#447 Rhinitis and Environmental Allergies with Dr. Olajumoke Fadugba
Jul 8, 2024
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Expert allergist Dr. Olajumoke Fadugba discusses distinguishing between allergic and non-allergic rhinitis, allergy skin testing, pathophysiology of allergies, allergy immunotherapy, chronic sinusitis, sinus rinses, and climate change impact on allergies.
Differentiating between allergic and non-allergic rhinitis is crucial for tailored treatment plans.
Proper selection of antihistamines involves considering potency, sedation potential, and individual response.
Climate change can impact sinus symptoms and allergies, potentially necessitating increased allergy shots and surgical interventions.
Deep dives
Key Point 1: Managing Allergic Rhinitis
For patients like Clara experiencing seasonal allergies, initial treatment often involves a combination of nasal corticosteroids and second-generation antihistamines to manage symptoms effectively. Nasal corticosteroids, such as fluticasone, mometasone, or triamcinolone, are commonly recommended as first-line therapy due to their efficacy in reducing inflammation in the nasal passages. Additionally, prescribing a second-generation antihistamine like loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra), or levocetirizine (Xyzal) helps alleviate symptoms like nasal congestion, sneezing, and itching. Proper use of nasal sprays is crucial, emphasizing preventive usage rather than symptom relief post-onset.
Key Point 2: Understanding Non-Allergic Rhinitis and Treatment Options
Non-allergic rhinitis, including conditions like vasomotor rhinitis, can account for a significant proportion of rhinitis cases, especially in the adult population. Vasomotor rhinitis, often triggered by factors like temperature changes, strong odors, or humidity fluctuations, presents with symptoms like nasal congestion and post-nasal drip but lacks the characteristic itching and sneezing seen in allergic rhinitis. Treatment strategies for non-allergic rhinitis may differ from allergic rhinitis and typically involve addressing symptoms with nasal corticosteroids tailored to the patient's preferences and tolerances.
Key Point 3: Selecting and Administering Antihistamines
Choosing the appropriate antihistamine for allergic rhinitis involves considering factors like potency, sedation potential, and individual response. While second-generation antihistamines like fexofenadine are often preferred for their lower sedative effects, patient variability in response necessitates flexibility in medication selection. Patients may benefit from doubling up antihistamine doses, such as taking two tablets at night, to enhance symptom control during peak allergy seasons. Educating patients on proper antihistamine use and potential sedative effects ensures effective management of allergic symptoms.
Antihistamine Options for Allergic and Non-Allergic Rhinitis
When treating allergic rhinitis, options include intranasal corticosteroids, second-generation antihistamines, and topical antihistamines like azelastine, which now has an over-the-counter version. Patients may benefit from a combination of nasal corticosteroids and nasal antihistamines. For non-allergic rhinitis, therapies like intranasal mast cell stabilizers can be used and are effective in specific situations.
Considerations for Allergy Shots and Sinus Surgery
In cases where allergic rhinitis or sinus symptoms do not improve with medication, allergy shots can desensitize patients to allergens. Allergy immunotherapy involves subcutaneous injections over several years. Sinus surgery may be considered for chronic sinusitis or structural issues like nasal polyposis. Climate change may impact sinus symptoms and allergic conditions, leading to an increase in allergy shots and surgical interventions.
Learn from expert allergist Dr. Olajumoke Fadugba about rhinitis and environmental allergies. You’ll review how to distinguish between allergic and non-allergic rhinitis, and how to decode the drugstore allergy aisle for your patients!
Writer, Show Notes, Infographic, and Cover Art: Leah Witt, MD
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
Reviewer: Sai S Achi, MD MBA
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Olajumoke Fadugba MD
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