Discuss the epidemiology of allergies

Allergy is one of the most widespread chronic health issues in the world, and in developed countries, the number of people suffering from allergies is higher than in developing ones. In the US, the prevalence of allergic rhinitis is 10-30% and 0.5-2% for anaphylaxis (Dougherty et al., 2021). Another type of allergy, atopic dermatitis, affects 10-30% of children in developed countries and up to 20% of adults. As the patient from the case study exhibits allergy symptoms in a certain season, he probably has allergic rhinitis, which is characterized by nasal congestion, increased lachrymation, and rhinoconjunctivitis. Allergic rhinitis reduces the quality of life of the affected individuals and can be a cause of disability.

Pharmacotherapy for an allergy depends on the type of allergic reaction and the severity of the patient’s condition. To alleviate the symptoms of allergic rhinitis, patients are usually given second-generation antihistamines such as loratadine and cetirizine. I would prescribe loratadine for this patient, as this medication has an affordable price (7-11$/10 tablets) and effectively relieves the symptoms of allergy. Second-generation antihistamines are a preferred therapeutic option over first-generation antihistamines because they have a better safety profile and their therapeutic effect lasts longer (Woo & Robinson, 2016. First-generation antihistamines are non-selective H1 receptor antagonists in the central and peripheral nervous systems and can cause severe sedation, headache, and dizziness (Woo & Robinson, 2016). Second-generation antihistamines selectively bind to peripheral H1 receptors and therefore cause fewer CNS side reactions. There are first-generation antihistamines that are cheaper than loratadine, but they cause more side effects, which is why loratadine was chosen.

Patient education will include the way of loratadine administration and information about the possible adverse reactions. The optimal therapeutic dose of loratadine for adults is 10 mg (1 tablet per day) regardless of food intake (Sidhu & Akhondi, 2021). Loratadine is usually well-tolerated, but in rare cases, it can cause sedation, dizziness, abdominal pain, and diarrhea (Sidhu & Akhondi, 2021). It is also worth advising the patient not to take any other allergy medications without a prescription, as even antihistamines in rare cases cause allergic reactions. 

References

Dougherty, J. M., Alsayouri, K., & Sadowski, A. (2021). Allergy. StatPealrs. StatPearls Publishing, Retrieved February 11, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK545237/

Sidhu, G., & Akhondi, H. (2021). Loratadine. StatPealrs. StatPearls Publishing, Retrieved February 11, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK542278/

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.). F.A. Davis Company.

As depicted in the case study, a 35-year-old man wants to take some prophylactic measures to control his allergies. Allergies can take many different forms in that people can be allergic to various items, such as food products (nuts, shellfish, etc.) as well as to other allergens, such as pollen. Pollen and dust are the causes of some of the most common forms of seasonal allergies. There are many treatment options for people who suffer from such allergies, which include taking antihistamines. These antihistamines can come in various forms, such as in nasal sprays, pills, as well as inhalers.             Antihistamines can be depicted as drugs that are used to treat acute allergic reactions. Such antihistamines are used for short-term treatments and they relieve some of the symptoms associated with allergic reactions, such as hives, sneezing, congestion, and headaches. Most of the antihistamines are safe and they do not have many or serious side effects. Antihistamines can be broadly categorized as being either first-generation or second-generation. First generation antihistamines work by affecting the histamine receptors in the brain and spinal cord and they can cross the blood-brain barrier, which can cause drowsiness. On the other hand, second generation antihistamines were developed later and they do not cause as much drowsiness and do not cross the blood-brain barrier (Fein et al., 2019). 

            Patient education for taking antihistamines will include warning the patient to consult the physician if he has diabetes, heart disease, hypertension, epilepsy, or an overactive thyroid (Lou et al., 2022). The patient should also be instructed to take the antihistamines as prescribed and directed. The patient should also not drive after taking the antihistamines until he is aware of how they are affecting him, such as if they are making him drowsy. Alcohol can interact with antihistamines and worsen the side effects, which is why it is generally a good idea to avoid drinking alcohol while taking antihistamines. 

References

Fein, M. N., Fischer, D. A., O’Keefe, A. W., & Sussman, G. L. (2019). CSACI position 

statement: newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria. Allergy, Asthma & Clinical Immunology, 15(1), 1-6.

Lou, H., Huang, Y., & Zhang, L. (2022). Antihistamine. In Chronic Rhinosinusitis (pp. 

337-339). Springer, Singapore.

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Allergies

Ana Barreras Lopez

Discuss the epidemiology of allergies.

Allergy is in their vast majority an IgE- mediated sensitization to a foreign substance (allergen), which can be slight but sometimes reaches life-threatening severity. Since the industrial revolution this disease has increased its incidence and is a very common disease that is ranking on the 6th leading causes of chronic illness in United States. Most cases are concentrated in a few entities such as: allergic rhinitis, drug allergy, and food allergy (Allergy Facts | AAFA.Org, 2022). Asthma is another IgE mediated disease but many authors mentioned as a separated entity. The increase prevalence is a consequence of environmental factors acting over a genetically susceptible individuum. 

           Allergic rhinitis is the most common and affects 10-30% of the population worldwide. The adverse drug reaction affects the 10% of world’s population and anaphylaxis is responsible of 20% of death. On hospitalized individuum, the risk to have this kind of complications is double. By the other hand, food allergy is more complex and the most common food that causes this reaction are: milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish. It is a complex disease with a severe allergic reaction in more than a third of affected (Smith, 2019).

What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines.

           There is no cure for allergies, but it can be managed with allergen avoidance and promptly treatment of allergic reaction. Identification of the environmental protective and susceptible factors leads to the design of proper intervention and personalized strategies. In this matter, as usually following instructions and compliance with the treatment is important (Allergy Facts | AAFA.Org, 2022) . Some of the medications used to treat this disease are: corticosteroids, antihistamines, mast cell stabilizers, decongestants, and in the more severe cases epinephrine.

           Also, immunotherapy has been an option for many patients. The most common method are allergy shots and sublingual immunotherapy. Both with the aim of progressively desensitizing the person by putting him in contact with the previously identified allergen. It works better with allergies to pollen, pets, dust, etc. but result ineffective to food, drugs, hives, or eczema (Fein et al., 2019).

           Antihistamines (AHs) are the most common drug to treat allergies. First generation (diphenhydramine, hydroxyzine) have significant side effects such as: sedation, decrease cognitive function, dryness of mucosa, sleep disturbances, dizziness, and orthostatic hypotension. Well documented statics of fatal accidents, overdose, and sudden cardiac death leads to the creation of new generations of AHs with fewer side effects and long-acting action. Second and third generation of AHs have improved potency, safety, and efficacy. These new medications are more expensive and cost remains as a barrier for treatment preferences (Fein et al., 2019).

What education will you provide to the patient?

 The importance of identifying allergens and how to avoid exposure to them is the first line of prevention. Educating patients on this directive is essential as well as educating patients on this directive is essential as well as promoting changes in lifestyle. If the allergen results unavoidable, then reduce the contact with it. Take medication as prescribed is helpful for managing symptoms and lower the severity of reactions. Follow instructions and treatment plan implemented by a professional (Chiriac et al., 2019).

           Keep epinephrine auto-injectors at reach all times, and/or wear a medical alert bracelet can be a life saving in a critical situation. Know what to do during an allergic reaction and have a written emergency action plan to guide others helping you if it is the situation. Promptly recognition of symptoms leads a quickly and properly response. If the reaction increases in severity, call emergency medical services for help (Allergy Facts | AAFA.Org, 2022).

References

Allergy Facts | AAFA.org. (2022). Aafa.Org. https://www.aafa.org/allergy-facts/

Chiriac, A. M., Banerji, A., Gruchalla, R. S., Thong, B. Y., Wickner, P., Mertes, P. M., Terreehorst, I., & Blumenthal, K. G. (2019). Controversies in Drug Allergy: Drug Allergy Pathways. The Journal of Allergy and Clinical Immunology: In Practice, 7(1), 46–60.e4. https://doi.org/10.1016/j.jaip.2018.07.037

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Week 7 Discussion

Villelixe Soto

Advanced Pharmacology

           The epidemiology and prevalence rates of allergies such as asthma, IgE-mediated sensitization and allergic diseases vary throughout the world (Putnam-Casdorph, & Badzek, 2015). In asthma, for example, there is some evidence for geographical variations in prevalence; exercise challenge tests prove positive more often in urban areas than in rural areas. Although genetic predisposition is the strongest single risk factor for atopic eczema, air pollutants may aggravate the condition by acting as unspecific irritants and immunomodulators, leading to increased immunoglobulin E expression.

           The most common treatment options that are pharmacoeconomic for allergies include nasal corticosteroids, antihistamines block histamine, mast cell stabilizers, and decongestants. Although the efficacy of the different H1 antihistamines in the treatment of allergic patients is similar, even when comparing first- and second-generation drugs, they are very different in terms of chemical structure, pharmacology and toxic potential (Lee, Hess & Nestler, 2013). The first generation antihistamines, such as diphenhydramine, are fairly potent muscarinic antagonists in addition to being H1 selective antihistamines. The antimuscarinic action is often not desirable since it is in part responsible for the drying of secretions in the airways and the sedative effect.

           Patient education includes teaching patient how to avoid the trigger, how to use glucocorticoid nasal sprays, if the patient has severe symptoms, the patient may need to use a nasal decongestant for a few days before starting a nasal steroid to reduce nasal swelling (Lee, Hess & Nestler, 2013).

Some patients notice symptom relief on the first day of treatment with nasal steroids, although it may take days to weeks to notice the full effect. For this reason, nasal steroids are most effective when used regularly. Some people are able to use lower doses when symptoms are less severe.

References

Lee, S., Hess, E. P., Nestler, D. M., (2013). Food, drug, insect sting allergy, and anaphylaxis: Antihypertensive medication. The Journal of Allergy and Clinical Immunology, 131, 1103–1108. https://doi.org/10.1016/j.jaci.2013.01.011.

Putnam-Casdorph, H., & Badzek, L. A. (2015). Asthma and allergy medication self-administration. Journal of Nursing Law, 14(1), 32–36. https://doi.org/10.1891/1073-7472.14.1.32

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Henly Rojas

Epidemiology of Allergies

It is of vital importance when talking about allergies, to start with their concept, so it must be said that it is a mechanism where the immune system of each person responds to the appearance of a foreign body, called an allergen. The allergy can appear in a variety of situations such as eating some food, inhaling some component that reaches the lungs, some drug injected into our body, and even topically when accidentally touching a foreign body such as a plant. Allergies can cause symptoms such as coughing, sneezing, hives, rashes, itchy eyes, runny nose, and itchy throat. In more acute cases, low blood pressure, shortness of breath, asthma attacks, and even death can occur. It is worth noting that there are no cures for allergies, they can only be treated through prevention and treatment. Another valid point to mention is that it is considered one of the most frequent diseases, especially in children, and it is common for people not to worry about treating them. One of the most common examples and that causes more visits to emergency rooms is food anaphylaxis, being a cause of High Death along with insect bites and medications, with African Americans and older adults being the ones with the highest incidence.

In the United States, the annual cost of allergies is High, with food allergies being the highest. The various manifestations of allergies, both internal and external, cause sinus, seasonal and recurring allergies, hay fever and nasal allergies. Among the most frequent triggers of allergies, we can mention pollen from trees, grasses and weeds, mold spores, dust mites, cockroaches and dander from cats, dogs, and rodents. Allergies at the skin level cause eczema, hives, chronic hives, and contact allergies. Plants such as poison ivy, poison oak, and poison sumac are the most common triggers of skin allergies. Skin contacts with cockroaches and dust mites, certain foods or latex can be mentioned as factors that produce clinical symptoms of allergy at the skin level.

Among the foods that cause the greatest number of allergies we can mention milk, soy, eggs, wheat, peanuts, nuts, fish, and shellfish. Milk is the most common allergen in children followed by eggs and peanuts. In adults, the most observed cause of allergies is shellfish along with peanuts and tree nuts. In relation to medications, the most common is penicillin. On the other hand, latex is frequently seen, especially in people who work in the health field. People who are allergic to insects are usually allergic to the stings of poisonous bees, wasps, and ants. Cockroaches and dust mites also cause nasal or skin allergy symptoms.

Treatment Options for Allergies

There are different drugs that are used to treat allergies in addition to antihistamines such as decongestants, which are used to produce rapid and temporary relief when we find ourselves with nasal and paranasal congestion. These drugs have contraindications such as sleep problems, headaches, increased blood pressure and irritability, with the recommendation not to use them in patients with high blood pressure, cardiovascular diseases, glaucoma or hyperthyroidism. Another of the medications that should be mentioned are the corticosteroids that are used when there are symptoms of inflammation related to allergies. They are also used as mast cell stabilizers that block the release of chemicals in the immune system that contribute to allergic reactions. In general, they are safe medications used for several days to achieve the full and desired effect and are used when antihistamines do not work effectively or are not well tolerated.

A leukotriene inhibitor is a drug prescribed to block the chemicals that cause symptoms called leukotrienes. This oral medication relieves allergy symptoms such as nasal congestion, runny nose, and sneezing. Within this classification, only montelukast is validated to treat hay fever. Allergen immunotherapy is put on a meticulous schedule gradually increasing exposure to allergens, especially pollen, dust mites and mold. The goal of immunotherapy is to prepare the body’s immune system so that it does not react to these allergens. Some patients carry injections of epinephrine, which is used to treat anaphylaxis, as this sudden reaction is life-threatening. The drug is injected using a syringe device and a self-injection needle. If we find ourselves in a situation where the patient has a severe allergic reaction to a certain food, such as peanuts, or if they are allergic to bee or wasp venom, they may need to carry two auto-injectors, since one is often needed. second injection, being of vital importance to contact the emergency systems or seek immediate medical attention.

This patient has seasonal allergies. For allergy season, treatment is with oral antihistamines such as loratadine, cetirizine, and fexofenadine. Oral decongestants such as pseudoephedrine offer temporary relief of nasal congestion, and nasal sprays such as oxymetazoline and phenylephrine can also be used. Nasal sprays, such as cromolyn sodium nasal spray, relieve allergy symptoms and do not have serious side effects, but are most effective when started before symptoms appear.

Comparison of First- and Second-Generation Antihistamines

I can start by noting that first generation antihistamines have an antagonistic function on the impact of histamine on peripheral H1 receptor sites in the gastrointestinal tract, uterus, large blood vessels and bronchial muscle. This drug non-selectively combines with central H1 receptors and can cause stimulation and recession of the central nervous system. This is also the case with therapeutic doses of first-generation antihistamines. Each of this type of drugs exerts its pressure more than others on the central nervous system of each patient. First-generation prescription antihistamines include diphenhydramine (Benadryl) and clemastine (Tavist), alkylamines brompheniramine (Dimetane) and chlorpheniramine (Chlor-Trimeton), piperazine hydroxyzine (Atarax, Vistaril), piperidine cyproheptadine (Periactin), and maleate of carbinoxamine (Arbinoxa). Second-generation antihistamines target H1 receptors and are less sedating. These drugs do not pass the blood-brain barrier in trace amounts, very few of the second-generation antihistamines reach the brain. Commonly prescribed second-generation antihistamines include the piperazine cetirizine (Zyrtec) and the piperidines desloratadine (Clarinex), fexofenadine (Allegra), and the brand name of loratadine: Claritin.

Different first-generation antihistamines have antiemetic and anti-nausea characteristics, since they have powerful anticholinergic properties caused by the binding of antihistamines to muscarinic receptors. Diphenhydramine is used to reverse the extrapyramidal side effects caused by phenothiazines. On the other hand, it should be noted that due to anticholinergic properties, several antihistamines such as diphenhydramine have effects on Parkinson’s symptoms. About more specific pharmacokinetics, absorption, and distribution, first-generation antihistamines are stable, lipid-soluble amines that are well absorbed from the gastrointestinal tract. Examples of the absorption and distribution of these drugs are diphenhydramine, which spreads extensively through body tissues and fluids, including the central nervous system.

About second-generation antihistamines, they are rapidly absorbed from the gastrointestinal tract, however, it should be noted that food intake decreases or delays their absorption. Examples of these drugs are fexofenadine is rapidly absorbed and its absorption is not affected by food intake. Desloratadine is well absorbed, and doses taken with food do not affect absorption. The absorption of cetirizine is slightly decreased with food, its distribution is wide except for the central nervous system. When it comes to metabolism and excretion, first generation antihistamines are essentially metabolized in the liver and their metabolites are excreted in the urine. As for second-generation antihistamines, they are metabolized by the liver to active metabolites by the P450 hepatic microsomal system. They are mainly excreted unchanged in the urine. They can also be excreted in the feces as loratadine, which is also excreted in the urine.

Regarding Pharmacotherapeutics, precautions and contraindications differ between first- and second-generation antihistamines. First-generation antihistamines are available without a prescription and are generally prescribed without problem. It is important that the provider knows the precautions and contraindications of this type of drug. Antihistamines are contraindicated in patients with narrow-angle glaucoma, lower respiratory tract symptoms as they thicken secretions and impair expectoration, patients with stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction, pyloroduodenal obstruction, and the use of antihistamines. monoamine oxidase inhibitors.

First-generation antihistamines do not have many warnings, but if they are important, due to their anticholinergic effects, caution is needed in patients with a predisposition to urinary retention, a history of bronchial asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease or hypertension. Antihistamines cause different levels of sedation and drowsiness. First-generation antihistamines such as chlorpheniramine, brompheniramine, diphenhydramine, clemastine, and cyproheptadine are in pregnancy category B. Hydroxyzine and carbinoxamine are the only first-generation antihistamines classified as pregnancy category C. Second-generation antihistamines have very few contraindications, but it should be noted that two second-generation antihistamines, astemizole (Hismanal) and terfenadine (Seldane), have been voluntarily withdrawn from the market due to possible life-threatening drug interactions and prolonged QT interval increase. linked to its use.

Patient Education

Patient education is based on the correct use of the prescribed drug, its adverse reactions and safety precautions during its use. Before administering the drug, our patients should be educated regarding the correct dose of the drug, especially if patients are switching from a shorter acting first-generation antihistamine to a longer acting second generation, they should be educated regarding at the dosing schedule.

There are antihistamines that cause gastrointestinal discomfort, so the patient should be educated to take them with food. Patients should be educated not to crush or chew sustained-release tablets. It is of vital importance in education to include adverse reactions, the patient should be notified that there are first-generation antihistamines that can cause drowsiness, that they should be careful when driving or performing any task that requires the person to be alert, as well as avoiding alcohol and other depressants. Other things to keep in mind when educating our patients is that to decrease your exposure to things that trigger your allergy signs and symptoms, you should stay indoors on dry, windy days. Additional measures should be taken when pollen levels are high, such as wearing a mask. Avoid outdoor activities early in the morning, keep indoor air clean. Use air conditioning inside the house and car. Keep indoor air dry with a dehumidifier. Use a high-efficiency portable particulate air. These measures can help, so it is good to include them in patient education.

References

Asthma and Allergy Foundation of America. (2021). Allergy Facts and Figures. Retrieved from https://www.aafa.org/allergy-facts/

Moser, T., & Robinson, M.V. (2016). Pharmacotherapeutics for Advance Practice Nurse Prescribers. (4th ed.). Philadelphia: F. A. Davis Company.

Lee, Y. M., Song, I., Lee, E. K., & Shin, J. Y. (2017). Comparison of first- and second-generation antihistamine prescribing in elderly outpatients: A health insurance database study in 2013. International Journal of Clinical Pharmacology and Therapeutics, 55(10), 781-790. https://doi.org/10.5414/CP203072

Cox, L. (2021). Pharmacoeconomics of allergy immunotherapy versus pharmacotherapy. Expert Review of Clinical Immunology, 17(3), 255–268. https://doi.org/10.1080/1744666x.2021.1886079 

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Gioconda Orellana

2/14/22, 3:42 PM 

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Epidemiology of Allergies

A 35-year-old patient has a seasonal allergy, which is a group of allergic diseases caused by plant pollen and characterized by acute inflammatory changes in the mucous membranes, mainly the respiratory tract and eyes. The Asthma and Allergy American Foundation conducted an epidemiological study of asthma in 2018 and found that more than 50 million Americans have suffered from allergy symptoms each year (AAFA, 2021). In addition, in the United States, allergies are a risk factor for chronic diseases. About 15% of children have seasonal allergic rhinitis or respiratory allergies, the most common health problems. In 2018, allergies were diagnosed in 7.2% of children and almost 8% of adults in America (AAFA, 2021). Allergic rhinitis, often referred to as seasonal allergies, affects more than 5 million children and more than 19 million adults in the United States (AAFA, 2021). Therefore, this patient and many other people suffer from allergies, which is a significant medical problem in America.

Treatment options for a given patient are immunotherapy and pharmacotherapy. Cox (2021) conducted a comparative study of pharmacotherapy and immunotherapy, taking into account the cost savings and effectiveness of allergy treatment. Injections, sprays, tablets, and inhalers previously given to the patient provide a quick but short-term effect. However, immunotherapy has more benefits than pharmacotherapy, preventing disease progression and saving treatment costs by 80% (Cox, 2021). First-generation antihistamines are non-selective and interact with H1-histamine receptors and other receptors in the human body, including muscarinic, serotonin, and α-adrenoceptors (Lee et al., 2017). As a result, there are many negative consequences and side effects when using this group of drugs. Second-generation antihistamines do not penetrate the central nervous system, so they do not have a sedative effect and may be prescribed to this patient (Lee et al., 2017). The education I would provide for this patient includes taking second-generation antihistamines and immunotherapy, avoiding self-administration of anti-allergy drugs, rational using of drugs, not taking them uncontrolled, avoiding triggers, strengthening the immune system, avoiding stress, leading a healthy lifestyle, and eating right.

References

Asthma and Allergy Foundation of American. (2021, April). Allergy facts and figures. Retrieved February 8, 2022, from https://www.aafa.org/allergy-facts/

Cox, L. (2021). Pharmacoeconomics of allergy immunotherapy versus pharmacotherapy. Expert Review of Clinical Immunology, 17(3), 255–268. https://doi.org/10.1080/1744666x.2021.1886079

Lee, Y. M., Song, I., Lee, E. K., & Shin, J. Y. (2017). Comparison of first- and second-generation antihistamine prescribing in elderly outpatients: A health insurance database study in 2013. International Journal of Clinical Pharmacology and Therapeutics, 55(10), 781-790. https://doi.org/10.5414/CP203072

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