allergies Flashcards
what is the clinical term for canker sores?
Recurrent Aphthous Ulcerations
what are the causes of canker sores
Common; familial relationship
Unknown pathogenesis; Immune-mediated process
Most common in children and young adults
what are the common “triggers” of recurrent aphthous ulcerations?
stress, local trauma, menstrual cycle
immune dysregulation; allergy/contact rx
list the 3 forms of recurrent aphthous ulcerations
Minor
Major
Herpetiform
what is the most common variation of aphthous ulcers? what are its characteristics?
Minor Aphthous Ulcerations
Almost exclusively occur NON-KERATINIZED mucosa
Fewest recurrences; shortest duration of lesions
where are minor aphthous ulcerations commonly found?
buccal and labial mucosa
ventral tongue
floor of mouth
soft palate
list the morphological characteristics of minor aphthous ulcers
1-5 painful ulcers; preceded by erythematous macule with prodromal symptoms
Round to oval ulcer; 3-10mm diameter
ERYTHEMATOUS HALO
Heal without scarring 7-10 days
list the characteristics of major aphthous ulcers
Larger than minor aphthae; 1-3 cm diameter
Longer duration per episode; heal in 2-6 weeks often with SCARRING
1-10 lesions per episode
what are the most common sites for major aphthous ulcers?
labial mucosa, soft palate, tonsillar fauces
which form of aphthous ulcers have the highest rates of reoccurrence and present with the largest number of lesions?
Herpetiform Aphthous Ulcerations
characteristics of Herpetiform aphthous ulcers:
Individual lesions small (1-3mm), with many present per episode
occur on ANY oral mucosal surface
healing characteristics of herpetiform aphthous ulcers:
Heal in 7-10 days, but recurrences tend to be closely spaced
how are Recurrent Aphthous Ulcerations treated?
Respond well to topical high –potency corticosteroids
Applied early in course of disease; thin film, multiple times per day
T/F: once an Aphthous ulcer has lost its erythematous border, a corticosteroid steroid will not speed healing
True
__________ syndrome is a multisystem disorder with oral aphthous-like ulcerations
Behcet’s Syndrome
which ethnic groups are at highest risk for Behcet’s syndrome?
Highest prevalence in Middle East and Japan; much less frequent in US
classic triad of Behcet’s syndrome:
Oral ulcerations
Genital ulcerations
Ocular disease
describe the oral lesions of Behcet’s syndrome:
First manifestation in up to 75% cases
Occur in 99% cases
Commonly involve soft palate and oropharynx
Variable size, ragged borders, large zone erythema
T/F: the genital lesions of Behcet’s syndrome resemble the oral lesions
true
what are the characteristics of the “ocular disease” present in Behcet’s syndrome?
Posterior uveitis
conjunctivitis, corneal ulceration, arteritis, etc.
how is Behcet’s syndrome diagnosed?
Based on clinical presentation
Positive PATHERGY test
Treatments & prognosis for Behcet’s syndrome:
Topical or systemic immunosuppresive or immunomodulatory therapy; early aggressive therapy for severe cases
Prognosis: generally good; relapsing/remitting course
Orofacial Granulomatosis seems to represent a abnormality in what?
abnormal immune reaction
clinical characteristics of Orofacial Granulomatosis lesions
non-necrotizing granulomatous inflammation, presenting as persistent non-tender swelling
where in the mouth would you expect to find orofacial granulomatosis lesions?
Lips most common site; may involve any oral mucosal or perioral location
Edema and swelling of other parts of face can be seen
what are the 2 forms of Orofacial Granulomatosis?
Cheilitis granulomatosa:
- Involvement of the lips alone
Melkersson-Rosenthal syndrome
characteristics of Melkersson-Rosenthal syndrome:
non-tender lip swelling
Bell’s palsy
fissured tongue
Microscopic features of Orofacial Granulomatosis:
Superficial vascular ectasia, vasculitis, edema
Non-necrotizing granulomas
No evidence of foreign material and special stains to rule out specific infection
how is Orofacial Granulomatosis diagnosed & treated?
Patients require thorough medical evaluation
Remove sources of inflammation
Intralesional corticosteroids work best
Multiple injections may be necessary
Good prognosis; primarily a cosmetic problem
_________________ is Granulomatosis with Polyangiitis
Wegener’s Granulomatosis
characteristics of Wegener’s Granulomatosis:
Uncommon; well-recognized disease
Unknown etiology; necrotizing granulomatous process with vasculitis
what areas are affected by Wegener’s Granulomatosis?
Can affect upper airway, lungs, kidneys, skin and mucosa
what are the 3 types of Wegener’s Granulomatosis and what areas do they effect?
Generalized Wegener’s (Classic Wegener’s)
– upper and lower respiratory tract, kidneys
Limited Wegener’s
– upper and lower respiratory tract
Superficial Wegener’s
– lesions primarily of skin and mucosa
what are the clinical manifestations of Wegener’s Granulomatosis?
Epistaxis, pain, nasal obstruction
Destruction of nasal septum (saddle-nose deformity)
Dry cough, hemoptysis, dyspnea, chest pain
Proteinuria, red blood cell casts
Large, chronic oral ulcers
“Strawberry gingivitis” – pathognomonic
Palatal ulcer with oral-antral fistula
Microscopic appearance of Wegener’s Granulomatosis:
Poorly formed granulomas, mixed inflammation
Subepithelial hemorrhage
Vasculitis
what antibodies are used to diagnose Wegener’s Granulomatosis?
c-ANCA (cytoplasmic) – most useful
p-ANCA (perinuclear) – also seen in other systemic vasculitides
prognosis for Wegener’s Granulomatosis:
Prednisone and cyclophosphamide
Complete response (remission) is expected in 75% of patients; relapse rate 30%
Limited and superficial forms may progress to classic WG
During an allergic reaction to systemic drugs, a _________ relationship may be acute or delayed
temporal
what are the common clinical characteristics of oral lesions due to allergic reactions to drugs?
where are these lesions most commonly located?
mucosal ulceration and erosion with variable erythema and white striae
Most common sites: buccal mucosa, labial mucosa, ventro-lateral tongue
what is a fixed drug reaction?
inflammatory alterations that recur at the same site after the administration of a medication
what is a Lichenoid drug reaction?
medication induced mucosal alterations which mimic appearance of lichen planus
how are Allergic Reaction to Systemic Drugs DIAGNOSED?
Biopsy non-specific
Detailed medical and clinical history with complete list of Rx and OTC medications
If more than one medication suspected, serial elimination of the medications in collaboration with pt. physician
Mucosal alterations resolve after discontinue medication (recur on reintroduction)
what are the treatment options for Allergic Reaction to Systemic Drugs?
Discontinue responsible medication in conjunction with pt. physician (replace with alternate drug)
+/- Topical corticosteroids
what are the clinical characteristics of Allergic Contact Stomatitis?
Mild/barely visible erythema to extensive erythema, edema, erosions, ulcerations, exfoliation
May be asymptomatic; burning, itching, stinging
name some of the causes for Allergic Contact Stomatitis:
Foods, flavoring agents, gum, candies, oral hygiene products, cosmetics, dental gloves and rubber dam material, metals, denture materials, impression materials, etc.
how is Allergic contact stomatitis Diagnosed?
Identification of temporal relationship between contact with agent and oral changes
Patch testing
name the 3 types of Allergic contact Stomatitis:
1) Dentrifice-Related Sloughing
2) Oral Mucosal Cinnamon Reaction
3) Lichenoid Amalgam Reaction
characteristics of Dentrifice-Related Sloughing:
Toothpaste can cause widespread desquamation of the superficial layers of epithelium
Minimal/mild erythema
Associated with sodium lauryl sulfate
treatment for Dentrifice-Related Sloughing:
No treatment necessary; harmless process
Switching to a bland toothpaste will result in resolution
causes of Oral Mucosal Cinnamon Reaction:
- Contact reaction to ARTIFICIAL CINNAMON flavoring
- Clinical distribution varies by medium of delivery
A) Toothpaste = diffuse, gingiva
B) Chewing gum/candy = localized
clinical presentation of Oral Mucosal Cinnamon Reaction:
Erythema with overlying shaggy hyperkeratosis
Pain and burning are common symptoms
T/F: the lesions caused by an Oral Mucosal Cinnamon Reaction will normally resolve within ONE WEEK after discontinuing use
true
what type of allergic reaction is associated with old amalgam restorations undergoing corrosion and release of metallic ions?
Lichenoid Amalgam Reaction
where are lichenoid amalgam reaction lesions usually found?
Limited to mucosal surfaces directly in contact with the restoration (buccal mucosa, ventral and lateral tongue)
characteristics of Lichenoid Amalgam Reaction lesions:
Mucosal alterations mimic lichen planus, however are localized
May be white or erythematous, +/- peripheral striae
how are Lichenoid Amalgam Reaction lesions treated?
Smooth, polish, recontour old amalgam
Replace amalgam with non-metallic restoration (composite resin, porcelain crown)
__________ is a diffuse edematous swelling of soft tissue
Angioedema
name the 3 types/causes of Angioedema:
1) IgE mediated hypersensitivity reaction
2) Angiotensin-converting enzyme (ACE) inhibitors
3) C1 esterase inhibitor (C1-INH) deficiency
what type of Angioedema is most common? what are its major causes?
most common = IgE mediated hypersensitivity reaction
Contact reaction: foods, cosmetics, drugs, etc.
Physical stimuli: heat, cold, exercise, sun exposure
Excess ___________ due to Angiotensin-converting enzyme (ACE) inhibitors will cause Angioedema
bradykinin
Clinical features of Angioedema:
Relatively rapid onset of soft tissue swelling
Non-painful; pruritis and erythema may be seen
Solitary or multiple sites of involvement
Commonly affects head and neck region
Resolves in 24-72 hours
how is Angioedema Diagnosed?
Based on clinical presentation, possibly in conjunction with known trigger
Evaluation for adequate functional C1-INH
how is Angioedema treated?
Oral antihistamine, IM epinephrine, IV corticosteroids
Prevention
ACE inhibitor-related and C1-INH deficiency non-responsive to standard tx
