From the case study, symptoms such as nasal stuffiness and congestion, sneezing, and rhinorrhea indicate allergic rhinitis. The 35-year-old lady who visited the primary care office complaining of deteriorating nose symptoms and recurring sinus infections is the subject of this paper’s discussion of the clinical findings and pathophysiology of the condition. This paper will offer suggestions for evidence-based treatments for allergic rhinitis using the Clinical Practice Guideline (CPG) for managing the condition.
Pathophysiology and Clinical Findings of the Disease
1) Hypersensitivity Reaction
Type I hypersensitivity, sometimes referred to as immediate hypersensitivity, is the ideal type of hypersensitivity reaction linked to allergic rhinitis. Immunoglobulin E (IgE) antibodies are released during this reaction as a result of encounters with allergens, including dust mites, pollen, or pet dander.
Scholarly research supports the pathophysiology of Type I hypersensitivity. According to Wiersinga and van der Poll (2022), Type I hypersensitivity happens when a person who has become sensitive to a particular allergen comes into contact with it again. IgE antibodies associated with allergens are created by B cells and attach to basophilic and mast cell Fc RIs, which are high-affinity IgE receptors. Another set of exposures to the allergen causes the bound IgE antibodies to cross-link, which results in mast cell and basophil degranulation. Prostaglandins, leukotrienes, and histamine are among the inflammatory mediators released during this degranulation and are linked to the clinical symptoms of allergic rhinitis (Wiesinga and van der Poll, 2022).
2) Subjective Case Findings
In this case, the subjective findings that point to allergic rhinitis include the patient’s history of chronic nasal congestion that got worse with time. Another indicator of this possibility is recurrent sinus infections. In addition, the fact that rhinorrhea got better on a Caribbean cruise kept getting worse when the patient returned home. Thus, these three inferred conclusions from the case are paramount in understanding the patient’s disease progression and reaction to potential stimuli.
3) Objective Case Findings
The first objective finding portrayed by the patient in this case study is the swelling and redness of the eyelids. Besides, erythema and swelling of the conjunctiva, inflamed snares, and an allergic crease (a lateral wrinkle on the nose) add to this list. Furthermore, they collectively support the patient’s diagnosis of allergic rhinitis.
Disease Management
Strongly Recommended Medication Classes
1) Intranasal corticosteroids such as Fluticasone (Flonase)
Intranasal corticosteroids reduce inflammation in the nasal mucosa by suppressing the generation of pro-inflammatory cytokines and other mediators, which is their mechanism of action. Sneezing, rhinorrhea, and nasal congestion are reduced as a result. Intranasal corticosteroids have been highly recommended by the Clinical Practice Guidelines (CPG) as a first-line treatment for allergic rhinitis. According to studies, intranasal corticosteroids effectively improve quality of life, lessen nasal symptoms, and have a good safety profile (Wallace et al., 2017).
2) Second-Generation Antihistamines such as loratadine (Claritin).
Second-generation antihistamines work by blocking specific histamine H1 receptors, which lessens the effects of the histamine generated during an allergic reaction. They reduce symptoms, including sneezing, itching, and rhinorrhea, without making you feel particularly sleepy. The CPG advises strongly against the use of first-generation antihistamines for the treatment of allergic rhinitis. These drugs are more suitable for daily usage since they effectively treat allergy symptoms without having the sedative side effects of first-generation antihistamines (Oliver & Hogan, 2020).
Treatment Options Not Recommended:
1) Oral Decongestants
Due to probable adverse effects such as elevated heart rate, hypertension, and CNS stimulation, oral decongestants such as pseudoephedrine are not strongly advised. With continued use, they may also cause rebound congestion. Due to its link to negative cardiovascular effects and the possibility of tolerance development with continued use, oral decongestants have been discouraged in the treatment of allergic rhinitis (Oliver & Hogan, 2020)
2) First-Generation Antihistamines
Due to their sedative effects, first-generation antihistamines like diphenhydramine (Benadryl) are not advised since they may impair daily functioning and produce sleepiness (Oliver & Hogan, 2020).
Conclusion
Allergic rhinitis is a Type I hypersensitivity reaction that causes sneezing, rhinorrhea, and nasal congestion. Intranasal corticosteroids and second-generation antihistamines are highly advised drugs for the proper treatment of the condition. Due to their potential negative effects, oral decongestants and first-generation antihistamines are not advised. The patient’s symptoms can be adequately managed, enhancing her overall quality of life.
References
Oliver, E. T., & Hogan, M. B. (2020). Eliminating Low-Value Medical Care in Chronic Spontaneous Urticaria. 8(7), 2370–2371. https://doi.org/10.1016/j.jaip.2020.04.065
Wiersinga, W. J., & van der Poll, T. (2022). Immunopathophysiology of human sepsis. EBioMedicine, 86, 104363. https://doi.org/10.1016/j.ebiom.2022.104363
Wallace, D. V., Dykewicz, M. S., Bernstein, D. I., Blessing-Moore, J., Cox, L., Khan, D. A., … & Lang, D. M. (2017). The diagnosis and management of rhinitis: an updated practice parameter. Journal of Allergy and Clinical Immunology, 140(4), e1-e31.
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