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Flashcards in Allergic Disorders Deck (43):
1

nasal turbinates: swollen (boggy), pale, bluish-gray
itchy eyes, itchy nose, nasal congestion, rhinorrhea (thin, watery) sneezing
no LAD
present most days, worse in fall + spring

allergic rhinitis

2

treatment of allergic rhinitis

can be used in combo:
avoid allergen (DOC, most successful tx)
antihistamines (if nasal + conjunctivitis)
decongestants (cold sx, if topical - can cause rebound congestion if excessive use)
intranasal steroids (if only nasal sx, most consistent symptomatic relief)
oral (systemic) CS if severe
immunotherapy

3

inflammation of nasal membranes (rhinitis) +/- eyes, eustachian tube, middle ear, sinuses, pharynx
sneezing, nasal congestion, nasal + eye + ears itchy, rhinorrhea, postnasal drip
tearing, red eyes
anosmia (lack of smell), HA, earache, drowsy

allergic rhinitis

4

rapidly progressing, life-threatening allergic reaction, mediated by IgE immediate HSR
urticaria or angioedema, SOB, visceral edema, hypotension + shock (widespread vasodilation, respiratory distress from bronchospasm or laryngeal edema, GI and uterine muscle ctx)

anaphylaxis

5

most common cause of rhinitis

allergic rhinitis

6

allergic sensitization: foreign protein exposure → IgE against protein coats mast cells in nasal mucosa
2nd exposure: allergen binds to IgE on mast cells → release of mediators
immediate release: histamine, tryptase, chymase, kinase
mast cells synthesize some immediately: LK, PGD2
immediate symptoms: ↑ mucous secretions, vasodilation → congestion, sensory nerves: sneeze, itch, conjunctivitis, postnasal drip, ear pressure
next 4-8 hrs: mediators recruit PMN, eosinophils, lymphs, macrophages to mucosa
symptoms for hrs-days: increase congestion, mucous, fatigue, sleepy, malaise

allergic rhinitis

7

allergic rhinitis consistent level throughout the year

perennial rhinitis

8

allergic rhinitis only during specific seasons (pollens, outdoor molds)

seasonal rhinitis (can have perennial with seasonal exacerbations)

9

allergic rhinitis during job

occupational rhinitis

10

response to antihistamines supports diagnosis of:

allergic rhinitis

11

spores, animals, cleaning, pollen
smoke, pollution, strong smells

allergic rhinitis triggers

12

dark circles around eyes due to vasodilation and/or nasal congestion

allergic shiners

13

horizontal crease across bridge of nose - rubbing tip of nose by palm of hand

allergic salute
nasal crease

14

thick, purulent nasal secretions

sinusitis (can also occur in allergic rhinitis)

15

thin, watery nasal secretions

allergic rhinitis

16

firm, gray masses attached by a stalk (may not be visible)
does NOT shrink after spraying topical decongestant (surrounding nasal mucosa does shrink)

nasal polyp

17

septal deviation or perforation caused by

chronic rhinitis
granulomatous disease
cocaine abuse
prior surgery
topical decongestant abuse
topical steroid overuse

18

tympanic membranes:
TM retraction
air-fluid levels
bubbles
altered mobility with pneumatic otoscopy

allergic rhinitis with eustachian tube dysfunction or secondary otitis media

19

injection + swelling of palpebral conjunctivae
excessive tear production
creases below inferior eyelid (Dennie-Morgan lines)

allergic rhinitis

20

cobblestoning of posterior pharynx: streaks of lymphoid tissue on posterior pharynx
tonsilar hypertrophy

allergic rhinitis

21

wheezing, ↑ RR, prolonged expiratory phase of respiration

asthma

22

tree pollens: worse in spring (some in fall)
grass pollens: most are cross-reactive, worse in late spring to fall
weeds: ragweed (worse in late summer to fall)

seasonal allergic rhinitis

23

home allergens: dust mite (clean to remove), indoor pets (also cockroaches)
year-round outdoor allergens (warmer climate: grass) or trees/grass in summer, mold/weed in winter

perennial allergic rhinitis

24

SE of first gen antihistamine: diphenhydramine, chlorpheniramine, hydroxyzine

sedation, anticholinergic (dry mouth + eyes, blurred vision, urinary retention) - caution if elderly

25

SE of second gen antihistamines: loratadine, desloratadine, fexofenadine, cetirizine

less sedation (except cetirizine)
less anticholinergic SE (good if BPH - urinary retention)
as effective as first-gen antihistamines
more expensive
available OTC

26

mild, intermittent symptoms of allergic rhinitis
med takes effect within 15-30 minutes after ingestion

antihistamines PO

27

med for nasal congestion
constrict blood vessels of nasal mucosa

decongestant PO or intranasal (risk of rebound congestion)

28

SE of pseudoephedrine: α receptor agonist (decongestant)

↑ HR, tremor, insomnia
rebound hyperemia, worsening congestion with chronic use or discontinuation of nasal decongestant

29

DOC for long-term management of mild-mod persistent allergic rhinitis
max effect after 2-4 wks of use
↓ mediator production and recruitment of ICs

nasal corticosteroid

30

SE of nasal corticosteroids

nosebleeds
pharyngitis
URIs

31

use: allergic rhinitis, persistent asthma maintenance therapy, if ASTHMA + allergies, allergens trigger asthma

leukotriene inhibitors: zafirlukast, montelukast, zileuton

32

inhibitor of cell-mediated immunity
use: severe allergies

oral corticosteroids

33

SE of oral corticosteroids

suppression of HPA
hyperglycemia
long-term use: peptic ulcer, susceptibility to infection, poor wound healing, reduction of bone density

34

treatment if remain symptomatic despite maximal medical therapy
test for antigens that patient is allergic
inject patient with diluted concentration of antigen
gradually increase concentration to reduce inflammatory response to antigen (given weekly)

desensitization therapy

35

irregular, pruritic, erythematous wheals

urticaria

36

painless, deep, subq swelling that involves periorbital, circumoral, and facial regions

angioedema

37

treatment of anaphylaxis

first suspicion: subq or IM epinephrine (repeat q 15-30 min PRN)
IV fluids (saline, lactated ringer solution, plasma, or plasma expanders) to replace loss of intravascular plasma into tissues
endotracheal intubation if airway obstruction
subq epinephrine or terbutaline: bronchospasm
antihistamine: urticaria, angioedema, pruritus
monitor for 24 hrs

38

infection of palpebral (eyelid) or bulbar (eye) conjuntiva
most commonly caused by virus or bacteria
less common: allergy, chemical
transmission: direct contact via finger, towel, handkerchief

conjunctivitis

39

cause of bacterial conjuncitvitis

staph
strep
H. influenzae
moraxella
pseudomonas

40

eye itching, tearing, redness, stringy clear discharge +/- photophobia

allergic conjunctivitus

41

tx of allergic conjunctivitis

oral antihistamine
topical antihistamine
anti-inflammatory eye drops

42

mild eye discomfort
no blurry vision
lasts 10-14 days if untreated, 2-3 days if use sulfonamide

bacterial conjuncitivitus

43

caused by adenovirus
very contagious: direct contact or fomites
red palpebral conjunctiva
lots of watery discharge
associated with: pharyngitis, fever, malaise, preauricular LAD

epidemic keratoconjunctivitis (pink eye)