This document discusses fever, pain, cough and cold/allergies. It begins by defining fever and listing its potential causes. Signs and symptoms of fever are described. Methods for diagnosing and treating fever non-pharmacologically and pharmacologically are outlined. Pain is then defined and how it occurs via nociceptors and the central nervous system is explained. Types of pain and approaches for assessing and managing pain are covered. Cough is defined and its causes, classifications as wet vs dry, and management strategies are presented. Finally, common drugs used to treat cough are named and their usage is described.

1. Agents for fever, pain, cough,
cold and allergic rhinitis
Clinical diploma Alexandria university 2018/2019
Presented by:
Sherif Gamal
Mona Kamel
Mona Abd EL Gawad
Heba Hammam
Dina Mohamed

3. What is fever?
fever is defined as having a temperature above
the normal range due to an increase in the body’s
temperature set point.

4. Etiology
 Viral or Bacterial infection
 Heat exhaustion
 Inflammatory conditions
 Medications
 Immunizations

5. Signs and symptoms
Fever is usually accompanied by sickness
behavior which consists of
 Lethargy
 Depression
 Anorexia
 Sleepiness
 Hyperalgesia
 Inability to concentrate.

6. Diagnosis
A wide range for normal temperatures has
been found.
Fever is generally agreed to be present if the
elevated temperature is caused by a raised set
point and ;
 Rectal temperature is at or over 37.5-38.3
 Oral temperature is over 37.7
 Axillary or tympanic temperature is over
37.2

7. Diagnosis
Site of
measurement
Normal range Fever
Rectal 36.6°C-38°C ≥ 38.0°C
Oral 35.5°C-37.5°C ≥ 37.5°C
Axillary 34.7°C-37.4°C ≥ 37.4°C
Tympanic 35.7°C-37.8°C ≥ 37.8°C
Temporal 36.6°C-37.8°C
≥ 38.1°C for 0-2 months old
≥ 37.9°C for 3-
47 months old
≥ 37.8°C for ≥ 4 years old

8. Fever, Hyperthermia & Hyperpyrexia
Fever:
a body temperature higher than the
normal core temperature of 37.8°C.
It is a regulated rise in body temperature
maintained by the hypothalamus in
response to a pyrogen.
It is a sign of an increase in the body’s
thermoregulatory set point.

9. Fever, Hyperthermia & Hyperpyrexia
Hyperthermia represents a
malfunctioning of the normal
thermoregulatory process at the
hypothalamic level caused by excessive
heat exposure or production.
Because of their different mechanisms,
treatment of fever versus hyperthermia
also varies.

10. Fever, Hyperthermia & Hyperpyrexia
Hyperpyrexia is a body temperature
greater than 41.1°C that typically results
in mental and physical consequences.
Hyperpyrexia may result from either a
fever or hyperthermia

11. Non pharmacological treatment

12. Non-pharmacologic therapy consists
mainly of adequate fluid intake to
prevent dehydration.

13. Body sponging with tepid water may
facilitate heat dissipation, given that
only a small temperature gradient
between the body and the sponging
medium is necessary to achieve an
effective antipyretic response.

14. Bathing with ice water or sponging with
hydroalcoholic solutions (e.g., isopropyl
or ethyl alcohol) is uncomfortable,
dangerous, and not recommended.

15. Pharmacological treatment

16. Antipyretics
Antipyretics inhibit PGE2 synthesis,
which decreases the feedback between
the thermoregulatory neurons and the
hypothalamus, thereby reducing the
hypothalamic set point during fever.
All antipyretics decrease the production
of PGE2 by inhibiting the
cyclooxygenase (COX) enzyme.

17. Antipyretics

18. Acetaminophen(Paracetamol)

19. Ibuprofen

20. Aspirin
Don’t give aspirin to children, because it
may trigger a rare, but potentially fatal,
disorder known as Reye’s Syndrome

21. Complications of fever
1. Epileptic seizures
2. Dehydration
3. Hallucinations and Delirium
4. Febrile Seizures

23. What is pain?
The World Health Organization defines pain as
“an unpleasant sensory or emotional experience
associated with actual or potential tissue damage

24. Etiology
Pain can occur from many causes, for
example:
 Surgery
 Trauma
 Labor
 Medical procedures
 Illnesses.

25. How pain occurs?
 Pain is a vital function of the human body, involving
nociceptors and the central nervous system (CNS) to
transmit messages from noxious stimuli to the brain.
The mechanism for neuropathic pain is distinct as it
is caused by injury to the nervous system itself and
can occur without the presence of noxious stimuli.
 Nociceptors
 Nociceptors are sensory receptors that are
responsible for detecting harmful or noxious stimuli
and transmitting electrical signals to the nervous
system. The receptors are present in skin, viscera,
muscles, joints and meninges to detect a range of
stimuli, which may be mechanical, thermal or
chemical in nature.

26. There are two main types of nociceptors:
C-fibres are the most common type and are slow
to conduct and respond to stimuli. As the proteins
in the membrane of the receptor convert the
stimuli into electrical impulses that can be carried
throughout the nervous system.
A-delta fibers are known to conduct more rapidly
and convey messages of sharp, momentary pain.
Additionally, there are silent nociceptors that are
usually unresponsive to stimuli but can be
“awoken” with high-intensity mechanical stimuli
in response to chemical

27. The perception of pain results from processing
of the electrical signals in various regions of the
brain. This explains the varied responses and
emotional reactions when an individual
experiences pain
Body modulates pain through several processes,
including endogenous opioid system.

28. Pain types and classification
 There are several ways to categorize pain. One is
to separate it into acute pain and chronic pain.
Acute pain typically comes on suddenly and has
a limited duration. It's frequently caused by
damage to tissue such as bone, muscle, or
organs, and the onset is often accompanied by
anxiety or emotional distress
 Acute pain (eg, surgery, trauma, labor, and
medical procedures) usually is nociceptive.

29.  Chronic pain lasts longer than acute pain and is
generally somewhat resistant to medical
treatment. It's usually associated with a long-
term illness, such as osteoarthritis. In some cases,
such as with fibromyalgia, it's one of the defining
characteristic of the disease. Chronic pain can be
the result of damaged tissue, but very often is
attributable to nerve damage.
 Chronic pain can be nociceptive, neuropathic

30. Both acute and chronic pain can be debilitating,
and both can affect and be affected by a person's
state of mind. But the nature of chronic pain - the
fact that it's ongoing and in some cases seems
almost constant - makes the person who has it
more susceptible to psychological consequences
such as depression and anxiety. At the same time,
psychological distress can amplify the pain.

31. **Pain is also classified by the type of tissue that's
involved or by the part of the body that's affected.
For example, pain may be referred to as muscular
pain or joint pain. Or a doctor may ask you about
chest pain or back pain.

32. CLINICAL PRESENTATION
SIGNS AND SYMPTOMS
Acute pain may be:
Sharp or dull Burning, Shock like,
Tingling, Shooting, Radiating, Fluctuating
in intensity & Varying in location.
Occurring in timely relationship with
obvious noxious stimulus.
Chronic pain can present similarly and
often occurs without time relationship to
noxious stimulus.
Over time, chronic pain presentation may
change (e.g. sharp to dull, obvious to
vague).
Acute pain can cause:
Hypertension, Tachycardia, Diaphoresis,
Mydriasis & Pallor.
These signs seldom present in chronic pain

33. Pain assessment
Practice essentials
Precise and systematic pain assessment is required to make
the correct diagnosis and determine the most efficacious
treatment plan for patients presenting with pain.
Techniques
Pain must be assessed using a multidimensional approach,
with determination of the following:
Onset: Mechanism of injury or etiology of pain, if identifiable
Location/Distribution
Duration
Course or Temporal Pattern
Character & Quality of the pain
Aggravating/Provoking factors
Alleviating factors
Associated symptoms
Severity: Intensity or impact on function, sleep, mood

34. Management of pain
Prevention
Trying to prevent pain before it happens can be dangerous.
Acute pain is an important message that is essential to
survival. Some people are born with a rare disorder
(congenital analgesia) and do not feel pain. They live in great
danger because they miss warning signals that could mean
life or death.
Once the cause of pain is diagnosed, it may be possible to
prevent the pain from coming back. For instance, a person
diagnosed with a stomach ulcer can take medications to heal
the ulcer and prevent continuation of the pain

35. Treatment
Your doctor probably will treat your pain while he
or she tries to figure out the cause. Many drugs are
helpful, though how well they work depends on the
patient and the nature of pain.
Analgesics (painkillers) are the most common pain
remedy.
Acetaminophen interferes with pain messages.

36. Aspirin
Ibuprofen
work in two ways:
1. by interfering with pain
messages
2. by reducing inflammation,
swelling and irritation that
can make pain worse.
Non steroidal agents act
mainly as analgesic
ketorolac & ketoprofen

37. Narcotic pain relievers:
Such as Hydrocodone ,Oxycodone, Hydromorphone,
Tramadol, morphine, codiene & nalbuphine.
are the most powerful pain treatments. These usually are
reserved for the most intense pain. They can cause serious
side effects, can be addictive and often cause constipation.

38. Other drugs
such as
anesthetics, antidepressants, anticonvulsants and
corticosteroids may work against certain types of
pain.
Sometimes medications are injected directly into
the region of pain or near a nerve to interrupt the
pain signal.

39. Non-drug treatments for pain include:
Acupuncture, Massage, Relaxation & psychotherapy
Transcutaneous electrical nerve stimulation (TENS),
which uses electrical impulses to stimulate the
nerve endings at or near the site of pain
Non-drug treatments may be especially useful for
people with chronic pain.

40. In some cases, these treatments may stimulate
natural painkillers, called endorphins, which are
created within the body. In other cases, non-drug
treatments work directly on nerves to interfere with
pain messages. Sometimes, it isn't clear why the
pain stops.

41. When To Call a Professional?
• Pain means some kind of problem exists. And
while different people tolerate different degrees of
pain, you should never ignore pain. Consult a
doctor if you cannot determine why you are
experiencing pain, if pain continues or if it doesn't
respond to simple treatment

42. COUGH

43. Cough
A cough is a common reflex action that clears
the throat of mucus or foreign irritants.

44. Cough
• cough that lasts for less
than three weeks
Acute cough
• A cough that lasts between
3 and 8 weeks
Sub acute
cough
• cough that lasts more than
eight weeks
Chronic
cough

45. Causes of Cough
1-Clearing the throat:
When your airways become clogged with mucus or
foreign particles such as smoke or dust, a cough is
a reflex reaction that attempts to clear the particles
and make breathing easier.

46. Causes of Cough
2-Respiratory tract infection
Bacteria
• Pneumonia
• pertussis
Virus
• Common cold
• flu

47. Causes of Cough
3-Smoking:
Smoking is common cause of coughing. A cough
caused by smoking is almost always a chronic
cough with a distinctive sound. It’s often known
as “smoker’s cough.”

48. Causes of Cough
4-Asthma:
A common cause of coughing in young children is asthma.
It’s possible for children to grow out of asthma as they get
older.

49. Causes of Cough
5-Medicines:
Some medications will cause coughing such as
Angiotensin-converting enzyme (ACE) inhibitors,
commonly used to treat high blood pressure and heart
conditions such as captopril, lisinopril and enalapril. The
coughing stops when the medication is discontinued.

50. Causes of Cough
6-Other conditions:
damage to the vocal cords.
postnasal drip.
Gastroesophageal reflux disease (GERD). In this condition,
stomach contents flow back into the esophagus.

51. Classification of cough:
Wet cough
(Productive cough)
Dry cough
(Nonproductive cough)
Definition There is production of phlegm
and sputum.
There is no secretion of
phlegm or mucus. Dry
cough causes a lot of
irritation and itchiness in
the throat.
Causes
Wet cough occurs when a
pathogen enters the
respiratory system or occurs
when an infection leads to
bronchitis or pneumonia.
Dry cough is a result of
asthma, gastroesophageal
reflux, smoking & use of
medications like ACE
inhibitors and dust and
pollen.
Treatment
Mucolytic and expectorants
soften the mucus and expel it
easily.
Antitussives (cough
suppressant) help in
suppression and treatment
of dry cough.

52. Management of cough
1-Keep hydrated by drinking plenty of
water.
2-Elevate your head with extra pillows
when sleeping.
3-Take warm, steamy showers to help
soothe the cough.

53. Management of cough (cont.)
4-Gargle hot salt water regularly to
remove mucus and soothe your throat.
5-Avoid irritants, including smoke and
dust.
6-Add honey or ginger to hot tea to relieve
your cough and clear your airway.
Never give honey to a child under one year
(baby can get botulism by
eating Clostridium botulinum spores found
honey).

54. Management of cough (cont.)
7-There is no evidence that milk product
worsen the sputum production.
8-The FDA advises against giving cold &
cough medicine to children under age 2,
Death can occur from the misuse of cough
and cold medicines in very young children.

55. Treatment of cough:
1-Home remedies.
2-Avoid triggers.
3-Time: Sometimes, the cough can last weeks
or months after the virus is gone. Over time
your airways will heal and the cough will stop.
4-Treatment for another problem.
5-Medicines: Suppressants and Expectorants.

56. Drugs used to treat cough
A)Dry cough preparations
1-Dextromethorphan:
Dextromethorphan is a cough
suppressant.
It affects the signals in the brain that
trigger cough reflex.
Important information:
1-Do not give dextromethorphan to a
child younger than 4 years old.

57. A)Dry cough preparations (Cont.)
2-Do not use dextromethorphan if you
have used an MAO inhibitor such as
isocarboxazid and selegiline within the
past 14 days.
3-It is contraindicated in pregnancy
&breast-feeding.

58. A)Dry cough preparations (Cont.)
2-Pholcodine:
It is a cough suppressant for the
relief of acute non-productive
cough associated with upper
respiratory tract infections.
Important information:
The dosage may be repeated after 4
hours if required but not more than
4 doses in any 24 hours.

59. A)Dry cough preparations (Cont.)
Contraindications of Pholcodine :
1-liver & renal failure patients.
2-patients in risk of developing respiratory failure.
3-Do not use pholcodine if you have used an MAO inhibitor
within 2 weeks.
4-Children under 6 years of age.

60. A)Dry cough preparations (Cont.)
3- Butamirate:
It is centrally acting cough suppressant with
bronchospasmolytic, used in non productive
cough.
Dose:
Pediatric:7-15dp/8hrs.
Children(3-6yrs):5ml/8hrs.
Adult:15ml/8hrs.
Note:
Only take Butamirate Syrup during the second or
third trimester of pregnancy.

61. A)Dry cough preparations (Cont.)
4-pipazethate:
It suppresses the cough center and has also bronchodilator
effect.
Dose:
Up to 2 years 4 drops /8 hrs.
2-6 years 1supp. or 8 drops/8 hrs.
Adult 1 tab./8hrs.

62. B)Wet cough preparation:
1-Ambroxol Hydrochloride:
• Ambroxol is the active
metabolite of bromohexine
hydrochloride.
• The onset of action occurs after
about 30 minutes.
• It makes the sputum thinner and
less viscous and therefore more
easily removed by coughing.

63. B)Wet cough preparation (cont.):
Important information of ambroxol:
1-It is advisable to avoid use during the first
trimester of pregnancy.
2-safe for children <2 years (dose 2 cm every 8
hours)

64. B)Wet cough preparation (cont.):
2-carbocisteine:
It is mucolytic agent by reducing the
viscosity of sputum.
Note:
It should be used in caution in patient
with peptic ulcer

65. B)Wet cough preparation (cont.):
3) Acetyl Cysteine:
Dose: dissolve one sachet in 100
ml water 3 times after meals.
Precautions:
Like ambroxol and carbocisteine used
with caution in asthmatic patient and
patients with history of peptic ulcers
,because mucolytic may disrupt
the gastric mucosal barrier

66. B)Wet cough preparation (cont.):
4- Guaifenesin:
Guaifenesin is an expectorant. It
works by thinning and loosening
mucus in the airways, clearing
congestion, and making
breathing easier.

67. B)Wet cough preparation (cont.):
Mucolytic with bronchodilator:
When cough is accompanied with
bronchospasm or difficulty in breathing.
Example:
All-Vent syrup:
It contain bromohexine + guaiphensin +
terbutaline sulphate + menthol.
Dose:
Children:2.5-5 ml./8hrs.
Adult:15ml./8hrs.

68. Cough preparation contain herbal
extract:
These drugs are suitable for pregnant,
nursing mothers & patients with liver or
kidney impairment.
Examples :
1-Bronchicum:
It contain primula root fluid extract and
thyme fluid extract

69. Cough preparation contain herbal extract
(cont.):
2-Balsam syrup:
Guava, Thyme, Tilia, Fennel &honey
3-Ivypront:
Dried Ivy leaves extract

70. Coughing Up Blood (Hemoptysis)
Causes:
•Bronchitis •Bronchiectasis
•Lung cancer •anticoagulant drugs
•Pneumonia •Tuberculosis
•Trauma •Autoimmune diseases

71. Coughing Up Blood (Hemoptysis)
Treatments for Hemoptysis:
•Antibiotics for pneumonia or tuberculosis.
•Chemotherapy and/or radiation for lung cancer.
•Steroids for inflammatory conditions.

72. Common cold

73.  The common
cold is a viral
infection of the
nose and throat
(upper
respiratory tract).
 More than 200
types of viruses
cause common
cold include
Coronavirus Influenza
virus
parainfluenza RSV

74. Rhinovirus
which is thought to be responsible for at least 50% of
colds

75. Mode of transmission
 Through droplets in the air
• sharing contaminated
objects
• Hand to hand contact
with infected people

77. Risk factors
 Age: Children younger than six are at
greatest risk of colds, especially if they
spend time in child-care settings.
 Weakened immune system: Having a
chronic illness or otherwise weakened
immune system increases the risk.
 Time of year: Both children and adults
are more susceptible to colds in fall
and winter.

78. Risk factors
 Exposure: If you're around
many people,
such as at school or on an
airplane
 Smoking: You're more
likely to catch a cold and
to have more severe colds
if you smoke.

79. When to see a doctor

80. • Fever greater than 38.5 C.
or lasting five days or
more or returning after a
fever-free period
• Severe headache or sinus
pain
• Shortness of breath,
Wheezing

81. Complications
• This occurs when bacteria or viruses
enter the space behind the eardrum
Otitis media
• A cold can trigger an asthma attack.Asthma
• These include streptococcal pharyngitis,
pneumonia or bronchiolitis.
Other secondary
infections

82. Treatment
 There's no cure for the
common cold.
 Antibiotics are of no
use against cold viruses
and shouldn't be used
unless there's a
bacterial infection.
 Treatment is directed at
relieving signs and
symptoms.

83. Non pharmacological treatment

84. Drinking plenty of fluids Resting
Saline nasal sprays and saline drops Gargling can moisten a sore
throat

85. Pharmacological treatment

86.  Analgesics and antipyretics
acetaminophen or NSAIDs.

87.  Antihistamines
 Chlorpheniramine, diphenhydramine, and
loratadine help to dry secretions, but impair
clearance of thick mucus.

88.  Over-the-counter oral decongestants
 containing pseudoephedrine and phenyl ephedrine can
help dry and clear nasal passages, but may
increase blood pressure and heart rate.

89.  Some OTC oral decongestant don't contain
antihistamines to avoid sedation during
day

90.  Nasal Decongestant
 like oxymetazoline, naphazoline, and
xylometazoline
 for more than 3 to 5 days, they may cause a
"rebound" effect. That worsen congestion.

91.  Local anesthetics lozenges and sprays.

92.  Cough syrups
 Cough suppressant such as dextromethorphan.
 Expectorants as guaifenesin.

93.  Vitamin C high dose only in prevention.

94. For pregnant

95.  Avoid all in one OTC
preparations, treat symptoms
separately
• Acetaminophen as analgesic.
• Herbal or
mentholated
throat
lozenges in
order to ease a
cough or sore
throat.

96. Decongestants:
1-Nasal: Oxymetazoline, phenylephrine,
naphazoline, and xylometazoline are
pregnancy category C.
2-Oral Pseudoephedrine and phenylephrine
are pregnancy category C they
are vasoconstrictors and may lead to
impaired blood flow to the fetus.

97. Prevention
Frequent Hand Washing
healthy lifestyle
Avoid contact with infected
people

99. Symptoms Cold Flu
Causative organisms
Most common rhinovirus
Others: coronavirus, respiratory
syncytial virus, influenza and
parainfluenza
Influenza virus types A, B, and C
Type A and B viruses cause the
large seasonal outbreaks.
Fever low grade fever
Usual; higher (<38.5
especially in young children);
lasts 3 to 4 days
Headache Less common Common
General Aches, Pains Slight Usual; often severe
Stuffy Nose, Sneezing Common Less common

100. Cold Flu
Sore Throat Common Sometimes
Chest Discomfort,
Cough
Mild to moderate Common; can become severe
Complications Sinus congestion; Otitis media
Sinusitis, bronchitis, pneumonia; can
be life-threatening
Prevention
• Wash hands often
• avoid close contact with anyone
with a cold
• Wash hands often; avoid close
contact with anyone who has flu
symptoms
• get the annual flu vaccine
Treatment
Decongestants, analgesics
,antipyretics
• Decongestants, analgesics,
antipyretics
• Antiviral drugs for flu may be given
in some cases.

102. It is a systemic disease
affecting the upper respiratory
system with prominent nasal
symptoms in response to
second exposure to allergens.

103. 1- Outdoor aeroallergens
i.e. pollutants(diesel exhaust particles)

104. Outdoor aeroallergens
i.e pollen,mold spores

105. Indoor aeroallergens
i.e house dust mites

106. Indoor aeroallergens
i.e. mold spores

108. The pathogenesis of allergic rhinitis is complex.

110. Classification of allergic rhinitis

111. Environmental or occupational rhinitis strong odors or cold air
Infectious rhinitis a)acute sinusitis viral infection last up
to 10 days
b)chronic sinusitis it is bacterial
infection lasts up to12 weeks
Hormonal Pregnancy, puberty, thyroid disorders
Drug Induced Cocaine, beta blockers, ACEIs,
chlorpromazine, clonidine, reserpine,
hydralazine, oral contraceptives,
aspirin or other NSAIDs, overuse of
topical decongestants
Structural Septal deviation, adenoid hypertrophy
Traumatic Recent facial or head trauma
Gustatory rhinitis hot or spicy foods
Causes of non allergic rhinitis

112.  Allergic rhinitis cannot be cured. The goal
of therapy is to reduce symptoms and
improve the patient’s functional status .
 Allergic rhinitis is treated in three steps:
 allergen avoidance
 pharmacotherapy
 immunotherapy

113.  1-reducing the mite population in
mattress,pillows
 2- lowering the household humidity to
less than 40%
 3-applying acaricides
 4-reducing mite harboring dust by
removing carpets, upholstered
furniture.

114.  Ventilation systems with HEPA filters
remove pollen, mold spores, and cat
allergens from household air.
 Filters need to be changed regularly to
maintain effectiveness.
 HEPA filters are also found in some
vacuum cleaners. Weekly vacuuming of
carpets, drapes, and upholstery,

115. *
 1-Intranasal corticosteroids
 2-Oral antihistamincs
 3-Oral leukotrien receptor antagonist
 4-Intranasal antihistaminics
 5-Decongestants
 6-Intranasal mast cell stabilizers
 7-Intranasal anticholinergics
 8-combination therapy
*2015 American academy of otolaryngology-head and neck surgery
foundation(AAO-HNSF) guidelines for allergic rhinitis

116. )
It is first line treatment for
most symptoms of allergic
rhinitis such as itching, rhinitis,
sneezing, and congestion.

118. Intranasal corticosteroids
 Beclomethasone(Qnasal) dry nasal
aerosol is the first non aquous nasal
formulation available.

119.  are indicated for relief of symptoms of
allergic rhinitis (e.g., itching, sneezing,
and rhinorrhea)
 Second generation, peripherally
selective i.
 e.acrivastine,ebastine,
loratadine,cetrizine
 Third generation i.e. levocetrizine
,desloratidine,fexofenadine

121. Oral leukotriene receptor
antagonist
 Montelukast is the only approved oral leukotriene
receptor antagonist for use in seasonal and
perennial allergic rhinitis

122. Intranasal antihistamines
 i.e. Azelastine
 They ara targeted
delivery drugs
Decongestants

123. Intranasal mast cell
stabilizers
 useful for patients with
specific known allergy
and are planning to be in
contact with that allergen
so it is given 30 minutes
before allergen exposure
Intra nasal anticholinergics
 Ipratropium (atrovent)
 relieving persistent
rhinorrhia and congestion
symptoms

124. Nasal wetting agents
 relieve nasal mucosal irritation and
dryness, thus decreasing nasal
stuffiness, rhinorrhea, and sneezing.

125. Subcutaneous
immunotherapy SCIT
First allergen skin testing
identifies a person’s
allergic triggers. A
personalized vaccine is
then formulated using all
natural protein extracts.
This extract is then
administered
subcutaneously with small
doses by developing
immunity or tolerance to
the allergen.

126.  Another form of allergy immunotherapy
was recently approved in the United
States called sublingual immunotherapy
(SLIT) allergy tablets
 one is for dust mites and one is for short
ragweed and two for grass pollen allergy
tablets

128.  Omalizumab (Xolair)
 shown effectiveness in
reducing nasal
symptoms and improving
quality of life.
 It only limitation yet is its
high cost.