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Dermatology (IHD Den303) > Allergy > Flashcards

Allergy Flashcards

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Dermatology Board Prep flashcards
1
Q

Type 1 vs type 4 hypersensitivity

A

1: mast cell mediated
4: cell mediated

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2
Q

Type 1

A

Histamine (mast cell) mediated
Atopic e.g. eczema, rhinitis, asthma, anaphylaxis*?
Urticarial: localised e.g. latex contact or generalised e.g. LA
Ask re swelling of lips or other systemic symptoms

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3
Q

High molecular weight vs low molecular weight

A

High molecular weight: immunoglobulin E mediated type 1 hypersensitivity reaction
Low: Absorbed directly - type 4 hypersensitivity reaction

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4
Q

Symptoms and signs due to dental allergies and irritants - patients

A

Mouth – sore: localised, generalised
Lips / perioral
White striae oral mucosa
Collapse, faint, short of breath

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5
Q

Symptoms and signs due to dental allergies and irritants - - dental personnel

A

Hands: acute, chronic itching, cracking,
Facial/ neck dermatitis
Respiratory: wheeze, rhinitis

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6
Q

Contact dermatitis

A

Irritant (80%?)
-barrier creams, dry hands properly, rinse off soap residue
Allergic
-type IV hypersensitivity reaction

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7
Q

Allergy to local anaesthetic

A 
Adrenaline (or preservative)
236 cases studied: no LA allergy found
Mostly psychogenic or vaso-vagal 
French study: 1 case of allergy in 1993
Systemic toxicity: cardiac dysrhythmia
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8
Q

Lichenoid reactions

A

Removing amalgams may remove white patch (limited evidence)

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9
Q

Cheilitis

A 
Dry, itchy, cracked lips
Usually irritant but sometimes allergy
-36% lip lick (ICD)
-25% ACD
-19% eczema
-9% unknown
Allergens: medicaments, toothpaste ingredients (including Na lauryl sulphate)
Rarely: potassium persulfate (dental cleaner), colophonium (floss), nail varnish, cosmetics, nickel (musical instrument)
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10
Q

Anaphylaxis

A

1) Oxygen, airway, breathing
2) Adrenaline from pre-filled autoinjectors
- flick off one end
- give 0.5mg (may be 2 pens)

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11
Q

Presentations in dental patients

A 
Oral lichenoid lesions: presents with discomfort, or may be asymtomatic
Cheilitis: +/- swelling
Collapse: faint, short of breath
Stomatitis: and ulceration, redness
Burning mouth: burning sensation
Facial swelling: may not be dental cause
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12
Q

Presentations in dental personnel: complaints include

A

Hand dermatitis or swelling, especially after use of gloves
Facial, exposed skin rash and itching +/- swelling
Respiratory: e.g. wheezing, rhinitis
Generalised: e.g. collapse

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13
Q

Anaphylaxis definition

A

A severe, life-threatening, generalised or systemic hypersensitivity reaction

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14
Q

Type 4 hypersensitivity reaction - contact dermatitis

A

Allergic contact dermatitis is due to cell-mediated immune response
Prior sensitization through antigen presentation by Langerhans cells
Secondary contact brings out the allergic reaction

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15
Q

Potential allergens often used in dental practice

A

Hygiene products: cleaning: disinfectant, mouthwash (e.g. chlorhexidine), toothpaste limonene, other flavourings,
Lip salve: flavourings
Cements: Glass ionomer, Zirconium, resin-modified glass ionomer, self-etching, resin
Rubber and rubber chemicals: latex gloves, rubber dam,
Impression materials: silicone, polyether, eugenol, colophony
Other: LAs, curing light, etching gel(benzalkonium Cl, dye), astringent, acid

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16
Q

Plastics used in dental surgery

A

Resins used in dentures: an oligomer matrix, eg Bisphenol-A glycidyl methacrylate (BISGMA) or triethylene glycol dimethacrylate (TGDMA)
Initiators: benzoyl peroxide, camphorquinone.
Inhibitors: hydroquinone
Adhesives: acrylates eg polymethyl methacrylate (PMMA)
Plasticiser - dibutyl phthalate

17
Q

Potential metal allergens used in dental surgery

A

Metals: used in dentistry for amalgam, crowns, inlays, bridges, posts and cores
Amalgam: Hg, Ag, Sn, Cu
Gold alloys: Au, lower amounts Ag & Cu, small amounts of Pt, Pd & Zn- for Silver-palladium alloys: Ag, Pd also Zn, Cu
Non-noble metal alloys: Co, Cr, Mo, C, Be,
Other metals in alloys: gallium, rhodium, iridium

18
Q

Patch testing: the basic principles

A

Allergens : prepared chemicals in petrolatum placed in aluminium chambers on tape on back
Probability trawl: up to 100 substances may be tested
Application: patches applied on Monday, removed & read on Wednesday & read again on Friday

19
Q

Patch testing: allergic and irritant reactions

A

Induces localised eczema patch: inexact science but the best available method to detect cell-mediated allergy
Reaction types: allergic vs irritant
Relevance: must show contact likely
Prick test: for type I allergy as needed, e.g. for latex, foods

20
Q

Prick testing: for immediate hypersensitivity to latex

A

Mechanism: relies on antigen-triggered mast cell histamine release
Wheal develops: at test site (>4mm) after 15 minutes
Blood test: allergen-specific IgE often + (not invariably)
Patch test: usually neg, v occasional +

21
Q

Oral lichenoid lesions: amalgam removal

A

May help even when no allergy
13/15 cases healed or much improved on removal of amalgam adjacent to OLL
13/16 cases healed on replacement of adjacent amalgam
8/9 improved at 1 y evaluable in Sheffield

22
Q

The gold conundrum: patch test positive of relevance?

A

Au+ not uncommon on PT for oral problem
If asymptomatic, 24+/71 with oral Au, 7+/65 no Au, on P/T
Correlate Au+ with presence Au in mouth
Problems stomatitis, lichenoid, dermatitis
Removal- some clear

23
Q

Acrylates

A

Quite common allergens in dentistry
-fingertip eczema typical appearance
-respiratory signs: occupational asthma
-cross reactivity between monomers
Generally: commonest acrylate problem is false nails
> dental use of acrylics as adhesives
Figure: red gum, acrylate allergy, capped teeth
Pt complaints: of swelling, pain, redness or gingivostomatitis
Commonest allergens: are EGDMA, HEMA, HPMA, MMA, PGDMA

24
Q

Burning mouth

A

Most cases are not due to allergy
Symptom syndrome: usually no signs
Most patients: are denture wearers
Causes: iron/ folate deficiency, C albicans, psychological factors
Acrylate allergy: in one report 6/22 cases had acrylate allergy on P/T
Most series: conclude no relevant allergy

25
Q

Red mouth

A

More likely to find an allergic cause
Different from burning mouth: physical signs
Acrylic resins: in composites can irritate
Partial denture: metals e.g. Pd, Au, may -> allergy
Red mouth: allergy reported to denture plastic 2-OH ethyl methacrylate
Metals or food additive: occasional cause of mouth tingling or jaw pain

26
Q

Allergic cheilitis from ortho appliance

A

Orthodontic wires contain Ni, Ti, Pd or ‘steel’ (Fe, Cr, Ni, C, Mo, Tc)
Perioral, eyelid & even hand dermatitis described

27
Q

Lip swelling

A

Several possible allergic causes
Rubber: eg latex (type I) rubber additives (type IV)
Food/cosmetic additive eg benzoate, antioxidants
Perfumes/flavours: e.g. cinnamaldehyde, eugenol
Local anaesthetic: allergy often suspected for facial swelling but rarely proven
Immunity: type I or IV
Avoidance: usually caused improvement

28
Q

Dermatitis in a peri-oral site

A

Possible allergies
Causes: as for cheilitis
Perioral dermatitis in Ni+ subjects, several reports of this settling on removal of wire
Dental braces prior to ear piercing: associated with less nickel allergy
Organic polymer an option for orthodontic malocclusion prostheses

29
Q

Anaphylaxis due to dental products

A

Latex no. 1 causeLatex: probably most likely, atopics at risk; confirm Hx- balloons, condoms, food allergy
Formaldehyde: used for root canal disinfectant
Chlorhexidine
Onset: within mins
Confirm: by prick or specific IgE test

30
Q

Occupational dermatitis in dental personnel

A

Usually on hands
2/3 ICD, 1/3 ACD
Hand eczema

31
Q

Allergens in dental workers

A

Several possible contacts
Latex allergy: 4-8%
Dentist/technician: metals, acrylates, Myroxolon, fragrance, thiuram, colophonium
Nurses: 25%+ glutaraldehyde 12%+ formaldehyde

32
Q

Glove reactions: allergens found in vinyl/ nitrile gloves

A

React to nitrile now seen
Contact urticaria to methylene-bis-methyl tertiary butyl phenol, an anti-oxidant
Dermographism recorded
Bisphenol A , anti-oxidant & inhibitor in PVC gloves, can be an allergen
Reactions to non-latex gloves need detailed P/T

Dermatology (IHD Den303) (2 decks)

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