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ENT > Allergy > Flashcards

Allergy Flashcards

1
Q

What is allergy

A

Type 1 hypersensitive disorder

Exaggerated or inappropriate immune reaction to harmless allergen and causes damage to the host

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2
Q

What can symptoms be

A 
Localised
- Rhinitis (upper) 
- Asthma (lower)
Systemic 
- Anaphylaxis
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3
Q

What are the RF

A 
Hereditary
Race
Age
Environmental exposure 
Occupational
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4
Q

What happens in sensitisation

A

Plasma cells produce IgE which binds to mast cells

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5
Q

What happens on re-exposure

A

Mast cells degranulate

Release of histamine, leukotrienes, prostaglandins and chemotactic factors

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6
Q

What does degranulation cause

A 
Vasodilation
Vascular permeability
Smooth muscle contraction
Nerve stimulation
Leucocyte infiltration esp eosinophils
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7
Q

What happens in acute response

A

Exposure to allergen
Degranulation
Causes sneezing, cough, wheeze, runny nose, weepy eyes and itch

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8
Q

What happens in late response

A

2-4 hours
Mainly due to cellular immunity
Due to migration of other leucocytes such as neutrophils, lymphocytes, eosinophils and MO

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9
Q

What is allergic rhinitis and what triggers

A

Allergic inflammation of the nasal airways - type 1 IgE mediated
Occurs when allergen inhaled by individual sensitized
Pollen, dust, pets
Seasonal / intermittent
Perennial - persistent
Occupation

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10
Q

What is associated

A

Asthma - basically asthma of the nose
Atopic dermatitis
Eczema
Nasal polyps

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11
Q

What are the symptoms

A 
Rhinorrhoea - nasal cavity filled with mucous
Clear nasal discharge - bilateral 
Post nasal drip
Watery red itchy eyes - bilateral 
Sneezing
Nasal itch
Nasal blockage
Hyposmia as olfactory nerves at top
Inflammed nasla turbinates
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12
Q

What do late symptoms causes

A

Vasodilation

Further oedema and blockage

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13
Q

What may occur

A

Chronic obstruction

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14
Q

What are RF

A 
Atophy
FH
Exposure to infectious disease
Environmental pollution
Diet change
Allergene exposure
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15
Q

What is intermittent symptoms

A

<4 days per week or <4 consecutive week

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16
Q

What is persistent

A

> 4 days and >4 weeks

17
Q

What suggests mild rhinitis

A

Normal sleep
No impairment of activities
No impairment work / school
Symptoms present but not trouble system

18
Q

What is mod-severe

A 
\+1 of 
Sleep disturbance
Impairment of activities
Impairment of school or work
Troublesome symptoms
19
Q

What do you do for mild symptoms

A 
Allergen avoidance
Nasal irrigation 
Barrier creams 
H1 blocking anti-histamine - oral or nasal
Topical nasal decongestant
LTRA can be useful if also have asthma 
Topical > systemic
20
Q

What do you do for persistent symptoms

A

Review

Step up or continue if worked

21
Q

What do you do for mod-severe

A

Intra-nasal corticosteroid + anti-histamine
- Beconase (risk of nose bleed if chronic use)
Occasionally oral steroid during severe symptoms

22
Q

If failure

A

Nasal spray technique - if left nostril hold in R hand
Review Dx / compliance
Query infection
Increase intranasal ICS
Add ipatropium if rhinorrhoea
Specialist referral for possible immunotherapy / anti-IgE = very expensive

23
Q

What tests can be done

A

Clinical Dx with Hx and exam = sufficient
Skin / patch test - can be done in clinic
- Risk of anaphylaxis
RAST - more expensive

Other
Total serum IgE
Nasal allergen challenge
Nasal cytology

24
Q

What is RAST

A

Shows presence and levels of allergen specific IgE

25
Q

What is immunotherapy

A

Chronic exposure to densities so body produces IgG not IgE

Very expensive

26
Q

What is risk of topical nasal decongestant

A

Tachyphylaxis
More required for same affect
Rebound on withdrawal where symptoms get worse

27
Q

What are other causes of chronic rhinitis

A 
Foreign body 
CSF e.g. after head injury 
Bacteria - TB 
HIV
CF
Age 
Pregnancy 
Decongestant overuse
28
Q

Most to least sedation anti-histaine

A

Certirizine
Loratidine
Pirtin
CHloramphenamine

ENT (14 decks)

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