Allergic DO including hay fever Flashcards
________ are one of the most common
causes of food-induced anaphylaxis in adults
Peanuts
Another special case is the___________, in which people with some degree of seasonal allergy to grass pollens or birch pollen suffer oral itch and swelling when they come into contact with certain fruits.
oral allergy syndrome
The development of urticaria on contact with latex is highly suggestive of underlying______
type 1 hypersensitivity
__________refers to those 40% of people who have an
inherited tendency for an exaggerated IgE antibody
response to common environmental antigens
Atopy
Of those who are atopic, onehalf
to one-third manifest an allergic disorder, most
commonly
1
2
3
4
allergic rhinitis, asthma, atopic dermatitis or allergic gastroenteropathy
MC manifestation of inhalant allergies
Allergic rhinoconjunctivitis and asthma are the main
manifestations
The history provides a strong pointer to the causative allergen. If symptoms are seasonal,_______ is most likely; perennial symptoms indicate an allergy to _____
pollen allergy
dust mites, household pets or moulds.
A_________ is an adverse reaction to a
specific food or food ingredient. It is regarded as a
food allergy if the reaction is immune based
food intolerance
Food allergies can be simply classified as:
1
2
• immediate reactions—occurring within 2 hours
• delayed reactions—occur up to 24 hours after
ingestion
These are immediate immune-mediated responses to
a foreign protein that are relatively easy to diagnose.
IgE-mediated food reactions
Pathophysio of IgE mediated food reactions
Due to release of mast cell mediators
Cow’s milk can cross-react with_____ and ______
goat’s milk and soy protein
Examples of Non-IgE-mediated food reactions
This includes cow’s milk protein intolerance with both breast milk- and formula-fed infants
T or F
Non-IgE-mediated food reactions
Uncommon after 3 years of age—50% resolve in
1–2 years
T
For milk protein intolerance first-line treatment
is a formula containing_______
Don’t use soy-based formulas under_______
months since many are also soy protein intolerant.
cow’s milk protein hydrolysate.
6
This is seen in young infants usually <6 months and
it is usually due to cow’s milk, soy or cereals. It can be
seen in breastfed infants and older children
Food protein induced enterocolitis syndrome (FPIES)
SSx of Food protein induced enterocolitis
syndrome (FPIES)
A typical reaction is delayed onset of projectile vomiting and protracted diarrhoea
Dx of Food protein induced enterocolitis
syndrome (FPIES)
The stool contains blood and eosinophils.
_____________testing is indicated
where skin testing contraindicated
Radioallergosorbent (RAST)
The combination of _____ and _______ is dangerous, as evidenced by fatal or near-fatal reactions in young children
peanut allergy
and asthma
Example of Adult anaphylaxis kit
Autoinjector 300 mcg adrenaline 1:1000 IM injection
Inject into outer thigh muscle at first sign of swelling of
throat or tongue, or other reaction (e.g. breathlessness)
What vaccine may not be given for pts with egg allergy?
Current vaccinations do not include egg; it is present
in only minute amounts in the MMR vaccine
Latex allergy is what type of allergic reaction?
The clinical manifestations of type 1 hypersensitivity
reactions to latex protein are wide-ranging, from
urticaria to life-threatening anaphylaxis and death
IgE testing
This is the preferred method as results can be read
at the first consultation, provided the high-quality
allergen preparations are used
Skin-prick tests
When is Skin-prick tests useful?
If tests are negative. A negative
test is very useful for excluding IgE-mediated allergy
A number of tests, including______________ measure allergen-specific IgE in the serum.
RAST tests and ELISA
tests,
Indications for Detection of serum specific IgE
history and skin tests not
matching, extensive eczema, dermographism, infants and very young children, immunotherapy work-up,
antihistamine use in past 48 hours
This involves repeated administration of small, increasing
doses of allergen by subcutaneous injection
Immunotherapy (desensitisation)
This is the
treatment of choice for severe wasp or bee venom allergy
and for resistant allergic rhinoconjunctivitis where a
single causative allergen can be identified.
Immunotherapy (desensitisation
May be seasonal or perennial. It
can be classified as either intermittent (lasting for
<4 days of the week or <4 weeks) or persistent
(lasting >4 days of the week or >4 weeks).
Allergic rhinitis
This is the most common type of allergic rhinitis and is
due to a specific allergic reaction of the nasal mucosa,
principally to pollens
Seasonal allergic rhinoconjunctivitis (hay fever)
The allergens responsible for perennial allergic rhinitis include
inhaled dust, dust
mite, animal dander and fungal spores
While patients with________tend to have
widespread itching (nose, throat and eyes), those with
______ rarely have eye or throat symptoms
but mainly sneezing and watery rhinorrhoea
hay fever
perennial rhinitis
In MX of hay fever, Avoid using __________: although they soothe at first, a worse effect
occurs on the rebound
decongestant nose drops and sprays
Pharma Tx for Mx of hay fever
1 antihistamines:
2 decongestants (oral or topical)
3 sodium cromoglycate
4 corticosteroids
What kind of Tx for hay fever
• oral (not so effective for vasomotor rhinitis)
• intranasal spray (rapid action)
• ophthalmic drops
Antihistamine
What kind of Tx for hay fever
- intranasal: powder insufflation or spray
- ophthalmic drops for associated conjunctivitis
sodium cromoglycate
What kind of Tx for hay fever?
• intranasal (not so effective for non-eosinophilic
vasomotor rhinitis)
• oral (very effective if other methods fail)
• ophthalmic drops for allergic conjunctivitis
corticosteroids
Consider __________ when
specific allergens are known (very important)
and conventional response is inadequate
hyposensitisation/immunotherapy
Immunotherapy by _____ or ______ administration can be intensive, often taking years
injection or oral
__________ are the first line of treatment
for seasonal hay fever and are generally effective
where symptoms are intermittent, or when they
can be used prophylactically before periods of high
pollen exposure
Oral antihistamines
___________either used alone or in
combination with antihistamines (where they may
help reduce drowsiness), may be of value, particularly
where nasal discharge and stuffiness are major
symptoms
Oral sympathomimetics,
When to use caution oral sympathomimetics
They should be used cautiously in patients
with hypertension, heart disease, hyperthyroidism,
glaucoma and prostatic hypertrophy.
Intranasal decongestants should be used for limited
periods only (i.e. less than a week) or intermittently
(3–4 doses per week) because of the potential
problems with _____ and _________
rebound congestion and rhinitis
medicamentosa
when are the decongestants of value?
They are often of particular value
during the first week of treatment with intranasal
corticosteroids (where the onset of action is
delayed several days), improving nasal patency
and allowing more complete insufflation of the
corticosteroids.
Intranasal ___________acts by preventing
mast cell degranulation and is effective without serious
side effects.
sodium cromoglycate
__________ sprays are the most
effective agents for treating seasonal allergic rhinitis
Intranasal corticosteroid
What to tell to pts with intranasal steroid
Patients should
be informed that these medications will not give
immediate relief (often taking 10–14 days to
have peak effect) and must be used continuously
throughout the hay fever season for at least 6–8
weeks
Mild SE of intranasal steroid
Local side effects include dryness and mild
epistaxis
__________ eyedrops are usually very
effective for springtime conjunctivitis
Sodium cromoglycate
best use of Sodium cromoglycate
They can
used as necessary (there is no dosage limit) and are
most helpful when used prophylactically before
periods of high pollen exposure
These can be very effective where other treatments
or methods have failed. A 6–10 day short course
can be used.
Oral CS
The nasal preparation of this topical anti-cholinergic
is often very effective when rhinorrhoea is the major
problem.
Ipratropium bromide (Atrovent
Regarded as equivalent to oral antihistamines,
they have a place in the management of children
with concurrent asthma and hay fever
Leukotriene receptor antagonist
________ aims to reduce the size
of turbinates and so reduce nasal obstruction when
congested
Inferior turbinate reduction
