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Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Much like asthma, allergic rhinitis that is present prior to pregnancy may remain stable, worsen, or improve (64). Skin testing to identify an allergen is avoided during pregnancy given the possibility of a severe systemic allergic response during testing. Intranasal cromolyn sodium is safe and efficacious, and unlike in non-allergic rhinitis of pregnancy, intranasal glucocorticoids are effective and considered safe (65). Antihistamines are generally less effective and the intranasal formulations should be avoided. Second-generation antihistamines such as loratadine and cetirizine are the formulations of choice if more than topical therapy is needed. Decongestants have the added benefit of having vasoconstrictive properties, but because of this effect, they should be avoided in the first trimester. Nasal oxymetolazone, as in nonpregnant patients, should be used only for a short duration of 2 to 3 days to avoid rebound symptoms. If necessary, pseudoephedrine can be used after the first trimester and if there is no maternal hypertension (65,66). Allergen immunotherapy is often successful in controlling symptoms of allergy—both rhinitis and asthma. While it is not recommended to start immunotherapy during pregnancy, for fear of systemic allergic reaction, patients who are tolerating a stable dose and who are benefiting from the therapy prior to pregnancy should continue their injections throughout pregnancy (67).
Ear, Nose and Throat
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
This is a rigid nasal endoscope/sinuscope used for nasal rhinoscopy (Figure 6.4). It is a rigid, fibre-optic tube which is connected to a light source where the practitioner can visualise structures directly. It can also be connected to a screen where the practitioner can capture and record images. It is inserted into the nostril to examine the nasal cavity through to the nasopharynx. Before insertion, a topical anaesthetic is used to numb the area and prevent sneezing. Nasal decongestants are usually given to reduce any nasal membrane swelling to ease passage of the endoscope. It is usually done as an outpatient procedure.
The Pharmacotherapy of Rhinitis and Asthma
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Amanda Grippen Goddard, Harold S. Nelson, Rohit Katial, Flavia Hoyte
Oral alpha-adrenergic agonists relieve nasal congestion by vasoconstriction of the capacitance vessels in the nasal mucosa. They are most often used in a fixed combination with an antihistamine to reduce symptoms of nasal congestion. In 429 patients with seasonal allergic rhinitis, symptom reduction was 14% with loratadine alone and 21% with the addition of pseudoephedrine to the loratadine (Kaiser et al. 1998). Oral decongestants can cause side effects such as insomnia, irritability and palpitations but they do not cause rhinitis medicamentosa and hence are acceptable for long-term use. Blood pressure should be monitored when they are used in patients with hypertension, and they should be used with caution in patients with arrhythmias, coronary artery disease, glaucoma and bladder neck obstruction (Bousquet et al. 2008, Wallace and Dykewicz 2008).
Brimonidine tartrate ophthalmic solution 0.025% for redness relief: an overview of safety and efficacy
Published in Expert Review of Clinical Pharmacology, 2022
Clinical trials using 0.025% brimonidine tartrate have proven the drug to be relatively safe with little systemic and ocular adverse events. The few adverse events identified included pain upon instillation, irritation, and pruritus, all of which were described to be mild to moderate in severity. However, many of the adverse events of concern, especially those that have limited wider uses of previous generations of vasoconstrictors, such as allergic reaction and tachyphylaxis, are known to occur with a long-term continuous use. The 4-week regimen of the 3 trials introduced in this review may not have been sufficiently long enough to identify all possible side effects. Furthermore, although the drug level was negligible in plasma samples of those topically applying the ophthalmic solution, we cannot entirely rule out the possibility of systemic adverse events. Theoretically, the drug might be able to cross immature or damaged blood–brain barrier such as those with previous history of head trauma, cerebral hemorrhage, or intracranial operations in considerable quantities. The vasoconstrictor may act on vessels systemically to aggravate preexisting vascular conditions such as the Raynaud phenomenon or cerebral aneurysm. Surveys of decongestant users have reported side effects such as headache, chest pain, and palpitations. Long-term studies and market surveys are necessary to confirm that brimonidine does not suffer from the same limitations of its predecessors.
Subcutaneous immunotherapy takes more than the time in the clinic
Published in Current Medical Research and Opinion, 2021
Mike Tankersley, Tonya Winders, Mark Aagren, Henrik Brandi, Mikkel Hasse Pedersen, Anne Sofie Ledgaard Loftager, Mette Bøgelund
The respondents’ demographics and disease-specific characteristics are shown in Table 1 and Table 2, respectively. The mean age of the adult respondents was 42 years; 68% were male, and the median EQ-5D score was 0.77. The mean age of the caregivers was 38 years, and 59% were male. The mean age of the children was 11 years, and 73% were male. The median household income category was $75,000 to $99,999 for both adults and caregivers. Of both the adults and children, 65% had an asthma diagnosis in addition to their allergy. The median EQ-5D scores for the adults with asthma and without asthma were 0.74 and 0.82, respectively. The majority of both the adults and the children used oral antihistamines, decongestants, nasal sprays and drops, and eye drops. Of the respondents using oral antihistamines, 68% of the adults and 59% of the children took the medication every day. More than three-quarters of both the adults and the children were polyallergic.
“I’m Going to Scope You”—The Balance between Examiner Visualization and Patient Comfort
Published in Journal of Investigative Surgery, 2021
Christina M. Parducci, Jason E. Cohn
The use of topical agents during upper airway visualization has been called into question over the years as numerous studies suggest that their use is not efficacious and may actually contribute to patient discomfort2 .When comparing routinely used topical agents, it has been found that there is little difference in their effectiveness and the side effects of lidocaine make it less appealing when assessing patient comfort [3]. Alternative methods such as visual distractions have shown to be significantly more pleasant for patients than lidocaine4 .However, other studies suggest that lidocaine is effective at decreasing patient discomfort and can be used to avoid general anesthesia [5]. From a physician’s perspective, the use of anesthetic has proven advantageous in both ease and quality of examination when compared to a placebo6 .Different maneuvers used by more experienced physicians can also allow for increased visualization that may otherwise not be attained7 .Topical decongestants may be used in combination with other methods to maximize the efficiency of upper airway procedures and patient comfort. For example, the use of xylometazoline and oxymetazoline has shown to produce less patient discomfort and a subsequent shorter duration of examination [8], especially when combined with a topical anesthetic [9].