ENT - Allergy

Question 1

What is the incidence of asthma in the UK?

Answer 1

10%

Question 2

Where is asthma most common?

Answer 2

Developed countries

Question 3

Treatment of allergy-related disorders costs how much p/a in Scotland?

Answer 3

£130 million

Question 4

Allergy/hypersensitivity is mediated by what?

Answer 4

IgE

Question 5

What are the risk factors for allergy related disorders/

Answer 5

Heredity, race, age
Environmental exposure
Occupational

Question 6

What environmental factors increase the risk of allergic disease?

Answer 6

Infectious diseases in childhood
Pollution
Diet

Question 7

How many asthma patients have atopy?

Answer 7

4/5

Question 8

Risk factors for allergic rhinitis?

Answer 8

Atopy
Family history
Childhood infectious disease
Pollution
Allergen levels

Question 9

Allergic rhinitis often presents with what?

Answer 9

Asthma

Atopic dermatitis

Question 10

What are the immediate symptoms of allergic rhinitis?

Answer 10

Sneezing
Itch
Nasal blockage
Rhinorrhoea

Question 11

Why does allergic rhinitis cause watering eyes?

Answer 11

Swelling in nasal end of naso-lacrimal duct causing blockage

Question 12

What are the late symptoms of allergic rhinitis?

Answer 12

Chronic obstruction
Hyposmia
Hyperreactivity

Question 13

How is allergy defined?

Answer 13

Hypersensitivity disorder of the immune system

Question 14

What is an allergic reaction?

Answer 14

Type 1 Immediate Hypersensitivity reaction

Question 15

What is the pathological process leading to allergy?

Answer 15

Sensitization
(plasma cells to IgE, bind to mast cells)
Re-exposure
(Mast cells degranulate, release histamines, prostaglandins, leukotrienes, chemotactic factors)

Question 16

What factors are released in mast cell degranulation?

Answer 16

Histamines,
Postaglandins,
Leukotrienes,
Chemotactic factors

Question 17

How do the factors released in mast cell degranulation effect the body?

Answer 17

Vasodilation
Vascular permeability inc.
Smooth muscle contraction
Leukocyte infiltration

Question 18

What leukocytes are associated with allergy?

Answer 18

Eosinophils

Question 19

What is the late phase of allergic response?

Answer 19

2-4hrs

Migration of leukocytes to initial site

Question 20

What is allergic rhinitis?

Answer 20

Allergic inflammation of the nasal airways

Question 21

What are the ARIA classifications of allergy symptoms?

Answer 21

Intermittent or Persistent

Mild or Moderate Severe

Question 22

What is intermittent allergy?

Answer 22

<4 days per week

OR <4 consecutive weeks

Question 23

What is persistent allergy?

Answer 23

> 4 days/week

AND >4 consecutive weeks

Question 24

What is mild allergy according to ARIA?

Answer 24

All of:
Normal Sleep
No impairment (activities, work)
Symptoms NOT troublesome

Question 25

What is a moderate-severe allergy according to ARIA?

Answer 25

ONE OR MORE OF: Sleep disturbance Impairment of activities, work Troublesome symptoms

Question 26

How is allergy diagnosed?

Answer 26

Symptoms Skin test RAST

Question 27

What is RAST?

Answer 27

Presence and levels of allergen specific IgE

Question 28

What is the allergy skin test?

Answer 28

Response to known allergens, <15% false positives

Question 29

What are the controls for the allergy skin test?

Answer 29

Positive control - saline | Negative control - histamine

Question 30

What investigations can be performed for a patient presenting with allergy?

Answer 30

``` RAST Skin test Total serum IgE Nasal allergen challenge Nasal cytology ```

Question 31

How is allergy treated?

Answer 31

Avoid allergy (education) Pharmacotherapy Immunotherapy

Question 32

How does immunotherapy work in treatment for severe allergy?

Answer 32

Stops the patient from producing IgE

Question 33

What drugs can be indicated for treatment of a patient with allergy?

Answer 33

``` Topical Intranasal steroids Systemic Steroids Antihistamines Sodium Cromoglycate Allergen Immunotherapy Anti-IgE ```