Asthma, Allergy Flashcards by Lauren Ames

type of allergic reaction (immune mediated pathway) involved in hemolytic anemia

Type II

How well did you know this?

Not at all

Perfectly

first line therapy for eczema

emollients and moisturizers

How well did you know this?

Not at all

Perfectly

Type I hypersensitivity mediated by what?

IgE

How well did you know this?

Not at all

Perfectly

What three things are released with Type I hypersensitivity

histamine, leukotriene, prostaglandin

How well did you know this?

Not at all

Perfectly

histamine responsible for what?

bronchoconstriction, bronchial smooth muscle contraction vasodilation, local pain/pruritis (immediate)

How well did you know this?

Not at all

Perfectly

leukotrienes responsible for what?

Powerful bronchoconstricton, sustains inflammation (more long term)

How well did you know this?

Not at all

Perfectly

prostaglandins responsible for what?

smooth muscle constriction, inflamm. mediation

How well did you know this?

Not at all

Perfectly

Types of type I HS reactions

atopic dermatitis
urticaria
allergic rhinitis
anaphylaxis
food allergies
PCN allergy

How well did you know this?

Not at all

Perfectly

Type II HS reactions involve what

antibody response

How well did you know this?

Not at all

Perfectly

Type II HS mediated by

IgM, IgG, IgA

binds to patients own cells

How well did you know this?

Not at all

Perfectly

What gets activated by type II reactions

complement pathway and B cell response

lysis of cells releases anaphylactoxins, which trigger mast cell degranulation

How well did you know this?

Not at all

Perfectly

Examples of type II reactions

hemolytic anemia, thrombocytopenia, graves disease, rheumatic fever, myasthenia gravis, idiopathic thrombocytopenic purpura

How well did you know this?

Not at all

Perfectly

type III reactions involve what

antigen-antibody complexes form (immune complex)

How well did you know this?

Not at all

Perfectly

examples of type III HS reactions

serum sickness, Henoch-Schonlein purpura, post streptococcal glomerulonephritis, SLE

How well did you know this?

Not at all

Perfectly

Type IV reactions involve what

cellular immune mediated or delayed hypersensitivity

How well did you know this?

Not at all

Perfectly

In type IV sensitivity, what recognizes antigens?

sensitized T cells

How well did you know this?

Not at all

Perfectly

This type of HS is usually seen with contact allergies, but can be autoimmune (DM I, hashimoto, MS, celiac disease)

type IV

How well did you know this?

Not at all

Perfectly

Over 80% of patients with atopic dermatitis will develop these two things:

asthma and allergic rhinitis (ATOPIC TRIAD)

How well did you know this?

Not at all

Perfectly

the majority of patients with atopic derm have elevated levels of this

IgE

How well did you know this?

Not at all

Perfectly

Presence of atopic derm in young kids vs toddlers

younger- face, neck folds, EXTENSOR surfaces

older- FLEXOR lichenification

How well did you know this?

Not at all

Perfectly

kid comes in with pruritic, erythematous papules with associated excoriations and vesiculations

atopic dermatitis

How well did you know this?

Not at all

Perfectly

pt comes in with erythematous papules over groin and axillary, with linear lesions

scabies

How well did you know this?

Not at all

Perfectly

kis comes in with yellow scales on the scalp that didnt itch

seborrheic dermatitis

How well did you know this?

Not at all

Perfectly

kid comes in with coin shaped lesions

nummular eczema

How well did you know this?

Not at all

Perfectly

treatment for atopic dermatitis

rehydration therapy: moisturizers and occlusives (emollients, ointments- NOT lotion) topical corticosteroids: fluticasone, tacrolimus

what type of HS reaction can cause urticaria

type I HS

Raised, red, itchy lesions on the skin that often come and go and can coalesce together in to larger, red, itchy areas. Unlike other rashes, these come and go and move about the skin. Superficial dermis.

urticaria

edema extending into deep dermis or subcutaneous tissues

angioedema

Angioedema resolves faster than urticaria. T or F

False... Ang takes 72 hours, urticar takes 24 hours

serious complication of type I HS. Rapid onset, serious allergic reaction in a previously sensitized patient

anaphylaxis

Patient comes in withGeneralized pruritus, anxiety, urticaria (very common), angioedema, throat fullness, dyspnea, hypotension, and collapse. May present with severe abdominal cramps, vomiting.

anaphylaxis

Anaphylaxis ia a systemic response. T or F

True

First line treatment for anaphylaxis

epinephrine Other options after epi: diphenhydramine, corticosteriods, vasopressors

three most common antibiotic causes of cutaneous drug reactions

amox, bactrim, ampicillin

How do you distinguish between serum sickness and anaphylaxis?

FEVER and delayed response (7-21 days after if new, 1-4 days after if sensitized)

Pt comes in with fever, rash, lymphadenopathy, myalgias and arthralgias. What do you think?

serum sickness

treatment for serum sickness

corticosteroids (MAINSTAY), antihistamines, epi (if severe)

Patient comes in with a papular, rough, sandpaper rash. What do you think?

contact dermatitis

what type of HS reaction is a latex allergy?

type I

Patients with this condition have a unique sensitivity to latex

spina bifida

food allergy is what type of HS

type I

Food allergies- who has the highest prevalence

children with moderate to severe atopic dermatitis

Most common food allergens in young children

eggs, milk, peanuts, tree nuts, soy and wheat

most common food allergens in adolescents and older children

fish, shellfish, nuts- may be lifelong

how long does it take for food allergy reactions to occur

minutes to 2 hours

cutaneous reactions to insect bites include

urticaria, papulovesicular eruptions - mosquitos, fleas, bedbugs

what can you prescribe to someone with allergic rhinitis

zyrtec, allegra

Transient wheezing is common in infancy and during preschool. True or false?

TRUE. associated with viral infections, smaller airways

which area of the respiratory tract does asthma affect?

lower respiratory tract- a bronchiole problem

Causes of cough in the first months of life

``` CF Resp tract infection Aspiration Dyskinetic cilia Lung or airway malformations Edema (heart failure, CHD) ```

the narrowing that occurs in asthma is caused by three major factors:

inflammation bronchospasm hyperreactivity

most common chronic illness in children

asthma

is asthma reversible? is COPD reversible?

asthma yes COPD no

Pt comes in with intermittent dry cough, expiratory wheezing, shortness of breath, chest tightness, limited exercise tolerance. What do you suspect

asthma

PE on pt revealed expiratory wheezing and prolonged expiration. Tachypnea, retractions, distress. What do you think

Asthma (acute)

To document asthma, lung function testing should show what

diurnal variation

Asthma symptoms may be differentiated into which three categories?

daytime (cough, dyspnea due to allergens, cold, heat) exercise nocturnal (tussive spells, nocturnal dyspnea/chest tightness)

CXR reveals hyperinflation, flattening of the diaphragm, peribronchial thickening, prominence of pulm arteries, areas if patchy atelectasis

asthma

this pt has daytime asthma symptoms less than 2 days a week and nighttime symptoms less than 2 times a month. How will you treat her?

no daily meds, give her a bronchodilator PRN | she has mild intermittent asthma

this patient has daytime asthma symptoms more than 2 days a week (but not everyday) and nighttime symptoms more than 2 times a month. How will you treat her?

daily low-dose inhaled corticosteriods, plus the rescue bronchodilator PRN she has mild persistent asthma

this patient has daytime asthma symptoms everyday and nighttime symptoms more than 1 time a week. How will you treat this?

A daily low dose inhaled corticosteroid plus a LABA or medium dose inhaled corticosteroid, plus the rescue bronchodilator PRN Moderate persistant

This pt has continual daytime asthma symptoms and frequent symptoms at night. How do you treat

daily high dose inhaled corticosteroid, LABA, oral corticosteroids, plus their resue inhaler PRN Pulm/allergy consults are VITAL severe persistant

asthma severity and control are assessed based on 2 domains

impairment (present) and risk (future)

ACT score below 19 means what

uncontrolled asthma

first choice treatment for all initial persistent forms of asthma

ICS, azmacort, vanceril, AeroBid, Flovent, pulmicort

these drugs can be used as a second indication for asthma with allergies

leukotriene inhibitors (singulair and accolate)

You can add these to ICS to relax airway smooth muscle. Not to be used as monotherapy

LABA (serevent) | fluticasone/salmeterol= advair

these two drugs can be used for long term asthma control, but are not used very often

aminophylline or theophylline

Rescue treatments for asthma can include

SABA (albuterol, levalbuterol) Anticholinergics (inhaled- ipratropium bromide) Corticosteroids

how long should asthma be controlled before stepping down therapy

3 months

At which step of therapy should you consider referral to an asthma specialist?

step 4 or higher, step 3 for children 0-4 years of age

T or F: every patient with intermittent asthma should have a written home management plan

FALSE. persistant asthma should

severe complication of asthma, not responsive to treatment, FEV1 and peak expiratory flow less than 50%

status asthmaticus

pt comes in with severe bronchospasm, excessive mucus secretion, inflammation, and edema of airways. Won't respond to treatment

status asthmaticus

first line treatment for status asthmaticus

humidified O2 inhaled b2 agonist (systemic corticosteroids, inhaled anticholinergic bronchodilators, IV beta agonists)

use epi to treat status epilepticus, yes or no?

NO, unless associated with anaphylaxis