The chief complaint is Jane, a 28 years old white patient who has recently relocated to Florida from Phoenix. Jane is presenting severe nasal congestion, running nose, constant sneezing, itching, and a bilateral clear discharge from the eye. She reports that the symptoms are more severe at the middle of the day. Jane started to experience these symptoms in mid-April, that it, a month ago ( Ådjers et al., 2017). The patient’s father is 52 years old and is having a history of asthma and allergic rhinitis. Her mother, on the other hand is 50 years old with a history of migraines. Jane is allergic to TMP-SMX (hives). The signs and symptoms presented by Jane indicates moderate to severe allergic rhinitis and conjunctivitis.
Pathophysiology
The step of the development of allergic rhinitis and conjunctivitis is the binding of the allergens with nasal mucosa. This leads to the production of allergen specific IgE which has high affinity to IgE receptors. The IgE receptors then present on the surface of mast cells located on the surface of the mast cells that are located on the nasal mucosa ( Wheatley & Togias, 2015) . As a result of sensitization of the mast cells, the deregulation and initiation of inflammatory events begins to occur. During the early phase of inflammation, there is a release of preformed mediators like histamine, tryptase, kinin and heparin. The migration of other inflammatory cells happens during the late phase.
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Causes
Allergic rhinitis and conjunctivitis is caused by allergens. When the body comes into contact with allergens like in this case, TMP-SMX (hives), the body releases natural chemicals that defend it from the allergen known as histamine. This chemical can cause allergic rhinitis and conjunctivitis and their symptoms like running nose, sneezing, and itchy and watery eyes ( Seidman et al., 2015) . Other allergens that commonly cause this reaction include; animal fur, pollen, dust mites and cat saliva among others.
Diagnostic Criteria
Minor allergic rhinitis and conjunctivitis are diagnosed through physical examination of the symptoms. The doctor may ask the patient about the symptoms like sneezing or running nose. The doctor can even conduct some tests to identify the best treatment and prevention plan for the patient. Skin prick test is one of the commonly performed tests where the doctor places several substances on the patient’s skin to see the reaction of the body to them. If one is allergic, a small red bump usually appears on the skin. A blood test known as Radioallergosorbent test can also be done to measure the amount of immunoglobin E antibodies that are present in the blood.
Goals of Drug Therapy
Allegra drugs are given to the patient to reduce the effects of the chemical substance called histamine that is usually produces when the body reacts to the allergen. Histamine can causes symptoms like sneezing, itchy and watery eyes and runny nose ( Campo et al., 2018) . Allegra is therefore used with the aim of reducing the symptoms of allergy in patients. Another goal of this therapy is to treat skin itching and hives. Patanase is another drug therapy that is administered to the patients with allergic rhinitis and conjunctivitis. The goal of using this drug is to block the actions of histamine and relieve the body from the common symptoms.
Proposed Pharmacologic interventions
The primary pharmacological interventions chosen for the patient are Allerga and Patanase. Allegra is an antihistamine that is known to reduce the effects of natural chemical histamine in the body. The chemical compound is known to produce symptoms such as sneezing, itching, watery eyes and running nose. The medication is capable of treating the symptoms of seasonal allergies for adults and for children. On the other hand, Patanase is a nasal spray that is not only an antihistamine, but a mast cell stabilizer that can help the patient to respond well to the external risk factors including the development of allergens.
Contraindications and precautions
The medications chosen are known to have a pseudoephedrine component, which is fexofenadine hcl and pseudoephedrine hcl, where they present a 12 hour contraindication in patients with narrow-angle glaucoma or urinary retentions. Patients prescribed to monoamone oxide inhibitor therapy may also experience contraindications such as dizziness upon 14 days of stoppage of use.
Potential drug reactions (common or rare but important)
Potential drug interactions
The drugs chosen for this case study are Allegra and Patanase, where they are known to interact with food substances such as grapefruit, orange, and apple juice ( Campo et al., 2018) . Consumption of large amounts of certain fruits such as oranges and apples is known to decrease the levels of fexofenadine in the body. This implies that the medications should be taken with large amounts of food to allow for easier absorption of the medication in the body.
Cost considerations
The cost should not be a factor of consideration when using the drugs as their benefits transcend above the costs. For instance, these generics can save the consumers such as Jane hundreds of dollars annually ( Leonardi et al., 2015) . The drugs including allegra and Patanase are known to be low-cost generics that one should not give up using them.
Compliance considerations
The compliance considerations are aligned with the cost considerations. It is evident that since the drugs are cost-effective, the patient can afford and use them as recommended by the health practitioner ( Scadding et al., 2017) . The drugs are also recommended to be used in full doses as they work well in as much as they are safe for use, bearing in mind that the full dosage does not present any clinical contraindications.
Patient education
The fact that there are different body interactions with the drugs means that patient education should be the pivotal point of ensuring that the patient takes the medication as prescribed by the health physician ( Corren, 2017) . It is evident that contraindications may be present if the patient contravenes the normal medication stipulated according to the diagnosis and the nature of the condition.
Monitoring and/or follow-up
A follow-up program is also vital as it may help the patient to improve in the levels of adherence to medication. Monitoring on the other hand helps the medical practitioner to observe the bodily interactions with the medication and to give a responsive measure that can restore health for the patient.
Prescription
| Medication | Dosage |
| Allegra Tablets | 60 mg twice daily or 180 mg once daily with water. The starting dosage should be 60 mg once daily for patients with decreased renal function |
| Patanase | The recommended dosage is two sprays per nostril twice daily. |
References
Ådjers, K., Luukkainen, A., Pekkanen, J., Hurme, M., Huhtala, H., Renkonen, R., ... & Toppila-Salmi, S. (2017). Self-reported allergic rhinitis and/or allergic conjunctivitis associate with IL13 rs20541 polymorphism in Finnish adult asthma patients. International archives of allergy and immunology , 172 (2), 123-128.
Campo, P., Eguiluz‐Gracia, I., Bogas, G., Salas, M., Plaza Serón, C., Pérez, N., ... & Rondon, C. (2018). Local allergic rhinitis: implications for management. Clinical & Experimental Allergy .
Corren, J. (2017). Allergic Rhinitis and Conjunctivitis. In Middleton's Allergy Essentials (pp. 205-224).
Jutel, M., Agache, I., Bonini, S., Burks, A. W., Calderon, M., Canonica, W., ... & Kleine-Tebbe, J. (2015). International consensus on allergy immunotherapy. Journal of Allergy and Clinical Immunology , 136 (3), 556-568.
Leonardi, A., Castegnaro, A., Valerio, A. L. G., & Lazzarini, D. (2015). Epidemiology of allergic conjunctivitis: clinical appearance and treatment patterns in a population-based study. Current opinion in allergy and clinical immunology , 15 (5), 482-488.
Scadding, G. K., Kariyawasam, H. H., Scadding, G., Mirakian, R., Buckley, R. J., Dixon, T., ... & Nasser, S. M. (2017). BSACI guideline for the diagnosis and management of allergic and non‐allergic rhinitis (Revised Edition 2017; 2007). Clinical & Experimental Allergy , 47 (7), 856-889.
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., ... & Ishman, S. L. (2015). Clinical practice guideline: allergic rhinitis. Otolaryngology–Head and Neck Surgery , 152 (1_suppl), S1-S43.
Wheatley, L. M., & Togias, A. (2015). Allergic rhinitis. New England Journal of Medicine , 372 (5), 456-463.
