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Flashcards in ENT Allergy Deck (22)
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1

Why has the incidence of allergies been increasing rapidly since the 1960's?

Better hygiene, less exposure to environmental antigens, diet is becoming more processsed

2

What are risk factors for allergy?

Host factors:

Heredity

Race

Age

Environmental Factors:

Alterations in exposure to: Infectious diseases during early childhood, environmental polution, allergen levels, dietary changes

 

Occupational:

Flour

Latex

Wood Dust

 

3

What is allergy involving the a) skin, b) Upper respiratory, c) Lower respiratory, d) systemic

referred to as ?

A) Urticaria / angioedema

B) Rhinitis

C) Asthma

D) Anaphylaxis

4

What is allergic rhinitis associated with?

Asthma

Atopic dermatitis

5

What are symptoms of allergic rhinitis?

 

Immediate : sneezing, itch, nasal blockage, rhinorrhoea (a condition where the nasal cavity is filled with a significant amount of mucus fluid)

Late : chronic obstruction, hyposmia, hyperreactivity

6

What is an allergen?

antigen that causes allergic reactions

Usually a protein

7

What type of hypersensitivity reaction is allergy?

Type 1

8

What is the process of an allergic reaction?

Sensitization:

- Plasma cells produce IgE

- Bind to mast cells

 

Re - exposure:

Mast cells degranulate

Release histamine, leukotrines, prostaglandins and chemotactic factors

9

What is the result in mast cell degranulation?

Exaggerated response that causes damage to the host

Release of Histamine, leukotrienes, prostaglandins, chemotactic agents.

This has the effect of vasodilation, vascular permeability, smooth muscle contraction, leukocyte infiltration especially eosinophils

10

What is the acute phase and the late phase response of allergy?

Acute response:

Degranulation of mast cells, release of histamines, cytokines, leukotrines, interleukins, prostaglandins - systemic effects such as vasodilation, mucus secretions, nerve stimulation and smooth muscle contraction

 

Late phase response: 

2-4 hours

Due to migration of other leukocytes such as neutrophils, lymphocytes, eosinophils and macrophages to the initial site.

11

What is allergic rhinitis?

Allergic inflammation of the nasal airways

 

Occurs when the allergen is inhaled by an individual with a sensitized immune system

12

What does ARIA stand for?

Allergic rhinitis and its Impact on Asthma

13

What makes up intermittent / persistent classification of allergic rhinitis?

 

Intermittent = less than 4 days per week or less than 4 consecutive days

Persistent = Over 4 days per week and more than 4 consecutive days

14

What is the classification for mild allergic rhinitis?

 

Normal sleep

No impairment of daily activities, sport, leisure

No impairment of work and school

Symptoms present but not troublesome

15

What is the classification of moderate - severe allergic rhinitis?

 

Sleep disturbance

Impairment of daily activities, sport and leisure

Impairment of work / school

Troublesome symptoms

16

What is the diagnosis of allergic rhinitis?

 

Skin test

RAST (Radioallergosorbent testing (RAST) detects allergen specific IgE in the blood. They are used when skin prick tests (the preferred allergy test) is not suitable or not available)

17

What are other allergy investigations?

Total serum IgE

Nasal allergen Challenge

Nasal cytology

18

What is the treatment of allergic rhinitis?

Allergen avoidance

Pharmacotherapy 

  • Topical intranasal steroids
  • Systemic steroids
  • Antihistamines
  • Sodium cromoglycate (a synthetic non-steroidal anti-inflammatory drug, inhaled to prevent asthmatic attacks and allergic reactions.)
  • Allergen immunotherapy
  • Anti - IgE

Immunotherapy

19

What is the treatment for mild intermittent symptoms of allergic rhinitis?

 

Oral H1 blocker

OR

Intranasal H1 blocker and/or decongestant 

OR

LTRA

20

What is treatment for moderate severe intermittent symptoms / mild symptoms of persistent allergic rhinitis?

Oral H1 receptor blocker

OR 

Intranasal H1 blocker and/or nasal decongestant

OR intranasal Corticosteroid

OR 

LTRA

 

In persistent rhinitis review the patient after 2 - 4 weeks

 

If failure step up

If imporved - continue for one month

21

What is the treatment for moderate - severe persistent rhinitis?

Intranasal ICS

+

H1 blocker / LTRA

Review after 2 - 4 weeks 

If improved - step down and continue treatment for one month

Failure - review diagnosis, review compliance, look for infections or other causes

THEN - 

 

Add or increase intranasal CS dose

Rhinorrhea - add ipratropium

Bockage - Decongestant or oral corticosteroid (short term)

 

Failure - refer to specialist

22

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