Allergic Rhinoconjunctivitis and Asthma-Hogan Flashcards
What is this:
Collection of symptoms from the nose and eyes occurring when the individual inhales an allergen to which he is sensitized. When do symptoms occur and what are the hallmark features?
Symptoms may occur both early and late. A hallmark feature is itch or sneeze.
(blank) is a chronic inflammatory disorder of the airways characterized by obstruction of airflow
asthma
T or F
asthma may be completely or paritally reverse with or without specific therapy.
T
More than half of all asthmatics develop asthma before (blank) years old
3 (but now adult epidemic is being appreciated)
T or F
multiple triggers are possible even in the same adult
T
Who gets asthma the most?
males predominate in children, females in adult onset asthma
What does an anitgen bind to which causes an allergy? What do these release?
basophil and mast cells
Mediators of inflammation and cellular inflammation
What does the early phase of allergy look like and how long does it last?
15-20 minutes
congestion, sneezing/pruitus, secretions
What do the mediators of inlammation do?
bring in eosinophils, basophils, lymphocytes and neutrophils which triggers the late phase
How long does the late phase of asthma last?
4-6 hours
When is tree season?
Grass season?
Weed season?
easter day
memorial day
labor day
What is the predominant cell in the early phase? the late phase? the chronic phase?
mast cell
eosinophils
lymphocytes
After inhalation of allergen into the lung what happens?
the early phase of asthma is initiated by allergen binding to a specific IgE on mast cells
Once an allergen binds to a IgE on a mast cells what happens?
histamine release occurs and bronchoconstriction follows and cellular cytokines are released in the early phase creating a drop in FEV1
THe late phase of allergy response is initiated by influx of (blank) responding to mast cell released cytokine signals. What will this result in?
Eosinophils
A second drop in FEV1 occcurs several hours after initial allergen exposure
With continual exposure to allergen comes frequent drop in (Blank) and ongoing symptoms.
What other cell participates in the chronice phase (repeated exposire)?
pulmonary function
Lymphocytes
What happens to your airways during an asthma attack?
airway edema w/ secretions and constriction
In a person with asthma, what will their airways look like?
Have an eosinophilic infiltrate and thickening of airways
What are the immediate symptoms of allergic rhinitis?
Itch can occur in the nose, mouth, eyes, throat, ears Anosmia (loss of sense of smell) Rhinorrhea Sneezing Tearing Eyes
What are the late rhinits symptoms after allergen is inhaled?
- congestion
- coughing
- clogged/popping ears
- anosmia
- sore throat
- shiners
- fatigue/sleepiness/malaie
- headache
- mouth breathing
What are the physical exam findings of allergic rhinitis?
-Allergic shiners (caused by vasodilation or nasal congestion)
-Nasal crease (causd by repeated upward rubbing of top of nose)
Nasal exam: swollen (boggy) nasal turbinates with a pale, bluish-gray color
Ocular exam: injection and swelling of palpebral conjunctivae with excess tear production
What is the differential diagnosis for asthma in children?
- sinusitis
- adenoidal hypertrophy
- anatomic nasal variations
- cystic fibrosis (polyps)
- immotile cilia (kartageners)
- tic cough
- non allergic rhinitis
What is non allergic rhinits?
Anything from infectious to a reaction with the environment that is not an allergy
If you see a (blank) in a child it is CF until proven otherwise
polyp
What are the complications of allergic rhinitis?
Sinusitis Vernal Conjunctivitis (25% can have vision loss from this) Recurrent OM Eustachian tube dysfunction Worsening AD Worsening asthma Sleep apnea (adenoidal obstruction)
How does vernal conjunctivitis present?
photophobia and sticky mucus threads and cobbling in conjunctiva.
What is the cumulative prevlanence rate of AR?
20%
What is the mean number of allergens that pediatric patrients are sensitized to?
3
(blank) percent of patients have persistent rhinitis with 2/3 moderate to severe form
73%
Are children likely to have seasonal allergies
no more likely to have year round symptoms due to encountering different aeroallergens throughout the year
Lowest asthma symptoms was (blank)
Prevalence of wheeze was 32% in summer and 56% in fall (blank)
AR associated with increase risk of uncontrolled asthma during the (blank)
Presence of eczema was associated with higher risk of uncontrolled asthma during (blank)
Why is the wheeze the worst in fall?
summer
fall
spring
autumn
because of start of allergy season and school seaseon
169 asthmatic patients enrolled and 49 children were less than 1 year of age. Skin test evaluation performed.
28.5% (blank) allergic
10.2% (blank) allergic
10.2 % (blank) allergic
4% (blank)
0% (blank)
Cock Roach Dust Mite cat alternaria (fungus) dog
What children had the most pollen allergies with their asthma?
3 and 4 your olds
(blank) tests to outdoor allergens at baseline was the single most important predictive factor for incidence and persistence past puberty for allergic rhinitis and asthma. ie. this well tell you what children will remain asthmatics as adults
Positive skin tests
What is the most likely way to get asthma and AR?
2/3 get AR first then asthma
Developmentally the (blank) occur together. Therefore they share pathophysiologic pathways in common. For subjects with AR and asthma: the 49% taking nasal glucocorticosteriods had (blank) ER visits and hospitalizations
nose/lung
less
Allergic rhinitis patients treated with (blank) have improvement in both rhinitis symptoms (expected) and bronchial reactivity/asthma symptom scores
nasal steroids
(blank) is major allergen in rural and inner city and is linked to asthma severity.
Cockroach
12% of children with asthma allergic to (blank)…this allergy linked to increased asthma severity in the inner city.
mice
In the east, when are the most allergies?
monosoonal/hurrican season due to dust mites and mold
Do we get DM and mold allergies in the desert?
not really but if you have a swamp cooler you can
Name that region:
allergies to grass pollen, ash pollen, hazel pollen, plantain pollen
Rural
Name that region:
ornamental tree pollen
urban
If you have no redness or itch with a skin rash, what does this indicate?
not an allergic reaction
What is the first step in allergy treatment?
removal of allergen, start pharm therapy prior to season (cuz once mast cells are activated AR/asthma is hard to control)
What is a syrup that is over the counter and a good tx for Allergic rhinitis or allergic conjunctivitis managment? How often do you give it?
Cetrizine
once daily
What is this:
an oral suspension or tablet that doesnt cause sedation and is given 1-2 two times a day. It is used for allergic rhinits or allergic conjunctivits?
Fexofenadine
What is this:
This antihistamine is not as efficacious as fexofenadine/cetirizine…although non-sedating.
What is this:
This is found in every house in american but is not very effective for allergies, it is very sedative
What is this:
Available on medicaid formulary. Sedation less than diphenhydramine 4x/day
Loratidine
Diphenhydramine
Hydroxyzine
What is this:
You put in a nostril and is for allergic rhinitis or non allergic rhinitis.
Tastes bad but works well.
Rapid onset of action
Nose bleed as side effect, rare sedation
Shown to also improve AC symptoms.
Azelastine nasal spray
What should you give for Allergic conjunctivitis?
Cromolyn
Olopatadine
Ketotifen
What is used as pretreatment for AR “cat kit”
cromolyn
What is this:
for allergic rhinits and asthma, Kids love it. once daily.
Montelukast (leukotriene receptor antagonist)
What is this: princess nose spray (smells like roses) OTC steroid best as maintenance therapy
Fluticasone nasal spray (topical steroids)
(blank) is the only immunomodulatory therapy which is FDA approved AND induces fairly permanent tolerance.
Reduces risk of developing asthma in AR children by 40%.
Reduces risk of broadening allergic sensitization further.
Allergy Immunotherapy
Which of the following allergy immunotherpaies can cause anaphylaxis:
SCIT or SLIT?
Which only gives one allergen?
Which one is more efficacious?
SCIT
SLIT
SCIT
(blank) cells induce peripheral tolerance to allergens
T reg
(blank) T reg cells control the allergen specific immune response via suppression of:
Dendritic cells that support generation of effector T cells
TH1, TH2, TH17 effector cells
Allergen specific IgE and induction of IgG4.
Suppression of bone marrow derived cells to tissues
Skew dendritic cells towards IL-10/suppressor presentation.
CD4+/CD25+
In asthma, Eosinophilic or neutrophilic inflammation exists in children and adults. Younger children more likely (blank) driven.
viral
As an infant, asthma is may or may not be triggered by an (blank). But as an adult it is triggered by (blank)
allergy
allergy
When do you have wheezes in small children?
E>I
