Pediatric emergency medicine trisk 1689 1689
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (70.43 KB, 1 trang )
10 mg tab
10 mg po daily
Age ≥15 yrs
bid, twice a day; tid, three times a day; po, by mouth.
Goals of Treatment
Emergency management of allergic rhinitis includes acute symptomatic relief
symptoms both nasal (obstruction, secretions) and ophthalmic (irritation, pruritus,
tearing). Outpatient primary care and/or allergy follow-up is warranted in most
cases.
Clinical Considerations
Clinical Recognition
The classic symptoms of allergic rhinitis include nasal congestion, paroxysmal
sneezing, and ocular pruritus. Other complaints include noisy breathing, snoring,
repeated throat clearing or cough, itching of the palate and throat, “popping” of
the ears, and ocular complaints such as redness, itching, and tearing.
The physical examination is variable but may reveal the “gaping” look of a
mouth breather, dark discoloration of skin on the infraorbital ridge caused by
venous congestion (allergic shiners), and a transverse external nasal wrinkle
secondary to chronic rubbing of the nose (allergic salute). There may be
cobblestoning in the posterior oropharynx and palpebral conjunctiva, rhinorrhea
(clear, mucoid, or opaque), and edematous nasal mucosal which may appear pale
or violaceous.
Management
Although there is a paucity of high-quality evidence regarding the pharmacologic
management of children with allergic rhinitis, the mainstay of therapy includes
identifying and avoiding environmental allergens, symptomatic treatment (oral
antihistamines, nasal steroids, and decongestants), and immunotherapy.
Recognizing that long-term therapy must be individualized, emergency
providers should limit interventions to those that provide safe and rapid
symptomatic relief, while emphasizing the importance of establishing outpatient
follow-up with primary care providers and/or allergists. Special attention should
be made to ensure patients with concomitant asthma are appropriately managed
as data from adult studies suggest that effectively treating allergic rhinitis reduces
health care utilization related to bronchospasm.
Topical corticosteroids are considered first-line therapy for chronic allergic
rhinitis but may require as long as 2 weeks to achieve maximal relief. Rapid relief
can generally be achieved by using second-generation (nonsedating)
