Page 66 - Demo

64 CPD ACTIVITY FROM PAGE 63 • Nuts. • Seafood. A concise history can determine the cause of urticaria. However, the cause is idiopathic (unknown) in about 50 per cent of cases. Physicians with specialist knowledge of allergy testing can perform skin prick and serum immune testing in chronic cases or when concerning symptoms are present.21 Like in AR, urticaria is mediated by immunoglobulin IgE, which causes degranulation of mast cells and release of inflammatory mediators such as histamine, leukotrienes and prostaglandins. This causes vasodilation and leakage of serum into and below the skin. Longer lasting effects are caused by other pro- inflammatory mediators.21 Urticaria treatment Treatment for symptoms of chronic spontaneous urticaria involves a stepwise approach. Initial treatment with OTC antihistamines is first line. Prescription medicines including oral corticosteroids and immunomodulators are used for more severe or chronic cases.21,22 Less sedating antihistamines (eg, loratadine, desloratadine, fexofenadine and cetirizine) are used at standard doses initially for both acute and chronic urticaria. The standard dose should be continued if symptoms are controlled. The dose can be increased up to four times in chronic urticaria if response to the standard dose is inadequate after a two- to four-week trial.21 The four times standard dose is recommended for children by the ASCIA guideline for chronic spontaneous urticaria. However, safety and efficacy of higher doses have not been confirmed in children.22 The Therapeutic Guidelines indicates that children over 12 years and adults may benefit from a second dose in the late afternoon to prevent flare in the early evening.23 The more sedating antihistamines can cause adverse reactions, including sedation, which may not be desirable, particularly for chronic urticaria, which requires long term management. However, the Therapeutic Guidelines recommends a night-time dose of a more sedating antihistamine for adults and children over two years, if sleep is disturbed due to urticaria.23 Regular daily versus on-demand antihistamine has not been shown to influence the natural history of chronic urticaria. However, it may result in improved quality of life.24 Triggers for acute urticaria can be identified and avoided. Medicines such as NSAIDs and opioids, and alcohol can exacerbate chronic urticaria. However elimination diets have not been shown to be efficacious in chronic cases.21 References available on request. Accreditation Number: A2106RP3 (exp: 31/05/2023) This activity has been accredited for 1.5 hours of Group One CPD (or 1.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan, which may be converted to 1.5 hours of Group Two CPD (or 3 CPD credits) upon successful completion of the associated assessment activity. 1. Which of the following statements about allergic rhinitis (AR) is INCORRECT? A) AR presentation peaks in adulthood. B) Symptoms of AR include rhinorrhoea, congestion, respiratory tract itch and sneezing. C) AR only occurs during spring. D) AR symptoms can interfere with day-to-day activities. 2. The process of AR development involves which of the following? A) An aeroallergen sensitises the mucosa. B) Allergen specific IgE is generated. C) Future contact with the allergen is detected by IgE antibodies presented on mast cells. D) Early symptoms are caused by release of inflammatory mediators such as histamine from mast cells. E) All the above are involved in AR development. 3. Currently, AR can be classified as either intermittent or persistent AR. Persistent AR is defined as symptoms occurring: A) At least eight days per month for at least four months. B) At least four days per week for at least four months. C) At least eight times per week for at least four weeks. D) At least four days per week and for at least four weeks. 4. Intranasal corticosteroids (INCS) are the first line option for the treatment and prevention of persistent AR and intermittent moderate to severe AR. Which of the following statements regarding INCS is INCORRECT? A) INCS is only for fast relief of initial symptoms. B) INCS can also reduce ocular allergy symptoms. C) INCS provides local anti-inflammatory effects, which decrease capillary permeability of the nasal mucosa, causing vasoconstriction and reduced mucous production. D) INCS usage can vary in duration, from seasonal use to long term use. 5. Sally, a 25-year-old woman, presents to the pharmacy with a runny, itchy nose, and nasal congestion. She tells you that she has had these symptoms for a week, and always seems to get them around this time of year for a few months at least. Which of the following is the MOST appropriate choice of treatment for Sally? A) An intranasal antihistamine combined with an oral decongestant for the next five days. B) Intranasal corticosteroid for a few days to stop the allergy worsening. C) Regular intranasal corticosteroid, combined with intermittent use of an oral non-sedating antihistamine when required. D) A topical nasal decongestant. 6. Which of the following options for the management of AR is CORRECT? A) Cromoglycate eye drops for the fast relief of allergic conjunctivitis. B) Intranasal corticosteroids with the highest absorption across the nasal mucosa for maximum effect. C) Intranasal corticosteroid for nasal, ocular and skin symptoms. D) Intranasal saline for flushing the nasal cavity and sinuses, and as an adjunct therapy for intranasal corticosteroid. 7. In the stepwise approach for treating chronic spontaneous urticaria in adults and children, which of the following is the appropriate choice for the first step in treatment? A) Initial dosing with a less sedating antihistamine at a four times standard dose. B) Less-sedating antihistamines at a standard dose initially. C) Using a good emollient and ensuring the patient follows a strict elimination diet. D) Commencing the patient on fexofenadine and cetirizine at the same time. 8. Which of the following options regarding oral antihistamines for treatment of urticaria or AR is INCORRECT? A) Using combination treatment of an oral antihistamine with an INCS can be useful if the symptoms are not controlled with INCS alone. B) For patients starting treatment with an INCS, it may be useful to add an oral antihistamine for faster relief of symptoms. C) Taking an antihistamine when required for chronic urticaria, rather than daily, may be beneficial for a patient’s quality of life. D) If sleep is disturbed due to urticaria, a night-time dose of a more sedating antihistamine can be used for adults and children over two years. OTC management of allergic rhinitis and urticaria 3 CPD CREDITS RETAIL PHARMACY • JUN 2021