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afsha respiratory > Allergic conditions > Flashcards

Allergic conditions Flashcards

1
Q

T or F - antihistamines reduce rihnorrhoea and sneezing but are usually less effective for nasal congestion

A

True

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2
Q

True or false - antihistamines may be given in anaphylaxis following initial stabilisation of the pt, especially in pt with persistent cutaneous symptoms

A

True

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3
Q

Name 3 antihistamines that have a role in n+v

A
  • promethazine teoclate
  • cinnarizine
  • cyclising
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4
Q

This antihistamine is included as an antiemetic in a preparation that can be bought OTC for migraine

A

Buclizine

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5
Q

True or false - all older antihistamines cause sedation

A

True

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6
Q

Which ones are more sedating and which ones are less sedating: Alimemazine tartrate, promethazine, chlorphenamine and cyclizine

A

Alimemazine tartrate and promethazine = more

Chlorphenamine and cyclizine = less

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7
Q

Sedating activity of some antihistamines is sometimes used to manage …. associated with some allergies

A

pruritis

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8
Q

Why do non sedating antihistamines cause less sedation and psychomotor impairment than the older antihistamines?

A

they only penetrate the BBB to a slight extent

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9
Q

Why is the use of 1st gen antihistamines in elderly pt potentially inappropriate (STOPP)?

A

safer, less toxic antihistamines are widely available

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10
Q

Immunotherapy using allergen vaccines containing house dust mite, animal dander (cat or dog) or grass pollen extract and tree pollen extract can reduce …

A

symptoms of asthma and allergic rhinoconjunctivitis

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11
Q

vaccines containing wasp venom or bee venom extract may be used to

A

reduce risk of severe anaphylaxis and systemic reactions in pt with hypersensitivity to wasp and bee stings

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12
Q

an oral preparation grass pollen extract is licensed for

A

disease-modifying treatment of grass-pollen induced rhinitis and conjunctivitis

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13
Q

an oral prep of house dust mite extract is licensed for

A

disease-modifying treatment of house dust mite allergic rhinitis or asthma in certain pt

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14
Q

Desensitisation treatment with peanut protein may be offered to

A

pt with peanut allergy in childhood, and treatment can be continued into adulthood

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15
Q

what is Omalizumab

A

mab that binds to immunoglobulin E (IgE)

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16
Q

discuss use of omalizumab

A
  • mab binds to IgE
  • Used as additional therapy in pt with proven IgE-mediated sensitivity to inhaled allergens, whose severe persistent allergic asthma cannot be controlled adequately with high dose ICS together with LABA
  • must be initiated by physicians in specialist centres experiences in treatment of severe persistent asthma
  • Also indicted as add on therapy for treatment on chronic spontaneous urticaria in pt who have had an inadequate response to H1 antihistamine treatment
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17
Q

what is anaphylaxis

A

Severe, life threatening, generalised or systemic hypersensitivity reaction

prompt treatment required

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18
Q

anaphylaxis is characterised by

A

Characterised by rapidly developing airway and/or breathing and/or circulation problems
Usually associated with skin and mucosal changes

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19
Q

most common allergens that cause anaphylaxis include

A

Food (e.g. Peanuts, sesame, tree nuts, soy, shellfish, cows milk)
Drugs (e.g. abx, aspirin and other NSAIDs, neuromuscular blocking drugs, chlorhexidine, contrast media, vaccines)
Venom (e.g. insect stings)
Latex

20
Q

anaphylaxis is more common after what route of administration?

A

Parenteral administration
Resuscitation facilities must always be available for injections associated with special risk

21
Q

True or False - Anaphylactic reactions may also be associated with additives and excipients in foods and medicines

A

True

22
Q

True or false - refined arches (peanut) oil which is present in some medicinal products is likely to cause an allergic reaction in patients

A

False
Unlikely
However still wise so check full formula of preparations which may contain allergens

23
Q

True or false - some patients are at higher risk of anaphylaxis e.g. asthma, or increased likelihood of repeated exposure to same allergen such as those with venom or food allergies

A

true

24
Q

ABCDE

A

airways
breathing
circulation
disability
exposure

25
Q

true or false - cardiopulmonary arrest may follow an anaphylactic reaction

A

true
start CPR immediately

26
Q

full treatment pathway for suspected anaphylaxis

A
  • ABCDE, diagnosis - look for sudden onset of airway/and or breathing and/or circulation problems, and usually skin changes e.g. itchy rash
  • call for help (999)
  • remove trigger if possible (e.g. stop infusion, remove stinger)
  • lay pt flat, with or w/o legs raised, to aid in restoration of BP; or siting may make it easier to breathe; or recovery position if unconscious, or left side if pregnant to prevent artovaval compression
  • give IM adrenaline 1st line
  • repeat dose after 5 mins if no improvement in condition
  • if no improvement in respiratory and/or CV problems despite 2 appropriate doses of IM adrenaline, escalate care quickly and manage as having refract anaphylaxis
27
Q

is nebulised adrenaline effective ad adjunct to treat upper airways obstruction caused by laryngeal oedema?

A

Yes
but only after treatment with IM adrenaline, not as alternative

28
Q

Other treatments used in anaphylaxis (Adjunct)

A

High flow oxygen should be given as soon as it is available
Give IV fluids to patients with hypotension or shock, or if poor response to initial dose of adrenaline

29
Q

are antihistamines recommended as part of initial emergency treatment of anaphylaxis?

A

no

30
Q

following stabilisation of patient, you can give antihistamine … true or false

A

true
give a non sedating oral antihistamine e.g. cetirizine
especially in pt with persistent cutaneous symptoms e.g. urticaria and/or angioedema
if oral administration not possible, IM or IV chlorphenamine can be given

31
Q

discuss use of CCs as anaphylaxis treatment

A

Routine use of CCS for emergency treatment of anaphylaxis not recommended
Consider CCS after initial resuscitation for refractory reactions or ongoing asthma or shock
CCS must not be given preferentially to adrenaline
CCS should be given via oral route where possible

32
Q

use of bronchodilators in anaphylaxis

A

Inhaled bronchodilator therapy with salbutamol and/or ipratropium bromide may also be considered for patients with persisting respiratory problems, but should not be used as an alternative to further treatment with adrenaline

33
Q

what is refractory anaphylaxis

A

Anaphylaxis that requires ongoing treatment due to persisting respiratory and/or CV problems despite 2 appropriate doses of IM adrenaline - seek early critical care support

34
Q

patients with refractory anaphylaxis need to be treated with …. & what to give if this isn’t possible

A

IV adrenaline infusion
IV adrenaline should only be given by experienced specialists and in a setting where patients can be carefully monitored
If it cannot be administered safely e.g. due to patient being outside hospital setting, continue to give IM adrenaline at 5 minute intervals while life threatening CV and/or respiratory features persist
Adrenaline therapy should be supported with IV fluid therapy

35
Q

discharge and follow up after pt has had anaphylaxis

A

Prior to discharge from hospital, patients or their family and carers should be provided with 2 adrenaline auto injectors, trained on their correct use, and be advised to carry it would them at all times

Pt provided with auto injectors should have appropriate follow-up including contact with their GP
Patients and their family or carers should also be provided with info about anaphylaxis, the risk of biphasic reaction (with clear instructions to return to hospital if symptoms return), avoidance of suspected triggers, and what to do if anaphylactic reaction occurs
An Emergency Management or action plan should be provided, and referral to a specialist allergy clinic made

a rare but potentially serious reaction that occurs when anaphylaxis symptoms recur within 72 hours of the initial reaction, without re-exposure to the trigger

36
Q

Which patients should recieve auto injectors after having had anaphylaxis?

A

Provision of adrenaline auto injectors are appropriate for all patients who have had anaphylaxis, with the exception of those with a drug induced reaction unless future exposure to the trigger drug will be difficult to avoid

37
Q

patient has had anaphylaxis to a drug. will they need an epipen to carry with them going forward?

A

no they dont need it unless future exposure to the trigger drug will be difficult to avoid

38
Q

What is allergic angioedema & when should it be managed as anaphylaxis

A

Angioedema can be caused by allergic reaction
Involves swelling of deeper tissues, most commonly in eyelids and lips, and sometimes the tongue and throat
Allergic angioedema that occurs with life-threatening airway and/or breathing and/or circulatory problems should be managed as anaphylaxis

39
Q

treatment of hereditary angioedema needs to be

A

under specialist supervision

40
Q

treatment of hereditary angioedema - the following are ineffective

A

Unlike allergic angioedema, adrenaline/epinephrine, CCs and antihistamines should NOT be used for treatment of acute attacks (including attacks involving laryngeal oedema) as they are ineffective and may delay appropriate treatment - intubation may be necessary

41
Q

hereditary angioedema - treatment

A

Administration of C1-esterase inhibitor, an endogenous complement blocker derives from human plasma, (in fresh frozen plasma or in partially purified form) can terminate acute attacks of hereditary angioedema
Can also be used for short term prophylaxis before dental, medical or surgical procedures
Conestat alfa and icatibant are licensed for treatment of acute attacks or hereditary angioedema
Short term prophylaxis with tranexamic acid or danazol is started several days before planned procedures (e.g. dental work) and continued for 2-5 days afterwards
Danazol should be avoided in children because of its androgenic effects
Lanadelumab or berotralstat may be an option for the prevention of recurrent attacks of hereditary

42
Q

dose of IM injection of adrenaline for child up to 6 months

A

100-150mcg

43
Q

dose of IM adrenaline for child 6 months to 5 yrs

A

150mcg

44
Q

dose of IM adrenaline for child 6-11 yrs

A

300mcg

45
Q

dose of IM adrenaline for child 12-17 yrs& adults

A

500mcg

afsha respiratory (22 decks)

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