Allergy Flashcards
A chronic nonallergic rhinitis described as a syndrome of sneezing, rhinorrhea, congestion, or postnasal discharge in the absence of an identified cause
Vasomotor rhinitis
later onset than allergic rhinitis, exacerbated by weather and irritants rather than allergens
Diagnosis: systemic illness with saddle nose deformity, chronic sinusitis, malnourishment, infertility, and chronic or recurrent bronchitis
Granulomatosis with polyangiitis (Wegener granulomatosis)
Diagnosis: young person, nasal polyposis, chronic sinusitis, malnourishment, infertility, and chronic or recurrent bronchitis
Cystic fibrosis
Diagnosis: nonseasonal rhinitis with negative skin tests
Vasomotor rhinitis
Diagnosis: refractory congestion after chronic use of topical nasal decongestants
Rhinitis medicamentosa
Diagnosis: nasal congestion in the last 6 or more weeks of pregnancy
Pregnancy rhinitis
Diagnosis: rhinitis, nasal polyps, asthma, and aspirin intolerance (respiratory symptoms)
Aspirin sensitivity (triad asthma or Samter syndrome)
First-line drugs for allergic rhinitis
Intranasal corticosteroids
Most consistently effective treatments for chronic nonallergic rhinitis (3)
Topical intranasal corticosteroids, topical intranasal antihistamines, and topical ipratropium bromide
Hallmark of urticaria
Wheal
Chronic urticaria is defined as having symptoms most days for this duration
> 6 weeks
Most patients with chronic urticaria should be evaluated for this endocrine condition due to its higher incidence
Hypothyroidism
Chronic urticaria with lesions persisting >24 hours with purpura/ecchymoses upon resolution are likely due to this condition
Urticarial vasculitis
Definitive diagnosis of urticarial vasculitis
Skin biopsy
Diagnosis: urticaria with fever, adenopathy, arthralgias, and antigen or drug exposure
Serum sickness
First-line therapy for urticaria
Nonsedating antihistamines
Drug that blocks H1, H2, and serotonin receptors and is often effective for urticaria
Doxepin
Presence of this finding points against bradykinin-mediated angioedema
Urticaria
(bradykinin-mediated angioedema [e.g., hereditary angioedema, acquired C1 inhibitor deficiency, ACE inhibitor effect] is not associated with urticaria)
Treatment for acute episodes of bradykinin-mediated angioedema (hereditary or acquired)
IV C1 inhibitor concentrate
use FFP in an emergency
Long-term management of hereditary angioedema
Danazol or stanozolol
elevates hepatic synthesis of C1 esterase inhibitor protein
First-line therapy for anaphylaxis when only hives or pruritus are the presenting signs
Epinephrine
Treatment for epinephrine-refractory anaphylaxis
Glucagon
Dose and route of epinephrine as first-line treatment for classic anaphylaxis
IM or SC epinephrine (0.3-0.5 mg of 1:1000)
IV epinephrine [1:10,000] is reserved for anaphylactic shock or refractory symptoms
Most common self-reported medication allergy
Penicillin
Test that identifies 95% of patients at risk for immediate reaction to penicillin if it must be used in a patient with penicillin allergy (e.g., neurosyphilis)
Skin test
not RAST or ELISA
IgE-mediated cephalosporin reaction occurs in this percentage of patients who are allergic to penicillin
2%
Diagnosis: acute onset of widespread pustules, fever, leukocytosis, eosinophilia after drug exposure
Acute generalized exanthematous pustulosis (AGEP)
Diagnosis: acute onset of generalized papular eruption, facial edema, fever, arthralgia, generalized lymphadenopathy, elevated serum aminotransferases, eosinophilia, and lymphocytosis
Drug reaction with eosinophilia and systemic symptoms (DRESS) also known as hypersensitivity syndrome
Antibiotic associated with a phototoxic reaction consisting of severe sunburn after drug exposure
Tetracycline
Antibiotic associated with a photoallergic reaction presenting as a rash after days or months of use
Sulfonamides
Aside from vancomycin, this commonly used antibiotic is also associated with red man syndrome
Ciprofloxacin
Most common type of drug reaction
Morbilliform rash
Second most common drug-reaction type
Urticaria
Two most common classes of drugs that cause skin eruptions
Antibiotics (penicillin and sulfa drugs) and anticonvulsants (phenytoin and carbamazepine)
In patients with EBV or CMV infection, or underlying acute lymphoblastic leukemia, use of this drug is associated with the appearance of a maculopapular rash
Ampicillin
Most common mechanism of drug fever
Hypersensitivity
Most common primary immunodeficiency
Congenital IgA deficiency
Most common symptomatic immunodeficiency
Common variable immunodeficiency
Malignancies with increased incidence in common variable immunodeficiency (3)
Gastric adenocarcinoma, intestinal lymphoma, non-Hodgkin lymphoma
First-line therapy for common variable immunodeficieny
IV immune globulin
Initial test for suspected complement deficiency
CH50 assay
