R97 Allergic rhinitis (ICD-10:J30.4)

Introduction

Allergic rhinitis is a common condition characterized by inflammation of the nasal passages due to an allergic reaction. It is estimated to affect approximately 10-30% of the global population.^[1] The aim of this guide is to provide healthcare professionals with a comprehensive overview of the diagnosis and management of allergic rhinitis.

Codes

• ICPC-2 Code: R97 Allergic rhinitis
• ICD-10 Code: J30.4 Allergic rhinitis, unspecified^[2]

Symptoms

• Sneezing: Frequent and repetitive sneezing is a common symptom of allergic rhinitis. It is often triggered by exposure to allergens such as pollen, dust mites, or pet dander.
• Nasal congestion: Allergic rhinitis can cause a stuffy or blocked nose, making it difficult to breathe through the nose.
• Runny nose: Excessive nasal discharge, often clear and watery, is another common symptom of allergic rhinitis.
• Itchy nose, eyes, or throat: Allergic rhinitis can cause itching in the nose, eyes, or throat, leading to discomfort and irritation.
• Watery eyes: Allergic rhinitis can cause excessive tearing or watery eyes.
• Fatigue: Some individuals with allergic rhinitis may experience fatigue or tiredness due to disrupted sleep caused by nasal congestion or other symptoms.^[3]

Causes

• Pollen: Allergic rhinitis can be triggered by exposure to pollen from trees, grasses, or weeds.
• Dust mites: Dust mites are tiny insects that thrive in warm and humid environments. Their droppings can trigger allergic reactions in susceptible individuals.
• Pet dander: Allergic rhinitis can be triggered by exposure to allergens found in the skin cells, saliva, or urine of animals, such as cats or dogs.
• Mold spores: Mold spores can be found both indoors and outdoors and can trigger allergic reactions in susceptible individuals.
• Other allergens: Allergic rhinitis can also be triggered by other allergens, such as cockroach droppings or certain foods.^[4]

Diagnostic Steps

Medical History

• Obtain a detailed medical history, including information about the patient’s symptoms, their duration, and any triggers that worsen the symptoms.
• Ask about the presence of other allergic conditions, such as asthma or eczema, as these conditions often coexist with allergic rhinitis.
• Inquire about the patient’s exposure to potential allergens, such as pets, pollen, or dust mites.
• Assess the impact of symptoms on the patient’s daily activities and quality of life.^[5]

Physical Examination

• Perform a thorough physical examination, focusing on the nose, throat, and eyes.
• Look for signs of nasal congestion, such as swollen nasal turbinates or pale, bluish nasal mucosa.
• Check for the presence of nasal polyps, which can be associated with allergic rhinitis.
• Examine the eyes for signs of conjunctivitis, such as redness or watery discharge.^[6]

Laboratory Tests

• Allergy testing: Skin prick tests or blood tests, such as specific IgE testing, can help identify the specific allergens that trigger allergic rhinitis.
• Complete blood count (CBC): A CBC can help identify any underlying infections or other abnormalities.
• Nasal smear: A nasal smear can be performed to assess the presence of eosinophils, which are often elevated in allergic rhinitis.^[7]

Diagnostic Imaging

• Diagnostic imaging is not typically necessary for the diagnosis of allergic rhinitis. However, in some cases, imaging studies such as sinus X-rays or CT scans may be ordered to evaluate for sinusitis or other complications.^[8]

Other Tests

• Pulmonary function tests: Pulmonary function tests may be performed to assess lung function and rule out the presence of asthma, which often coexists with allergic rhinitis.
• Rhinoscopy: Rhinoscopy involves the use of a small camera to visualize the nasal passages and assess for any structural abnormalities or nasal polyps.^[9]

Follow-up and Patient Education

• Schedule regular follow-up visits to assess the patient’s response to treatment and adjust the management plan if necessary.
• Provide patient education on allergen avoidance strategies, such as using allergen-proof bedding covers, keeping pets out of the bedroom, and regularly cleaning the house to reduce dust mite exposure.
• Educate the patient about the appropriate use of medications and the importance of adherence to the treatment plan.
• Discuss the potential benefits of allergen immunotherapy for patients with persistent symptoms despite optimal medical management.^[10]

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Allergic rhinitis:

1. Intranasal corticosteroids (e.g., Fluticasone, Budesonide):
   • Cost: Generic versions can range from $10 to $50 per month.
   • Contraindications: Hypersensitivity to corticosteroids.
   • Side effects: Nasal irritation, nosebleeds.
   • Severe side effects: Adrenal suppression (rare).
   • Drug interactions: None significant.
   • Warning: Regular use is required for optimal effect.
2. Oral antihistamines (e.g., Cetirizine, Loratadine):
   • Cost: Generic versions can range from $5 to $20 per month.
   • Contraindications: Hypersensitivity to antihistamines.
   • Side effects: Drowsiness, dry mouth.
   • Severe side effects: None significant.
   • Drug interactions: Sedatives, alcohol.
   • Warning: May cause drowsiness, use caution when driving or operating machinery.
3. Leukotriene receptor antagonists (e.g., Montelukast):
   • Cost: Generic versions can range from $10 to $50 per month.
   • Contraindications: Hypersensitivity to leukotriene receptor antagonists.
   • Side effects: Headache, gastrointestinal upset.
   • Severe side effects: None significant.
   • Drug interactions: None significant.
   • Warning: May be less effective than intranasal corticosteroids for nasal symptoms.
4. Decongestants (e.g., Pseudoephedrine, Phenylephrine):
   • Cost: Generic versions can range from $5 to $20 per month.
   • Contraindications: Hypertension, cardiovascular disease.
   • Side effects: Increased heart rate, elevated blood pressure.
   • Severe side effects: None significant.
   • Drug interactions: Monoamine oxidase inhibitors (MAOIs), beta-blockers.
   • Warning: Prolonged use may lead to rebound congestion.
5. Mast cell stabilizers (e.g., Cromolyn sodium):
   • Cost: Generic versions can range from $10 to $30 per month.
   • Contraindications: Hypersensitivity to mast cell stabilizers.
   • Side effects: Nasal irritation, sneezing.
   • Severe side effects: None significant.
   • Drug interactions: None significant.
   • Warning: Requires regular use for optimal effect.

Alternative Drugs:

• Nasal antihistamines (e.g., Azelastine): May be used as an alternative to intranasal corticosteroids for nasal symptoms.
• Nasal ipratropium: May be used as an alternative to intranasal corticosteroids for nasal symptoms.
• Oral corticosteroids: Reserved for severe cases or short-term use in acute exacerbations.
• Allergen immunotherapy: May be considered for patients with persistent symptoms despite optimal medical management.

Surgical Procedures:

• Surgical intervention is not typically indicated for the management of allergic rhinitis. However, in some cases, surgical procedures such as septoplasty or turbinate reduction may be considered for patients with structural abnormalities or refractory symptoms.

Alternative Interventions

• Acupuncture: May help alleviate symptoms of allergic rhinitis by stimulating specific acupuncture points. Cost: $60-$120 per session.
• Herbal supplements: Some herbal supplements, such as butterbur or stinging nettle, may have potential benefits for reducing allergic rhinitis symptoms. Cost: Varies depending on the specific supplement.
• Nasal irrigation: The use of saline nasal rinses or neti pots can help flush out allergens and reduce nasal congestion. Cost: $10-$20 for a nasal rinse kit.
• Probiotics: Certain strains of probiotics may help modulate the immune response and reduce allergic rhinitis symptoms. Cost: Varies depending on the specific probiotic supplement.
• Air purifiers: High-efficiency particulate air (HEPA) filters can help remove allergens from the air, reducing exposure and symptoms. Cost: $100-$500 for a HEPA air purifier.

Lifestyle Interventions

• Allergen avoidance: Encourage patients to minimize exposure to known allergens, such as pollen, dust mites, or pet dander.
• Regular cleaning: Regularly clean the house, including vacuuming carpets, washing bedding in hot water, and dusting surfaces to reduce allergen levels.
• Keep windows closed: Keep windows closed during high pollen seasons to minimize exposure to outdoor allergens.
• Use air conditioning: Use air conditioning with HEPA filters to filter out allergens from the indoor air.
• Wear a mask: When performing outdoor activities, wearing a mask can help reduce exposure to allergens.
• Humidify the air: Use a humidifier to add moisture to the air, which can help alleviate nasal congestion. Cost: $20-$100 for a humidifier.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – R97 Allergic rhinitis (ICD-10:J30.4)

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Use the Mirari Cold Plasma device to treat Allergic rhinitis effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Allergic rhinitis. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 Suppl 86:8-160.
2. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva: WHO; 2019.
3. Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015;152(1 Suppl):S1-43.
4. Wheatley LM, Togias A. Clinical practice. Allergic rhinitis. N Engl J Med. 2015;372(5):456-463.
5. Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017;47(7):856-889.
6. Dykewicz MS, Wallace DV, Baroody F, et al. Treatment of seasonal allergic rhinitis: An evidence-based focused 2017 guideline update. Ann Allergy Asthma Immunol. 2017;119(6):489-511.e41.
7. Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 Suppl 3):S1-148.
8. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39.
9. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464.
10. Roberts G, Pfaar O, Akdis CA, et al. EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy. 2018;73(4):765-798.