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ENT > Allergy > Flashcards

Allergy Flashcards

1
Q

Definition of allergy

A

A hypersensitive disorder of the immune system

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2
Q

What do allergic reactions occur in response to?

A

Normally harmless environmental substances known as allergens

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3
Q

Definition of allergic reaction

A

An exaggerated or inappropriate immune reaction and causes damage to the host

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4
Q

What are some common allergic reactions?

A

Eczema
Allergic Rhinitis
Asthma
Food allergies

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5
Q

How does skin manifest with allergic reactions?

A

Urticaria / angioedema

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6
Q

How does the upper respiratory system present in allergic reactions?

A

Rhinitis

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7
Q

How does the lower respiratory system present in allergic reactions?

A

Asthma

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8
Q

How can allergic reactions present systemically?

A

Anaphylaxis

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9
Q

Pathology of allergic reaction

A

IgE mediated triggering of mast cells and subsequent accumulation of inflammatory cells at sites of antigen deposition
First allergen exposure - response with T cells and B cells producing IgE
IgE circulates in the blood and binds to IgE-specific receptor (mast cells and basophils)

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10
Q

Pathology of the acute response to an allergen

A

Ag+ specific IgE
Degranulation with release of histamine, cytokines, interleukins, leukotrienes, and prostaglandins from their granules causing systemic effects such as vasodilation, mucous secretion, nerve stimulation and smooth muscle contraction

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11
Q

When does the late phase response after allergen exposure occur?

A

2-4 hours

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12
Q

Pathology of late phase response after allergen exposure

A

Migration of other leukocytes such as neutrophils, lymphocytes, eosinophils and macrophages to the initial site

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13
Q

Risk factors for allergies

A 
Hereditary 
Race
Age 
Exposure to infectious diseases during early childhood
Environmental pollution 
Allergen levels
Dietary changes
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14
Q

Presentation of an allergic reaction

A 
Flushing or rash 
Burning or itching of skin 
Hives
Nausea / vomiting
Abdominal cramps
Diarrhoea
Sneezing
Nasal congestion 
Runny nose
Swelling and tenderness of mouth 
Difficulty breathing
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15
Q

What are some common food allergens?

A

Peanuts
Eggs
Milk
Dairy

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16
Q

What is allergic rhinitis?

A

Allergic inflammation of the nasal airways

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17
Q

When does allergic rhinitis occur?

A

When allergen is inhaled by an individual with a sensitised immune system

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18
Q

Associations of allergic rhinitis

A

Asthma

Atopic dermatitis

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19
Q

Symptoms of allergic rhinitis

A 
Immediate
- sneezing
- itch 
- nasal blockage 
- rhinorrhoea 
- weepy eyes
- coughing
Late
- chronic obstruction 
- hyposmia
- hyperreactivity
20
Q

Two types of allergic rhinitis

A

Seasonal

Perrennial

21
Q

What should you check for in patients diagnosed with allergic rhinitis, especially if persistent or severe?

A

Asthma

22
Q

What is the classification system of allergic rhinitis called?

A

ARIA-classification

23
Q

Definition of intermittent allergic rhinitis

A

symptoms < 4 days per week of < 4 consecutive weeks

24
Q

Definition of persistent allergic rhinitis

A

Symptoms > 4 days / week and > 4 consecutive weeks

25
Q

Definition of mild allergic rhinitis

A

All of

  • normal sleep
  • no impairment of ADLs, sport, leisure
  • no impairment of work and school
  • symptoms present but not troublesome
26
Q

Definition of moderate - severe allergic rhinitis

A

One of more of

  • sleep disturbance
  • impairment of ADLs, sport, leisure
  • impairment of school or work
  • troublesome symptoms
27
Q

Pathology of type I allergic reaction

A

Immediate hypersensivity reactions
mediated by IgE antibodies
Which bind to receptors on mast cells and basophils
When cross linked by antigens the IgE antibodies trigger the mast cells and basophils to release pharmacologically active agents that are responsible for the characteristic symptoms of anaphylaxis

28
Q

Features of a type I allergic reaction

A

Rapid
Occurring within minutes of exposure to antigen
Late phase reaction also present with recruitment of inflammatory cells

29
Q

Pathology of a type II allergic reaction

A

Occur when IgM or IgG antibodies bind to antigen on the surface of cells and activate the complement cascade, which cumulates in the destruction of cells

30
Q

What is a type II allergic reaction?

A

Cytotoxic reaction

31
Q

What is a type III allergic reaction?

A

Immune complex reaction

32
Q

Pathology of type III allergic reactions

A

Complexes of antigen and IgM or IgG antibodies accumulate in the circulation or in the tissue and activate the complement cascade.
Granulocytes are attracted to the site of activation, and damage results from the release of lytic enzymes from their granules

33
Q

How quickly does the reaction occur after exposure in a type III allergic reaction?

A

Hours

34
Q

What is a type IV allergic reaction?

A

Cell mediated immunity reaction

35
Q

Another name for a type IV allergic reaction

A

Delayed type hypersensitivity reaction

36
Q

What is a type IV allergic reaction mediated by?

A

T lymphocytes

37
Q

Pathology of type IV allergic reaction

A

T cells release cytokines that cause accumulation and activation of macrophages, which cause local damage

38
Q

When is the onset of type IV allergic reactions?

A

Delayed onset - 1 - 2 days after antigen exposure

39
Q

What does the skin test test?

A

Responses to known allergen

40
Q

What is RAST?

A

Presence and levels of allergen specific IgE tested in the blood

41
Q

What level of RAST in the blood is negative?

A

Level 0 = < 0.35

42
Q

What level of RAST shows a very high sensitivity?

A

Level 6 = > 100

43
Q

What tests can be done for allergies?

A 
Skin test
RAST level in blood
Total serum IgE
Nasal allergen challenge
Nasal cytology
44
Q

Treatment of allergies

A 
Avoidance 
Antihistamines
Glucocorticoids
Epinephrine
Immunotherapy
45
Q

What is immunotherapy useful in?

A

Allergic rhinitis
Allergic asthma
Allergic conjunctivitis

46
Q

Where is immunotherapy NOT used?

A

Food allergy
Urticaria
Atopic dermatitis

47
Q

What does immunotherapy involve?

A

Controlled exposure to known allergens to reduce the severity of the allergy

ENT (17 decks)

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