Allergology Chap 140-152 Flashcards
Drug of choice for the treatment of anaphylaxis
Epinephrine
Effective treatment for allergic NASAL disease
Alpha-adrenergic agents
- decongestant effect
- vasoconstiriction -> decrease nasal congestion
S8de effect of alpha adrenegic agents
Rhinitis medicamentosa (rebound nasal congestion) - must not be given for more than 3 days
Inflammatory disorder of the nasal mucosa
Nasal congestion, rhinorrhea, itching, often accompanied by sneezing & conjuctival inflammation
Allergic Rhinitis
Main cause of allergic rhinitis
Inhalant allergens
Sneezing, rhinorrhea, nasal itching & congestion
Clear nasal secretions, edematous, boggy and bluish nasal mucosa
Elevated serum IgE
Positive allergy skin test
Allergic Rhinitis
Allergic Rhinitis (AR) occuring in <4day/week No change in sleep and daily activities
Mild Intermittent AR
Allergic Rhinitis (AR) occuring in >4day/week Sleep disturbances and impairment in daily activities
Moderate to severe Persistent AR
Chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction
Airway hyperresponsiveness
Asthma
Strongest identifiable factor for the persistence of childhood asthma
Allergy in young children with recurrent cough &/or wheeze
MC chronic symptoms of asthma
Intermittent dry coughing & expiratory wheezing
T/F: Respiratory symptoms in asthma are worse at night
True
T/F: Asthma produces clubbing
False
Objective measure of airflow limitation
Spirometry
Management of INTERMITTENT ASTHMA
SABA as needed
Preferred treatment for all patients with PERSISTENT ASTHMA
Inhaled corticosteroids (ICS)
Not intended for use as rescue medication in Asthma
Long acting Beta agonist (LABA)
- Salmeterol, Formoterol
May be used to reduce exercise-induced bronchospasm
Nonsteroidal Anti-inflammatory agents
- Cromolyn, nedocromil (taken off market)
Drug of choice for ACUTE asthma symptoms
Short acting beta agonists (SABA)
- Albuterol, levabuterol, terbutaline, pirbuterol
T/F: Chest physiotherapy, incentive spirometry and mucolytics are NOT RECOMMENDED in the early acute period of asthma exacerbations
True.
They can trigger severe bronchoconstriction
Preferred SABA for pregnant women
Albuterol
Preferred ICS for pregnant women
Budesonide
MC chronic relapsing skin disease in infancy & childhood
Atopic Dermatitis or Eczema
Skin lesions characterized with marked intercellular edema (SPONGIOSIS)
With noted marked perivenular T-cell infiltrate with occasional monocyte-macrophages
Acute Atopic Dermatitis
Characterized by hyperplastic epidermis with hyperkeratosis and minimal spongiosis
Chronic, lichenified Atopic Dermatitis (AD)
Hallmark of Atopic Dermatitis
Severely Dry skin
Infant, who came in with intenesely pruritic, erythematous papules on the face, scalp and extensor surfaces of the extremities
Noted to have dry lackluster skin
Acute Atopic Dermatitis
Child who came in with noted thickened skin lesions with accenuated surface markings (lichenification), and fibrotic papules on the flexural folds
With intense pruritus, especially at night
Chronically relapsing rashes when exposed to pollen (allergens)
Chronic Atopic Dermatitis
Cardinal features of Atopic Dermatitis (2)
Intense pruritus, especially at night
Cutaneous reactivity
Cornerstone of anti-inflammatory treatment for acute Atopic Dermatitis
Topical corticosteroids
MC hypersensitivity response of the eye
Allergic Conjunctivitis
Bilateral ocular itching, increased tearing, watery discharge
Pe: bilateral conjunctival injection with congestion, conjunctival swelling (chemosis)
Allergic Conjunctivitis
Severe Bilateral Chronic Inflammatory process of the Upper Tarsal Conjunctival surface
Potentially sight threateninb with involvement of the cornea
Vernal Keratoconjunctivitis
Patient came with SEVERE ocular itching exacerbated with exposure to light and perspiration. Note pf photophobia, foreign-body sensation and lacrimation
With history of atopy
Pe: giant papillae on the upper tarsal plate (COBBLESTONING); Stringy, ropey discharge; transient yellow-white points in the Limbus (Trantas dots) & conjuctiva (Horner points), long eyelashes
Vernal Keratoconjunctivitis
Chronic inflammatory ocular disorder most common in the LOWER tarsal conjunctiva
Sight-threathening
Associated with Atopic dermatitis
Atopic Keratoconjunctivitis
Severe bilateral ocular itching, burninh, photophobia & tearing with MUCOID discharge, and persists throughout the year
Secondary staphylococcal blepharitis is common
Atopic Keratoconjunctivitis
Mild bilateral ocular itching, tearing, foreign-body sensation with mild mucoid discharge that is clear on awakening but becomes thick ang stringy due to chronic exposure to FOREIGN BODIES
Giant Papillary Conjunctivitis
Erythematous, pruritic, raised wheal that blanches with pressure, transient, and resolves without residual lesions
Urticaria (Hives)
Lesions that burn more than itch, lasts for >24h, DO NOT BLANCH, blister, heal with SCARRING, or may have bleedinh into the skin (purpura)
Urticarial Vasculitis
Development of localized pruritus, erythema and urticaria AFTER EXPOSURE to COLD STIMULUS
Cold Urticaria
Onset of Small, Punctate, pruritic wheals surrounded by a prominent erythematous flare
Associated with EXERCISE, HOT SHOWERS, & SWEATING
Cholinergic Urticaria
Ability to write on skin
Dermatographism or Urticaria Factitia
Noted cellular infiltrates predominantly around small venules
Not an allergic reaction
Skin reveals infiltrative hives with palpably elevated borders varying greatly in size and shape
Biopsy: non necrotizing, perivascular, mononuclear cellular infiltration
Chronic Idiopathic Urticaria & Angioedema
MC cause of Acute Urticaria
Drug
Food
Serious allergic reaction that is rapid in onset and may cause death
Anaphylaxis
An example of Type III hypersensitivity reaction caused by antigen-antibody complexes
It is a systemic, immune complex-mediated hypersensitivity vasculitis attributed to THERAPEUTIC ADMINISTRATION of FOREIGN serum proteins
Serum sickness
Child came in due to edema and erythema of the right deltoid. Noted to be given antitetanus toxoid in the site 7 days prior. Also complains of fever, myalgia, arthralgia and URTICARIAL rashes
Labs: thrombocytopenia in cbc, ua showed microscopic hematuria, mild proteinuria, C3 is low
Serum sickness
T/F: Serum sickness can be prevented by desensitization and pretreatment with corticosteroids
FALSE
