Allergic Disorders Flashcards
nasal turbinates: swollen (boggy), pale, bluish-gray
itchy eyes, itchy nose, nasal congestion, rhinorrhea (thin, watery) sneezing
no LAD
present most days, worse in fall + spring
allergic rhinitis
treatment of allergic rhinitis
can be used in combo:
avoid allergen (DOC, most successful tx)
antihistamines (if nasal + conjunctivitis)
decongestants (cold sx, if topical - can cause rebound congestion if excessive use)
intranasal steroids (if only nasal sx, most consistent symptomatic relief)
oral (systemic) CS if severe
immunotherapy
inflammation of nasal membranes (rhinitis) +/- eyes, eustachian tube, middle ear, sinuses, pharynx
sneezing, nasal congestion, nasal + eye + ears itchy, rhinorrhea, postnasal drip
tearing, red eyes
anosmia (lack of smell), HA, earache, drowsy
allergic rhinitis
rapidly progressing, life-threatening allergic reaction, mediated by IgE immediate HSR
urticaria or angioedema, SOB, visceral edema, hypotension + shock (widespread vasodilation, respiratory distress from bronchospasm or laryngeal edema, GI and uterine muscle ctx)
anaphylaxis
most common cause of rhinitis
allergic rhinitis
allergic sensitization: foreign protein exposure → IgE against protein coats mast cells in nasal mucosa
2nd exposure: allergen binds to IgE on mast cells → release of mediators
immediate release: histamine, tryptase, chymase, kinase
mast cells synthesize some immediately: LK, PGD2
immediate symptoms: ↑ mucous secretions, vasodilation → congestion, sensory nerves: sneeze, itch, conjunctivitis, postnasal drip, ear pressure
next 4-8 hrs: mediators recruit PMN, eosinophils, lymphs, macrophages to mucosa
symptoms for hrs-days: increase congestion, mucous, fatigue, sleepy, malaise
allergic rhinitis
allergic rhinitis consistent level throughout the year
perennial rhinitis
allergic rhinitis only during specific seasons (pollens, outdoor molds)
seasonal rhinitis (can have perennial with seasonal exacerbations)
allergic rhinitis during job
occupational rhinitis
response to antihistamines supports diagnosis of:
allergic rhinitis
spores, animals, cleaning, pollen
smoke, pollution, strong smells
allergic rhinitis triggers
dark circles around eyes due to vasodilation and/or nasal congestion
allergic shiners
horizontal crease across bridge of nose - rubbing tip of nose by palm of hand
allergic salute
nasal crease
thick, purulent nasal secretions
sinusitis (can also occur in allergic rhinitis)
thin, watery nasal secretions
allergic rhinitis
firm, gray masses attached by a stalk (may not be visible)
does NOT shrink after spraying topical decongestant (surrounding nasal mucosa does shrink)
nasal polyp
septal deviation or perforation caused by
chronic rhinitis granulomatous disease cocaine abuse prior surgery topical decongestant abuse topical steroid overuse
tympanic membranes: TM retraction air-fluid levels bubbles altered mobility with pneumatic otoscopy
allergic rhinitis with eustachian tube dysfunction or secondary otitis media
injection + swelling of palpebral conjunctivae
excessive tear production
creases below inferior eyelid (Dennie-Morgan lines)
allergic rhinitis
cobblestoning of posterior pharynx: streaks of lymphoid tissue on posterior pharynx
tonsilar hypertrophy
allergic rhinitis
wheezing, ↑ RR, prolonged expiratory phase of respiration
asthma
tree pollens: worse in spring (some in fall)
grass pollens: most are cross-reactive, worse in late spring to fall
weeds: ragweed (worse in late summer to fall)
seasonal allergic rhinitis
home allergens: dust mite (clean to remove), indoor pets (also cockroaches)
year-round outdoor allergens (warmer climate: grass) or trees/grass in summer, mold/weed in winter
perennial allergic rhinitis
SE of first gen antihistamine: diphenhydramine, chlorpheniramine, hydroxyzine
sedation, anticholinergic (dry mouth + eyes, blurred vision, urinary retention) - caution if elderly
SE of second gen antihistamines: loratadine, desloratadine, fexofenadine, cetirizine
less sedation (except cetirizine) less anticholinergic SE (good if BPH - urinary retention) as effective as first-gen antihistamines more expensive available OTC
mild, intermittent symptoms of allergic rhinitis
med takes effect within 15-30 minutes after ingestion
antihistamines PO
med for nasal congestion
constrict blood vessels of nasal mucosa
decongestant PO or intranasal (risk of rebound congestion)
SE of pseudoephedrine: α receptor agonist (decongestant)
↑ HR, tremor, insomnia
rebound hyperemia, worsening congestion with chronic use or discontinuation of nasal decongestant
DOC for long-term management of mild-mod persistent allergic rhinitis
max effect after 2-4 wks of use
↓ mediator production and recruitment of ICs
nasal corticosteroid
SE of nasal corticosteroids
nosebleeds
pharyngitis
URIs
use: allergic rhinitis, persistent asthma maintenance therapy, if ASTHMA + allergies, allergens trigger asthma
leukotriene inhibitors: zafirlukast, montelukast, zileuton
inhibitor of cell-mediated immunity
use: severe allergies
oral corticosteroids
SE of oral corticosteroids
suppression of HPA
hyperglycemia
long-term use: peptic ulcer, susceptibility to infection, poor wound healing, reduction of bone density
treatment if remain symptomatic despite maximal medical therapy
test for antigens that patient is allergic
inject patient with diluted concentration of antigen
gradually increase concentration to reduce inflammatory response to antigen (given weekly)
desensitization therapy
irregular, pruritic, erythematous wheals
urticaria
painless, deep, subq swelling that involves periorbital, circumoral, and facial regions
angioedema
treatment of anaphylaxis
first suspicion: subq or IM epinephrine (repeat q 15-30 min PRN)
IV fluids (saline, lactated ringer solution, plasma, or plasma expanders) to replace loss of intravascular plasma into tissues
endotracheal intubation if airway obstruction
subq epinephrine or terbutaline: bronchospasm
antihistamine: urticaria, angioedema, pruritus
monitor for 24 hrs
infection of palpebral (eyelid) or bulbar (eye) conjuntiva
most commonly caused by virus or bacteria
less common: allergy, chemical
transmission: direct contact via finger, towel, handkerchief
conjunctivitis
cause of bacterial conjuncitvitis
staph strep H. influenzae moraxella pseudomonas
eye itching, tearing, redness, stringy clear discharge +/- photophobia
allergic conjunctivitus
tx of allergic conjunctivitis
oral antihistamine
topical antihistamine
anti-inflammatory eye drops
mild eye discomfort
no blurry vision
lasts 10-14 days if untreated, 2-3 days if use sulfonamide
bacterial conjuncitivitus
caused by adenovirus
very contagious: direct contact or fomites
red palpebral conjunctiva
lots of watery discharge
associated with: pharyngitis, fever, malaise, preauricular LAD
epidemic keratoconjunctivitis (pink eye)
