of commercial bias to the greatest 23 extent possible. Before confirming the selection of the work group chairperson and members, the JTFPP discusses 24 and resolves all relevant potential conflicts of interest (COI) of each workgroup member.
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