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PHAY0010 > Hayfever and Allergies [completed] > Flashcards

Hayfever and Allergies [completed] Flashcards

(100 cards)

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1
Q

The number of hay fever sufferers is increasing by how much each year?

A

5%

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2
Q

What is an allergy?

A

The response of the immune system to a substance (allergen) that is usually harmless but the body reacts as if it’s harmful.

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3
Q

What is the immune response to allergens?

A

Production of antibodies

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4
Q

What is a serious, systemic, life threatening allergic reaction called?

A

Anaphylaxis

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5
Q

Outline what happens in an allergic reaction?

A

On first exposure the person forms IgE antibodies specific to the antigen
IgE attaches to high affinity Fc receptors on basophils and mast cells,
The immune system stores this in memory - SENSITISATION
The person may not have an allergic reaction one first contact but upon re-encountering the allergen it will bind to IgE causing cross linking between IgE and degranulation of mast cells.
The mast cells then release histamine - a chemical mediator

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6
Q

What are some common allergens?

A

Poison plants
Animal scratches
Pollen
Latex
Bee sting
Medication
Nuts and Shellfish
Dust
Mold and mildew
Animal dander

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7
Q

How often after exposure do allergic reactions occur?

A

within minutes

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8
Q

what is allergic rhinitis?

A

Inflammation of the nose - can cause runny, blocked nose and sneezing

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9
Q

What is allergic conjunctivitis?

A

Inflammation of the eyes -
IN BOTH EYES
watery, red and itchy eyes

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10
Q

What is urticaria?

A

Also known as hives or nettle rash, very itchy and red

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11
Q

What is angioedema?

A

Swelling of tissues - lips, tongue, throat and eyelids
Feels tingly at first
Can cause airway obstruction, difficulty talking or swallowing
Can be life threatening

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12
Q

What breathing difficulties may arise with allergic reactions?

A

Wheezing, chest tightness and breathlessness
Can be life threatening

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13
Q

How are mild allergies managed?

A

Person is offered advice and treatment

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14
Q

How are severe/unknown allergies managed?

A

Refer to a specialist for testing and advice on treatment?

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15
Q

What is the skin prick test?

A

A drop of liquid containing the allergen is placed on the skin as well as a drop of saline solution. The skin is then pricked with a lancet.

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16
Q

What would be a positive result in the skin prick test?

A

A raised bump (over 3mm diameter) after about 15 minutes that looks different to the control

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17
Q

What is intradermal testing for allergies?

A

A small amount of allergen is injected subcutaneously under skin to look for a reaction

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18
Q

What are patch tests for allergies?

A

The allergen is applied to a small disc placed onto the back and worn for two days.

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19
Q

What is allergy challenge testing

A

Increasing amounts of allergen given orally in order to establish if there is a reaction.
Especially good for food allergies BUT needs to be in a safe medical environment.

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20
Q

What is an example of a commercial allergy testing kit? why are they not recommended?

A

Hair analysis - has very little scientific evidence

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21
Q

What other tests may be carried out to diagnose an allergy?

A

Blood tests

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22
Q

What is a sensitivity?

A

An exaggeration of the normal effects of the substance.

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23
Q

Give an example of a sensitivity.

A

Drinking coffee –> caffeine causes palpitations and trembling

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24
Q

What is an intolerance?

A

When a substance causes unpleasant symptoms such as diarrhoea but DOES NOT involve the immune system. People with food intolerance can eat small amounts without issues

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25
What are common symptoms of a food allergy
Itching, tingling, burning, swelling of mouth lips and throat Vomiting Urticaria -- red raised rash Swelling
26
How soon after eating does the allergic response begin?
immediately or within thirty minutes
27
What food commonly cause an allergic reaction?
Milk, eggs, nuts, peanuts, fish, shellfish and some fruits and vegetables
28
Can trace amount cause food allergy?
Yes depending on severity
29
What is the only way to prevent a reaction in a food allergy?
Complete avoidance
30
What are symptoms of a food intolerance?
Diarrhoea Bloating Stomach cramps
31
How soon after eating does a food intolerance occur?
After a few hours, caused by larger amounts of food (more food = stronger symptoms) NOT LIFETHREATENING
32
Why does allergic rhinitis occur?
Nasal mucosa is exposed and sensitised to allergens to produce sneezing, nasal itching, discharge and congestion
33
What three things can allergic rhinitis be classified by:
Timing Frequency Persistence
34
What is perennial rhinitis?
Occurs through the entire year
35
What are some symptoms of perennial rhinitis?
Nose is congested Reduced ability to smell (hyposmia) Runny nose Sneezing Itchy nose
36
What are some common allergens that can cause perennial rhinitis?
house dust mites, animal dander, mould
37
How long should perennial rhinitis be treated for?
All year round and then 3-6 months after symptom control
38
What is seasonal rhinitis?
Occurs at the same time each year. Made worse when pollen count is higher.
39
What are the symptoms of seasonal rhinitis?
Blocked nose Runny nose sneezing Itchy nose Itchy red water eyes Itchy throat loss of smell face pain headache wheezing breathlessness worsening/seasonal asthma
40
Who is hay fever more common in?
People with family members who have hay fever People who have other allergies or asthma
41
When are the peak months for allergic rhinitis?
May - july
42
What is one of the most common allergens for perennial rhinitis and why?
House dust mite as present throughout the year
43
How can we distinguish between allergic and infective rhinitis
Discharge : watery in hay fever, mucopurulent in infections Duration: hay fever can last months , infections 3-14 days Symptoms: immediately on contact in hay fever but may take a few days in infections Throat: itchy throat in hay fever sore throat in infections Itchiness: itchy eyes and nose in hayfever, no itching in infections Cough: cough more common in infection
44
What are some red flags in allergic rhinitis that may require referral?
Wheezing / Shortness of breath (may be asthma) Tightness in chest Associated ear pain - Abx? Painful sinuses - Abx? Purulent eye discharge Severe symptoms unresponsive to therapy - short course of oral steroid ?
45
What are some symptoms of anaphylaxis?
Unconsciousness Runny nose Fast/slow heart rate Itchy skin Wheezing/cough Swelling of lips, tongue or throat - difficulty speaking or swallowing MAY GO INTO SHOCK - pale, clammy skin
46
What should you do if you suspect someone is having an anaphylactic reaction?
Diagnosis - issues in airway, breathing and circulation Call - ambulance or resuscitation team and lie the patient flat with their feet elevated or sitting up to help with breathing. If pregnant lie on left side Treatment - IM Adrenaline - if no improvement give adrenaline again every 5 minutes
47
Where is adrenaline ideally administered?
Intramsucularly into the middle of the patients thigh
48
Do you need a prescription to administer adrenaline in an emergency situation?
No
49
What formulations is adrenaline available as?
Ampoules or pre filled autoinjecter
50
What is the dose of adrenaline given to adults and children over 12 years?
500mcg
51
Anaphylaxis is medical emergency and 999 has to be called. What will happen to the patient the hospital?
They are given antihistamines, steroids or further testig Observed for 6-12 hours depending on their response to treatment May be referred to a specialist allergy service on discharge and given adrenaline injection pens
52
What else may a patient have to keep on them if they are at risk of anaphylaxis?
Medical alert bracelet or card
53
How can a patient manage an allergy?
Avoiding allergens Taking medication or using it to treat an allergic reaction Desensitisation (immunotherapy)
54
When is desensitisation used to manage allergies?
In severe cases to wasp stings, bee stings, severe hay fever and some animal allergies BUT NOT IN MULTIPLE ALLERGIES
55
What happens during allergy desensitisation?
Allergen given via injection Tiny amount so allergic reaction not triggered but can teach the immune system not to produce a lot of IgE Dose is increase at a regular interval (weeks- months) DONE IN A SPECIALIST HOSPITAL OUTPATIENT SETTING
56
What are some disadvantages to desensitisation immunotherapy?
Time consuming Expensive Risky used as a last resort BUT TREATS DISEASE CAUSE
57
What is the first line treatment for mild-moderate allergy symptoms?
Antihistamines
58
How do antihistamines work?
Compete with histamine for receptor blocking the actions of histamine so allergic response is prevented or reduced
59
Which allergy symptom is an antihistamine not as effective on?
nasal congestion
60
After how long will there be relief of symptoms after using oral and topical antihistamines?
Oral - 1 hour Topical - 15 minutes
61
What are the two types of antihistamines?
1st generation sedating 2nd generation non-sedating
62
What types of antihistamines are reccomended by NICE?
Intranasal or a second generation non sedating antihistamine taken orally
63
What are some oral sedating antihistamines?
Chlorphenamine (Puritan) Promethazine (Phenergen) Diphenhydramine (Nytol)
64
Which oral sedating antihistamine is not actually indicated for allergic conditions?
Diphenhydramine
65
Why do first generation antihistamines cause drowsiness?
Cross the BBB and bind to H1 receptors in the brain
66
What is the usual frequency of Piriton (chlorphenamine) in adults)
Every 4-6 hours?
67
Who might sedating antihistamines not be appropriate for?
Elderly - risk of falls and confusion
68
What advice should be given to people taking sedating antihistamines?
Do not drive or operate heavy machinery Avoid alcohol as this can enhance the sedating effect
69
What are some non-sedating antihistamines
Loratadine (Claritin) Cetirizine (Piriteze) Acrivastine (Benadryl) Fexofenadine (Allevia)
70
How often are non sedating antihistamines taken?
1 tablet once a day or THREE TIMES A DAY FOR ACRIVASTINE
71
Fexofenadine used to be POM only. What strength is still POM and which one is available as a P medicine?
180mg - POM 120mg - P
72
Why do non sedating antihistamines have less effect on the brain?
Less penetration of blood brain barrier
73
What are some topical antihistamines?
Azelastine eye drops (POM - 4 years and over) Azelastine nasal spray (Rhinolast - POM only) Antazoline + Xylometazoline eye drops (P - 12 years and over)
74
How do antazoline and xylometazoline eye drops work?
antihistamine AND vasoconstrictor reduces eye redness and itching May cause temporary local irritation
75
What are some mast cell stabilisers?
Sodium cromoglicate eyedrops (P - 6 years and above) Lodoxamide eye drops (P - 4 years and above) Olopatadine drops (POM - 3 years and above)
76
How often do sodium cromoglicate eye drops need to be used?
4 times a day
77
How doe mast cell stabilisers work?
Stabilise mast cells preventing degranulation and the release of inflammatory mediators such as histamine.
78
When is it ideal to administer mast cell stabilisers?
BEFORE allergen exposure
79
What can happen of the first administration of a mast cell stabiliser?
Stinging sensation
80
How soon after opening should mast cell stabiliser eye drops be discarded
4 weeks
81
What are some examples of nasal corticosteroids?
Beclomethasone (beconase) Fluticasone (Pirinase) Budesonide (benacort) Mometasone (Clarinaze0
82
What is the usual dose frequency for nasal corticosteroids?
Varies from once daily to twice daily
83
Can nasal corticosteroids cause systemic effects?
Unlikely but patient should still be aware
84
True or false. Nasal corticosteroids are first line for SEVERE symptoms.
TRUE
85
What symptoms are nasal corticosteroids good for?
Nasal congestion Rhinorrhoea (runny nose) itching sneezing Also eases eye symptoms
86
How long does it take to see the maximum effect of nasal corticosteroids?
2-3 weeks
87
What age group are nasal corticosteroids licensed for OTC supply?
18 years and above
88
What is the ideal way to use nasal corticosteroids in a pollen allergy?
Use 1 or 2 weeks before exposure to delay onset of symptoms
89
What are some examples of of nasal decongestants?
Xylometazoline (Otrivine)
90
What is the maximum duration of use of nasal decongestant sprays and drops?
5-7 days
91
Why should nasal decongestants only be used short term
They can cause rebound congestion which can be worser than before
92
Why is it helpful to use a decongestant just before starting a nasal corticosteroid?
Congestion can stop the corticosteroid reaching the mucosa making it less effective
93
What are some examples of oral decongestants?
Pseudoephedrine, ephedrine, phenylephrine
94
What are some uses for oral decongestants?
Allergic Rhinitis Common cold Flu
95
What are the limits for supply of OTC ephedrine and pseudoephedrine?
Pseudoephedrine 720mg Ephedrine 180mg They are prone to abuse.
96
What comorbidities should we not supply oral decongestants in?
Diabetes High blood pressure Chronic heart failure
97
What age group are oral decongestants licensed for OTC sale in?
12 years and over
98
What is the duration of action for oral decongestants?
6 hours
99
What are some self-management tips to help with hay fever
- Nasal irrigation - Avoid grassy areas especially when mowed or high pollen count - Avoid drying washing outside when pollen count is high - Keep window shut - Vacuum regularly and use damp duster - Do not smoke
100
What are some self-management tips to help allergies?
Animal allergy - ideally do not allow animal in house :( - wash animal and surface they may regularly come into contact with Occupational allergies - reduce exposure e.g. by wearing latex free gloves or a dust mask - adequate ventilation - avoid hazardous chemicals where possible House dust mite allergy - use synthetic pillows and acrylic duvets - wash bedding and fluffy toys at least once a week on hot cycle - wooden or hard floors instead of carpet

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