CLASS MEDICATION MOA SIDE EFFECTS

Intranasal Beclomethasone 80 mcg/actuation 1-2 General mechanism is not yet well elucidated but may Nasal irritation, feeling of dryness,
Steroids sprays/nostril OD Involve inhibition of lgE-dependent release of epistaxis
Budesonide 32 mcg/actuation 2 histamine
sprays/nostril OD Provides adequate dmg concentrations at receptor sites In
Fluticasone 50 mcg/actuation 1 the nasal mucosa with very limited systemic exposure
spray/nostril OD Most potent drugs available for both seasonal and
Mometasone 50 mcg/spray 2 perennial allergic rhinitis
sprays/nostril OD Also effective in relieving nasal congestion
Substantially reduced side effects compared to oral
corticosteroids
Oral Steroids Prednisone 20-60 mg/day PO in a Brief courses may be needed for rapid relief of severe Infection, acne, adrenocortical
single daily dose or divided q12hr allergic rhinitis symptoms insufficiency, increase appetite,
for 5-7 days weight gain, osteonecrosis
Oral Cetirizine 10 mg OD PO Blocks H1 histamine receptors 1st Gen: Somnolence, headache
Antihistamines Loratadine 10 mg OD PO Effective for nasopharyngeal itching & sneezing, watery 2nd Gen: Headache, altered taste
Desloratadine 5 mg OD PO rhinorrhea and ocular manifestations (for oral
Chlorphenamine 4 mg q4-6h PO antihistamines) such as itching, tearing
Hydroxyzine 25 mg OD-QID PO
Diphenhydramine 25-50 mg TID-QID
PO
Nasal Azelastine 205. 5 mcg/spray 2 Bitter taste, headache, somnolence
Antihistamines sprays/nostril OD
Olopatadine 665 mcg/spray 2
sprays/nostril OD
Oral Phenylephrine 10-20 mg PO q4h (max Duration of efficacy is limited due to rebound rhinitis (7-to Rhinitis medicamentosa,
Decongestants of 60 mg/day) 14-day use can lead to rhinitis medicamentosa) and hypertension, dryness
Phenylpropanolamine 18 mg PO q4h hypertension
Pseudoephedrine 60 mg PO q4-66 Oral alpha-adrenergic agonists containing
pseudoephedrine are standard for management of
nasal congestion, generally in combination with an
antihistamine
Leukotriene Montelukast 10 mg PO OD Blocks CystLT receptor reducing inflammation & Headache, abdominal pain, diarrhea,
Modifiers Zafirlukast 20 mg PO BID symptoms of allergic rhinitis
Approved for treatment of both seasonal and perennial
rhinitis
Reduces both nasal and ocular symptoms
Cromones Cromolyn sodium 5.2 mg/spray 1 Mast cell stabilizer Diarrhea, headache
spray/nostril q6-8h (may increase Essentially without side effects
to 6 times/day) Used prophylactically on a continuous basis during allergic
Cromolyn sodium 4% (1-2 drops in season
each eye 4-6 times/day) Local treatment also effective in treating mild allergic
conjunctivitis
Topical Ipratropium 17 mcg/actuation 2 Anticholinergic agent effective in reducing rhinorrhea Headache, pharyngitis, URTI
Ipratropium actuations q6h then PRN (max 12
actuations/day)
Immunotherapy Also known as hyposensitization, consists of repeated subcutaneous injections of gradually Contraindicated in those with
increasing concentrations of allergen(s) responsible for symptom complex significant cardiovascular disease or
Duration is usually 3-S years unstable asthma
Omalizumab Monoclonal antibody to IgE which blocks mast cell and basophil sensitization Viral infections, sinusitis, headache
Currently approved only for treatment with patients with persistent allergic asthma not controlled
by inhaled glucocorticoid therapy

FOUR MAIN CATEGORIES OF TISSUE DAMAGE

MECHANISM PHYSIOLOGY PATHOLOGY
Extrinsic Autoimmune
Type I Immediate, IgE-mediated Extravascular recruitment of Anaphylaxis Chronic urticaria
immunological components Allergic asthma
Parasite expulsion Allergic rhinitis

Type II IgG, IgA or IgM-mediated Lysis of pathogens by Incompatible blood transfusion Hemolytic anemia
extracellular or intra- cellular Hemolytic disease of the newborn Thrombocytopenia
events Hyperacute graft rejection Pemphigoid
Goodpasture's disease
Myasthenia gravisa
Thyrotoxicosisa
Type III Immune complex- mediated Neutralization of pathogen- Local: arthus re-action, dermatitis, Local: rheumatoid arthritis
derived factors (e.g. Toxins) herpetiformis, allergic alveolitis Systemic: systemic lupus
Transport of antigen to germinal Systemic: serum sickness, vasculitis erythematosus, widespread
centers vasculitis
Type IV Cell-mediated Defense against intracellular Tuberculosis Thyroiditis
 parasites Leprosy Adrenalitis
Contact dermatitis Pernicious anemia
Graft rejection Diabetes
a
The receptor antibodies in these two conditions have inhibitory/stimulatory effects on the respective receptors rather than complement-mediated lysis