Hypersensitivity Allergiesvand Dental Care

Question 1

Allergic diseases

Answer 1

Immunologic reaction to a non infectious foreign substance

Question 2

Type I humoral hypersensitivity reaction

Answer 2

IgE mediated hypersensitivity

Question 3

Type II hypersensitivity reaction

Answer 3

IgG mediated cytotoxic (transfusion reaction of mismatched blood)

Question 4

Type III hypersensitivity reaction

Answer 4

Immune complex mediated (serum thickness, SLE, streptococcal glomerulinephritis, vasculitis)

Question 5

Type IV

Answer 5

Cell mediated hypersensitivity or delayed

Question 6

Symptoms of type I

Answer 6

Hay fever, asthma, urticaria, angioedema, anaphylaxis

Question 7

List what happens during type I response

Answer 7

IgE —> mast cells —> histamine, leukotrienes, interlekins —> vascular dilation and endothelial leakage, smooth muscle contractions

Question 8

Antibiotics in dentistry associated with anaphylaxis

Answer 8

Penicillins, sulfonamides, cephalosporins, ciprofloxacin, tetracycline

Question 9

Allergens or antigens

Answer 9

Foreign substances that trigger hypersensitivity reactions

Question 10

Describe urticaria from type I

Answer 10

• superficial skin lesions ( hives, itching, wheels)

Question 11

Common causes of urticaria in type I for children

Answer 11

Food and infections

Question 12

Common causes of urticaria in type I for adults

Answer 12

Drug reactions

Question 13

Describe angioedema

Answer 13

In deeper skin layers
- Painless swelling
- Itching, burning
- Lasts 1-3 days
- Eyelids, lips, tongue, pharynx, larynx

Question 14

Acquired angioedema is allergic- Type I and occurs

Answer 14

soon after contact with antigen

Question 15

Other type of acquired angioedema- not allergic includes

Answer 15

Drug induced (impaired bradykinin degradation)
- Angiotensin converting enzyme inhibitors
- Angiotensin receptor blockers

Question 16

What does Mild type I angioedema effect?

Answer 16

Eyelids, lips, NOT tongue, pharynx and larynx

No respiratory distress

Question 17

How do you manage Mild Type I angioedema?

Answer 17

50mg diphenhydramine (Benadryl) qid until resolves

Question 18

What does severe type I angioedema involve?

Answer 18

Tongue, pharynx, larynx

Causes respiratory distress

Question 19

How do you manage severe type I angioedema?

Answer 19

• Emergency treatment: 0.5ml 1:1000 epi IM or SC and oxygen
• Once immediate danger is over, 50mg benedryl qid
• Call 911 if no response or severe resp distress

Question 20

Describe type I- anaphylaxis

Answer 20

Acute IgE mediated SYSTEMIC reaction
◦ Occurs within minutes of antigen exposure
◦ Acute respiratory compromise and cardiovascular collapse
◦ Respiratory – smooth muscle contraction of bronchi - bronchospasm
increased vascular permeability
◦ Cardiovascular – hypotension or shock from widespread vasodilation
◦ Skin – urticaria, angioedema
◦ GI – gastrointestinal and uterine contractions

Question 21

Why use epi in anaphylaxis?

Answer 21

• Relaxes bronchial muscles
• Improves cardiac output
• Reduces vascular permeability

Question 22

Describe Type IV reaction

Answer 22

• T cell mediated
• No antibodies involved
• Response not seen until 48-72 hrs later (delayed hypersensitivity)

Question 23

Examples of type IV hypersensitivities

Answer 23

• Contact dermatitis (metal, perfumes, formaldehyde, latex)
• TB test (autoimmune - DM-1, MS, RA)
• Organ transplant rejection (Graft vs host post bone marrow transplant– looks like lichenoid lesions)

Question 24

Describe latex allergies

Answer 24

• 1-6 general public
• Most type IV
• Rare Type I- those would be immediate

Question 25

Common allergic drug reactions in dentistry

Answer 25

- Antibiotics - Local anesthetics - Analgesics- aspirin, NSAIDs - reactions to other ingrediants (coating of pills, local anesthetic preservatives (parabens, sulfites))

Question 26

Antibodies produced against PCN cross-react with

Answer 26

synthetic penicillins (ampicillin, penicillinase, cloaxacillin, carbenicillin, methicillin)

Question 27

If PCN allergy, what should you use instead?

Answer 27

Macrolides (azithromycin, clarithromycin, erythromycin) or clindamycin

Question 28

Patients with history of PCN allergy have small risk of allergic reaction to

Answer 28

cephalosporins

Question 29

Infective endocarditis prophylaxis - Use

Answer 29

cephalexin (Keflex), azithromycin, clarithromycin, doxycyclin

Question 30

Do not use cephalexin if history of

Answer 30

anaphylaxis, angioedema or urticarial with PCN or ampicillin, potential for cross-reactivity

Question 31

Vasoconstrictor effects (epi)

Answer 31

Tachycardia, apprehension, sweating, hyperactivity

Question 32

Symptoms of a toxic reaction to local anesthetics

Answer 32

Talkativeness Slurred speech Dizziness Nausea Depression Euphoria Excitement Convulsions

Question 33

Symptoms of allergic reaction to local anesthetics

Answer 33

Urticaria Swelling Skin rash Chest tightness Dyspnea, shortness of breath Rhinorrhea Conjunctivitis

Question 34

Examples of esters

Answer 34

-Procaine (Novocain) - Tetracaine (pontocaine)

Question 35

Procaine is highest rate of

Answer 35

allergic reactions among local anesthetics

Question 36

What si the procaine metabolite?

Answer 36

PABA

Question 37

What are examples of amides?

Answer 37

- Articaine - Bupivacaine - Lidocaine - Mepivacaine - Prilocaine

Question 38

Cross reaction between methylparaben preservative in multidose vials of

Answer 38

lidocaine and procaine antibodies

Question 39

Dental anesthetic single use cartridges no longer contain

Answer 39

methylparaben

Question 40

How can antihistamine be used as anesthetic?

Answer 40

◦ Compounded by pharmacist ◦ 1-4 ml of diphenhydramine (Benadryl) with 1:100,000 epinephrine ◦ No methylparaben preservative ◦ Maximum dose 50 mg/appointment ◦ 30 min of anesthesia