Flashcards in Allergies Deck (22)
How long is exposure to an offending agent usually necessary to cause allergies?
What are the early and late phases of an allergic response?
Early - mast cell and basophil mediator release
Late - 4-6 hrs later, cellular influx
What are some classic allergic symptoms?
Associated eye or chest symptoms (pruritis in eyes, nose, throat)
What are some classic non allergic symptoms?
Congestion without sneezing or itching
Minimal eye symptoms
Unilateral, bleeding, or pain are red flags
What does then physical exam in rhinitis focus on in discriminating allergic from nonallergic rhinitis?
Turbinates - allergic is pale blue and edematous, nonallergic is erythematous and edematous
Secretions - allergic are thin and watery, nonallergic is variable
Septum - deviations, spurs, ulcers, perforations
Polyps (loss of smell and taste)
Peri orbital cyanosis = allergic shiners
Denny Morgan lines - extra skin creases under medial aspect of eye
What is vasomotor rhinitis?
A nonallergic rhinitis
Perennial symptoms of nasal obstruction, rhinorrhea, and postnatal drip with little pruritis
Symptoms exacerbated by irritants like strong odors and weather changes
What is rhinitis medicamentosa?
A nonallergic rhinitis
Due to Prolonged (several weeks) use of decongestant sprays which lead to rebound nasal congestion and tachyphylaxis
When is allergen skin testing necessary?
To guide allergen specific immunotherapy
RAST (immunoCAP) testing can detect in vitro specific IgE
What are general indications for allergy testing?
Prior to Specific environmental measures
Patients being considered for allergen immunotherapy
What are typical symptoms of anaphylaxis?
Cutaneous, respiratory, cardiovascular, GI symptoms
Two or more of the above after exposure to allergen within minutes to hours
How can anaphylaxis be diagnosed using blood tests?
Serum tryptase elevated during episode
Specific for mast cells, not really in basophils
Who doesn't require immunotherapy for sting induced anaphylaxis?
Children with cutaneous only reactions
What is anaphylactoid?
Non IgE mediated anaphylaxis response
Anaphylatoxins produced and directly activate mast cells and basophils
Can happen with admin of blood products or IVIG
Other than epinephrine what can be used to treat anaphylaxis?
Supplemental oxygen, IV fluids, maintain airway
H1 and h2 antagonists
What are the indications for using sensitization?
Patients allergic to essential therapeutic agent
Systemic reactions to stinging insects
What are perennial allergens (year round symptoms)?
Warm blooded animals
House dust mites
What are the different categories of medical management of asthma?
Severe persistent - daily anti inflammatory + long acting bronchodilator, evaluation by specialist
Moderate persistent - daily anti inflammatory + long acting bronchodilator
Mild persistent - daily anti inflammatory
Mild intermittent - bronchodilator as needed
What are indications asthma is not being well controlled?
Symptoms more than two days a week
Night time awakenings 1-3 times a week
Some limitation of normal activity
Short acting beta agonist use for symptom control more than 2 days a week
FEV1 60-80% predicted
How can a patient monitor their own asthma?
Use spirometry to assess lung function
Use of peak flow meters - effort dependent
Step and and step down approach
How does anaphylaxis typically present?
Initial signs and symptoms usually cutaneous in nature (urticaria and angioedema)
Episodic wheezing, chest tightness, sob, cough, symptoms worse during exercise or at night