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Y2 - Immunity > Lecture 4 - Anaphylaxis And Rhinitis > Flashcards

Lecture 4 - Anaphylaxis And Rhinitis Flashcards

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1
Q

What is anaphylaxis?

A

Severe life threatening systemic hypersensitivity reaction (rapid)

Potentially life threatening airway, breathing or circulation problems

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2
Q

What are some symptoms of anaphylaxis?

A

Hives
Angiodema
Cough
Stridor
Wheeze
Breathless
Shock
Hypotension
Headache

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3
Q

What is the pathogenic mechanism for anaphylaxis?

A

Mast cells get activated (can be IgE mediated or non IgE mediated) and their mediators act

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4
Q

What are some upper resp symptoms of anaphylaxis?

A

Rhinorrhea
Sneezing
Angiodema
Stridor

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5
Q

What are some resp symptoms of anaphylaxis?

A

Cough
Wheeze
Dyspnea
Bronchoconstriction
Hypoxia

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6
Q

What are some skin symptoms of anaphylaxis?

A

Flushing
Urticaria
Angiodema
Itch

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7
Q

What are some conditions that often occur with anaphylaxis?

A

Asthma
Allergic rhinitis and eczema
Psychiatric illness
Mastocytosis
CVS disease

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8
Q

What are some factors that amplify anaphylaxis?

A

Exercise
Acute infection
Emotional stress
Dysruption of routine (travel)
Premenstrual status

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9
Q

What is the diagnosis criteria for anaphylaxis?

A

Any once of the 2 criteria:
Acute onset of an illness with simultaneous involvement of the skin, mucosal tissue or both (generalised hives, puritis, flushing
+
Resp compromise
Reduced BP or symptoms of end organ dysfunction
Severe GI symptoms
Acute hypotension, bronchospasm or laryngeal involvement

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10
Q

Slide 42 and further information:

Does this patient need an Epi Pen?

A

No difficulty breathing only urticaria and angiodema episodes

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11
Q

What are thee 3 main features you need to manage in anaphylaxis?

A

Airways
Breathing
Circulation

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12
Q

Slide 48:

Is this anaphylaxis?

A

Yes

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13
Q

What is the management for Acute anaphylaxis?

A

look for sudden onset of Airway, breathing and circulation problems (can have skin changes)
Call for help
Remove trigger
Keep patient on the floor

IM ADRENALINE
Repeat IM adrenaline after 5mins if not worked
O2
Fluids if not response

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14
Q

What posture should we put a patient in with anaphylaxis?

A

Keep patient sat or lay down

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15
Q

Where do you administer IM adrenaline in anaphylaxis?

A

Anterolateral thigh

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16
Q

What dose of IM do under 6yrs receive?

A

150mg

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17
Q

What dose of IM adrenaline do over 6yr olds receive in anaphylaxis?

A

300mg

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18
Q

What part of the epipen faces the sky, what part of the epipen is in the thigh?

A

Blue = sky
Orange = thigh

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19
Q

What should be done after giving an epipen?

A

May need further adrenaline dosing to maintain optimal dose to resolve symptoms
Adrenaline via needle/syrinnge has better pharmacokinetics

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20
Q

Why are IV fluids useful in anaphylaxis?

A

Help increase venous return
Dec stroke volume
Inc heart rate

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21
Q

What volume of IV fluids should be given in a child with anaphylaxis?

A

10ml/kg

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22
Q

Why type of IV solution is given as a bolus for anaphylaxis for adults ?

A

500ml

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23
Q

What is refractory anaphylaxis?

A

Anaphylaxis that doesn’t resolve after 2 doses of intramuscular adrenaline

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24
Q

How do you treat refractory anaphylaxis?

A

IV fluids
Start adrenaline infusion (IV)

Ensure has oxygen

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25
Are anti-histamines and corticosteroids part of the initial emergency management for acute anaphylaxis?
Not initial emergency managemtn Given after stabilisation
26
How to you manage anaphylaxis long term?
Risk assessment Allergen avoidance Emergency plans
27
What are considered avoidable causes of anaphylaxis and not reliably avoidable?
Avoidable = prescription drugs Not avoidable = foods, stings, latex, idiopathic
28
What should be done if a patient presents with asthma in context with exposure to known allergen?
IM adrenaline Can consider bronchodilators like salbutamol/ipratropium
29
What is the definition of rhinitis?
Inflammation of the nasal mucosa Rhinorrhoea, nasal blockage, congestion, itchiness adn sneezing
30
What is rhinitis including the sinus linings called?
Rhinosinusitis
31
What is rhinitis called involving the conjunctivae?
Rhino-conjunctivitis
32
What are the different types of rhinitis?
Allergic Infective Non-allergic
33
What are the different classifications of allergic rhinitis?
Intermittent Persistent Mild Moderate-severe
34
What is considered moderate-severe allergic rhinitis?
Sleep disturbance Impairment of daily activities, sport, leisure’s
35
What is considered mild allergic rhinitis?
Normal sleep No impairment of daily activities, sport and leisure
36
What condition is strongly associated withi allergic rhinitis?
Asthma
37
What is the pathophysiology of rhinitis?
Allergen picked up by dendritic cells and macrophages in nasal epithelial cells MHC II to TH2 IgE made and binds to mast cells and basophils Activating the cells Degranulation occurs with allergen being reintroduced release of mediators
38
What is the pathophysiology of rhinitis?
Allergen picked up by dendritic cells and macrophages in nasal epithelial cells MHC II to TH2 IgE made and binds to mast cells and basophils Activating the cells Degranulation occurs with allergen being reintroduced release of mediators
39
What is the pathophysiology of rhinitis?
Allergen picked up by dendritic cells and macrophages in nasal epithelial cells MHC II to TH2 IgE made and binds to mast cells and basophils Activating the cells Degranulation occurs with allergen being reintroduced release of mediators
40
What are teh effects of some of the mediators being released in rhinitis?
Mucus oedema, mucus hypersecretion Infiltration of inflammatory cells Eosinophils Basophils Neutrophils
41
What are teh symptoms of rhinitis?
Sneezing Rhinnorrhrea Nasal obstruction Nasal itching Ocular symptoms
42
What is the process of being exposed to house dust mite allergens in rhinitis?
Allergen infiltration Cascade of IgE overproduction by B cells Th2 proliferation due to increased IL-6 House Dust Mite proteases cleave pulmonary surfactants causing dec lung core acne of allergens
43
What are some comorbidities associated with allergic rhinitis?
Asthma Conjunctivitis Rhinosinusitis/anosmia Otitis media with effusion Throat and laryngeal effects Sleep problems
44
How do you diagnose allergic rhinitis?
Mroe than 2 clinal sympotms for more than an hr on most days Sneezing Nasal itching Rhinorrheao Nasal obstruction Snoring, sleep problems +- conjunctivitis
45
What are some features of a Hx for rhinitis?
Seasonal Indoors/outdorrs location
46
What makes rhinitis mroe likely in Fhx?
Fhx of it
47
What are some clinical findings on examination for rhinitis?
Allergic salute/horizontal nasal crease Dennie-Morgan lines Hypertrophic, pale and boggy ITs Clear, coloured or purulent secretions
48
What signs are seen on slide 14 for rhinitis?
49
What are some differentials for rhinitis?
Adenoidal hypertrophy Acute/chronic sinusitis Foreign bodies Acute infectious rhinitis Look at slide 15
50
What are some investigations done for rhinitis?
Skin prick test ssIgE (serum specific IgE)
51
How is climate change affecting the prevalence of rhinitis?
More warming means more pollens likely to be spread around
52
What are the treatments for rhinitis?
Prevention of triggers Saline rinses Antihistamines Intranasal steroids Ipratropium bromide Surgical intervention Septoplasty Turbinate reduction
53
What are some symptomatic therapies in allergic rhinitis?
Antihistamines (cetirizine) Intranasal corticosteroid suppress immune cells infiltration momenta’s on furoate Intranasal H1 antihistamines + ICS combination therapies Leucotriene receptor antagonists
54
What is an example of a leukotreine receptor antagonist?
Monteleukast
55
How do nasal decongestants work?
Agonist at alpha 1 and alpha 2 adrenergic receptors on nasal mucosa reducing mucosal swelling
56
What are some nasal sprays?
Sudafed (pseudoephedrine) Neo-synephrine (phenylephrine)
57
What is the problem with overuse of nasal decongestant?
Rhinitis medicamentosa
58
What is rhinitis medicamentosa? How’s it treated?
Condition of rebound congestion upon withdrawal of nasal decongestants Treated by Intranasal corticosteroid
59
What is the treatment pathway for allergic rhinitis?
Antihistamines Intranasal corticosteroids
60
What are the mechanisms of immune tolerance with rhinitis?
Regulatory cells. Induced Regulatory cells produce IL-10 to suppress the Type 2 inflammatory cells Induces allergen specific immunogobin class switch
61
How do you take nasal drops?
Gently blow/clear nose Tilt head forward and keep bottle upright and squeeze a fine mist and breathe in slowly then out

Y2 - Immunity (9 decks)

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