Introduction
The immune system is a significant component of the body which offers protection against diseases. Allergy rhinitis emanates from immunoglobulin E (IgE)- allergy, which is related to nasal inflammation of different intensity (Raft et al., 2018). The condition can be induced by pollen when there is an interaction between the mediators from the cells, which are implicated in the resultant inflammation and other hyperreactivity. In other cases, the disease is mimicked when the nasal cavity has a challenge with the pollen allergens. The difference from the natural prognosis of the disease is a single provocation as opposed to multiple triggers occurring during the pollen season. The objective of this paper is to discuss the case of a 35-year-old woman with a history of nasal congestion.
Correct Hypersensitivity Reaction
Hypersensitivity reaction is an exaggerated or inappropriate response to an allergen or antigen. In the case of the woman, she has been experiencing rhinorrhea, nasal stuffiness, and sneezing, which never seem to stop for about 12 months (Week 1 Case Study Scenario). The history of nasal congestion has been worsening over time. However, the rhinorrhea greatly improved when she went for a family reunion and spent two weeks on the Caribbean cruise.
Explanation of the Related Pathophysiology
The woman has an IgE allergy, which causes inflammation of the nasal cavity when exposed to pollens that are specific to her home area. This explains why when she went for a family gathering, the hypersensitivity significantly reduced, and she had lesser symptoms (Week 1 Case Study Scenario). The cat that they bought one year ago could be the one with the pollen causing her symptoms. Notably, when they only had a dog as a pet, she was not suffering from the nasal inflammation.
Subjective Findings
Subjective findings are those that are reported by the patient so that there is no laboratory examination that has been done. The woman reported that she has a history of nasal congestion. The other subjective findings include experiencing sneezing, rhinorrhea, and nasal stuffiness, which have never been resolved. All these symptoms lowered when she travelled for a two weeks family meeting.
Objective Findings
The results received after professional assessment and examination of the patient using specimens in the lab or medical machines are objective. In this case of a 35-year-old woman, the findings that the nurse practitioner received indicate eyelid redness and swelling, allergic shiners (lower lid venous swelling), conjunctival swelling and erythema, inflamed nares, and allergic crease (lateral crease on the nose). Given that it is a competent clinician who did the test the results are more reliable.
Management of the Disease
Management and treatment of illnesses are often intended to alleviate the symptoms of a disease, improve prognosis, and the quality of life of a patient. The patient may be asked to take medications, improve lifestyle practices or change their environment to achieve the desired outcome. In the United States, the Food and Drug Administration (FDA) classifies allergic rhinitis into perennial and seasonal to guide in selection of the appropriate drug for the patient.
Strongly Recommended Medication Classes
Topical steroids are effective for patients diagnosed with allergic rhinitis and experiencing symptoms which affect their quality of life. These drugs are helpful because they have potent anti-inflammatory properties which modulate the pathophysiology of the disease. The drugs also help in reducing inflammatory cells and cytokines located in the nasal mucosa and the secretory glands of the patient (Seidman et al., 2015). The other strongly supported drug falls under the class of oral second-generation antihistamines, which is less sedating for patients who present with primary symptoms as itching and sneezing. The drugs in this class are advantageous due to their quick result, one dose per day, maintained effectiveness and availability over the counter.
Mechanism of Action for Each of the Medication Classes
The topical steroids modulate the pathophysiology of the disease, which is evident in studies where pre-treatment with intranasal steroids (INS). The findings indicated reduced “mediator and cytokine release along with a significant inhibition in the recruitment of basophils, eosinophils, neutrophils, and mononuclear cells to nasal secretions” (Seidman et al., 2015, p.S16). In addition, the medication also lowers antigen-induced hyperresponsiveness at the nose area, thus subsequent challenge by histamine and antigen release. The oral antihistamine mechanism of action is to “block the action of histamine on the H1 receptor” (Seidman et al., 2015, p. S19). This class of drugs is capable of reducing bronchial hyperreactivity leading to control of the symptoms.
Treatment Options that are not Recommended
One of the treatment options that is strongly recommended against is imaging. It is expected that clinicians do not frequently perform sinonasal imaging for patients who have symptoms that are consistent with those of allergic rhinitis. Second, oral leukotriene receptor antagonists are recommended against for the therapy of patients with allergic rhinitis. There is no need to perform radiographic imaging on a patient with allergic rhinitis, resulting in adverse events. The procedure also adds an unnecessary cost burden to the client and may cause future radiology-induced cancer.
Conclusion
People with allergic rhinitis have their natural immunity reacting against allergens leading to symptoms such as inflammation and nasal congestion. The disease is triggered by environmental or animal pollen, just as is the case with the woman. There are many treatment and management options for the disease. Removing the pets and environmental control can help to reduce the symptoms. In addition, the strongly recommended class of drugs includes topical steroids and an oral antihistamine. It is, however, not recommended for a patient with allergic rhinitis to undergo imaging as it may have detrimental effects.
References
Raft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2018). Understanding pathophysiology 3rd ed.). Elsevier.
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R.,… & Nnacheta, L. C. (2015). Clinical practice guideline: Allergic rhinitis. Official Journal of American Academy of Otolaryngology-head and Neck Surgery, 152(1 Suppl), S1-43. Web.