2. Allergy and Anaphylaxis Flashcards
Allergy
This is more likely to occur with medicine given by ____, since its direct in the body and doesn’t need to be absorbed in gut. This is overall cascade that occurs and this allergies can be anything: topical anesthetic, dental material, medication, local anesthetic. Want to know this process as a concept!
This tells us we are seeing more and more allergens. Lots of theories behind this. There are many new molecules, material and things today that our body is being exposed to. Our immune systems are constantly challenged in today’s time
IV
Allergy
This is the schematic, for you to understand what is happening with the immune system. Lets look at an allergen.
The most common medication allergen is ____. This picture shows penicillin.
When patients get wisdom teeth out may get pre operative dose of amoxicillin and/or dose after they get them removed. After taking penicillin for the firs time, immune system will see the beta lactam molecule that makes up penicillin. The B cells, which are responsible for making antibodies, will see the beta lactic ring from penicillin, will mature and stimulate a plasma cell, So direct B cell progenitor will release ab against penicillin. They will be IgE mediated. The different type of IgGs have a pneumonic GAIN –> IgG, IgA, IgM, IgG IgE will be released. The same Ig as person exposed to a protozoa worm. That Antibody will float around body. In Px you with take penicillin every 8 hours. Once they take their next dose 8 hours later. The process is reinitiated and the IgE receptor are mounding up. The IgE molecules are going to find a mast cells, the same ones involveed in asthma. Mast cells are circulating around, and will connect with IgE.
Pencillin
Allergy
~____% of children have a food allergy in the US
8% of children are going to go on to have a food allergy in US. Most common is ____ allergy. Selfish: iodine, shimp based, selfish is popular as well
8
peanut
Allergy
RISK FACTORS
- ____
- ____
The concept is that they have an immune system that is ____ to things when it doesn’t need to.
asthma
atopic dermatitis
sensitive
Allergy RISK FACTORS (Host Factors) • Gender (\_\_\_\_ > Female) • \_\_\_\_ predisposition • \_\_\_\_/Ethnicity
There is NO real known risk factor aside from a person having multiple previous ____ or having ____ or ____. No factors that you can say a person is of high risk category. If a person has many Antibiotics allergies should be nervous prescribing them more antibiotics cause may be allergic to them.
male
genetic
race
allergies
asthma
contact dermatitis
Allergy
RISK FACTORS (Environmental Factors)
- ____ smoke
- Air ____
- ____ infections
- ____ factors
- ____
- Indoor/outdoor ____
tobacco pollution respiratory socioeconomic obesity allergens
Allergy
Type 1: ____ mediated -This is when the penicillin goes from B cells to plasma cells, releasing IgG anybody, that go to mast cells, causing mast cells to degranulate and release ____ and prostaglandins
This is called type 1 immune reaction
◦ Type 2: this is more ____ conditions like good-pasture condition
Type 3: this is complexes of ____. More immune base conditions
reaction.
Type 4: ____ based ones will be lie ____. When something touch one’s ski or lips and skin and it causes it to break out
What we see in practice is
anaphylactic reactions, which are ____ base type 1 mediated reactions
◦ And type 4 which is ____ based like contact dermatitis, topical contact
IgE
histamine
immunologic
ABs and allergen complexes
T cell
contact dermatitis
IgE
T cell
Allergy
This shows that breakdown. Type 1 ____ and type 4 contact mediated ones are shown below (far left and far right).
Type 1 is anaphylactic reactions and things like ____. Immune complex ones are like ____, lupus.
____ reactions is like type 2
IgE
seasonal allergies
rheumatoid arthritis
blood transfusions
Allergy
- ____
- ____ phase reaction
- ____ phase reaction
1: this is first exposure of allergen: called sensitization, It primes the immune system. Most common reaction we see is to ____. If people complain feeling itchy, say don’t take anymore and if see symptom call 911.
2: When person complains braking out in a hive. If stomach hurts NOT necessarily due to allergy, its a drug reaction. Can take a probiotic to help this.
3: This is what we want to ____! This is where people’s airway close up and people. Go into cardiopulmonary arrest. He tells a story 37 min in about person peanut allergy. Person starts to feel sick but restaurant said restaurant said they did not use peanut oil. Therefore, they hesitated to inject him with epi pen, but it ended up being too late.
sensitization
early
late
penicillin
prevent
Allergy
- Sensitization
This is allegen, mediation, overproduction of ____. The mast cells are ready, roaming body looking for more penicillin. Every time person takes penicillin person is making more ____ cells
IgE
sensitized
Allergy
- Early phase reaction
- Late phase reaction
In early phase and late phase reactions, when ____ occurs. In sensitization did not granulate they jus made ____ mast cells ready to react, so symptoms are not there yet. Person could have taken ____ awhile ago and been sensitized. They may be unaware of their allergy until take is a ____ time and symptoms occur.
degranulation
sensitized
medicine
second
Allergy
Early phase
Subsides in ____ minutes
Late phase
Within ____ hours after a decline in immediate reaction
The Hardest part of identifying a true penicillin allergy is when someone is young and has ____ infection. Parents may say they want the child to have antibiotics. However viral infections can cause hives. Therefore, no one knows whether the antibiotics or viral infection may be causing the hives. Keep this in mind for many patients who say they had a ____ allergic reaction when they were young. They could have just had a ____ infection at the time they took antibiotics. Tell them to be tested because they may not be allergic. Clindamycin does not work as well so want to use penicillin if we can.
30-90
3-4
viral
penicillin
cold/viral
Drug Allergy
Immediate reaction
Evolve within the ____ hour of drug exposure (e.g., anaphylaxis, pruritis, urticaria, angioedema)
Accelerate reaction \_\_\_\_ hours (e.g., pruritis, urticaria, angioedema
Delayed reaction
> ____ hours (e.g., benign skin eruptions, fever, serum sickness like reaction, systemic disorders)
1st
1-72
72
Anaphylaxis
90% of patients will have ____ and ____
This is how most present. Most patients will have urticaria: itchiness or angioedema: swelling puffiness. Hives can occur anywhere on body. We Immediately stop ____ if see these signs!!
urticaria
angioedema
meds
Anaphylaxis
Why do eyelids and lips get puffy and not the feet or hands?
has to do with the thinnest of their skin: which is the ____ and its, not hands
or feet
If retaining water eyes will show the fluid its retaining
Other sings:
Eyes puffy runny nose - BVs get ____, leaky, and can fill with fluid, like with seasonal allergies
Can get tired, confused anxious, which we think this has to do with ____
of the brain
BP drops cause heart rate to go ____ in compensation
Histamines can cause spams of bronchioles, causing ____ or asthma
attack
GI: can get ____ from histamines
skin: can break out in ____ become itchy
eyes dilated edema up wheezing hives
