Question

Gina, a 35 year old patient, has allergic rhinitis. Her prescription include:

• Loratidine 5mg/day
• Fluticasone 2 nasal inhalations per day

Previously, she had taken over-the-counter drugs and asked if she should continue to take the OTC drug with her prescriptions. She had never used a nasal inhaler before.

1. What additional information is needed from Gina concerning her health problems?

2. What is your response to Gina concerning the use of OTC drugs with her prescription drugs?

3. How would you instruct Gina to use a nasal inhaler? Explain your answer.

4. What are the similarities and differences between loratidine and diphenhydramine? Could one of those antihistamines be more effective than the other? Explain your answer.

5. What would you suggest to decrease allergens such as dust and mites in the home

Answer 1

1. Allergic rhinitis (hay fever) causes symptoms like red watery and itchy eyes, sneezing, swelling around the eyes and runny or stuffy nose in response to exposure to an allergen in the air (probably pollens or any foreign substances). Additional information needs to be collected are regarding the type, dose and frequency of the OTC drug used, her living condition including presence of pets (with fur) that may contribute to her symptoms, previous medical and medications history including intake of any herbal supplements as they may interact with the prescribed drugs.

2. Gina is prescribed with Loratidine which is an antihistamine and fluticasone that suppresses the inflammatory response as a result of exposure to allergen. These two drugs will provide her relief from the current symptoms and the OTC drug may no longer be required.

3. Teach the techniques of how to use the nasal inhaler: advice to blow and clear the nasal secretions before using the nasal spray,

Ensure the proper fitting of the canister and shake it several times before each use for proper mixing of the solution.

Advice to keep the head upright, hold the canister with one hand with its tip inside one nostril pointing towards back of the head. Close the other nostril with the other hand. If the nozzle is aimed right there won't be dripping of solution from the nose or into the throat after administration.

Press down the canister while slowly breathing in. Take the prescribed number of puffs and repeat the same in the other nostril.

The nurse can instruct the patient to go through the instructions given in the paper inside the nasal spray package in case of any doubts.

4. Loratidine and Diphenhydramine

Similarities	Differences
Both are antihistamines	Diphenhydramine belongs to first generation antihistamine. Loratidine belongs to second generation of antihistamines.
Both are common OTC drugs for treating allergic symptoms	Diphenhydramine is mainly for short term use Loratidine can be used for short term or long term use as per doctor's prescription.
Both the drugs are available in capsule, tablet, syrup and oral solution forms.	Diphenhydramine has sedating effect Loratidine is unlikely to cause any sedation
Both the drugs are prescribed only for adults and for children who are 2 years or older.	Diphenhydramine is also used to treat stiffness and tremors in Parkinson's disease and also prevents symptoms of motion sickness (nausea and vomiting) Loratidine is not used to treat the above conditions.
Both the drugs are generally safe to be used in pregnancy.	Loratidine needs to be taken once a day as its effect lasts for around 24 hours. Effect of diphenhydramine may fade sooner.

Loratidine is usually prescribed over diphenhydramine even if both have similar effectiveness on allergic conditions because of its less sedating effect.  

5. Limiting the environmental allergens like dust, pollens and animal dander can help to prevent symptoms of allergic rhinitis.

Keeping the home surfaces clean and uncluttered prevents accumulation of dust.

Advice to wash the bedding and pillow covers in hot water and drying in hot dryer cycle helps to kill dust mites once a week.

Vacuum cleaning the house once or twice a week helps to remove the allergens.

If allergic to fur or animal dander advice to avoid pets with feathers or fur.

Keeping the windows and doors closed keeps away pollen and use of an air conditioner in summer reduces humidity and control dust mites.

Reducing moisture inside house especially in kitchen and bathrooms helps to avoid mold spores.

Controlling rodents and insects by pest controls (not using chemicals as it may cause mucosal irritation) may also help.