Allergy and Anapylaxis

Question 1

What are the 4 types of allergic reactions?

Answer 1

Type I Anaphylactic
Type II Cytoxic
Type III Immune Complex
Type IV Delay hypersensitivity

Question 2

What is the MOA of anaphylactic reactions? onset?

Answer 2

MOA: involves IgE on basophils or mast cells to release mediators

Onset: within 30minutes

Question 3

What is the MOA of cytotoxic reactions? onset?

Answer 3

MOA: involves IgG or IgM

Onset: Within 5-12 hours

Question 4

What is the MOA of immune complex reactions? onset?

Answer 4

MOA: antigen-antibody complexes form and deposit on blood to activate compliment

Onset: 3 - 8 hours

Question 5

What is the MOA of delayed hypersensitivity? onset?

Answer 5

MOA: antigens cause activation of lymphocytes
->mediator release

Onset: 24-48 hours

Question 6

Which type of reaction is also called serum sickness?

Answer 6

Immune complex

Question 7

Explain the pathophysiology of allergies

Answer 7

Antigen presenting cell binds to T cell. T cell communicates with B cell with cytokines to signal for antibody production

-OR-

Antigens will bind to antibodies on mast cells and basophils to trigger reaction

Question 8

Type A ADR vs Type B ADR?

Answer 8

Type A ADR - predictable (overdose, side effect)

Type B ADR - unpredictable (drug allergy)

Question 9

When is the onset of DRESS occur? Which drug is associated with causing this?

What are the criteria for DRESS?

Answer 9

3 - 8 hours

Allopurinol

Cutaneous drug eruption
Hematologic abnormalities
Systemic involvement

Question 10

What is SJS/TEN? Which drug is most likey to cause this reaction?

How can you tell SJS from TEN?

Answer 10

Steven - Johnson syndrome

Bactrim

SJS >30% epidermal detachment
TEN <10% epidermal detachment

Question 11

What is SCORTEN?

Answer 11

Severity of illness score of SJS/TEN

Age >40
Presence of malignancy
Epidermal detachment >10%
HR >120
BUN > 180
Serum CHO >250mg/dL

Question 12

What is Red-Man syndrome? How do you treat this?

Answer 12

Pseudoallergic reaction that depends on vancomycin infusion rate

Question 13

What are some common drugs that causes allergies?

Answer 13

Aspirin and NSAIDs
Anticonvulsants
Biologics
Beta lactams
Chemotherapy
Radiocontrast media
Insulin
Sulfonamides
Excipients and additives

Question 14

Beta lactam antimicrobials that present cross reactivity….

Answer 14

Carbapenem
Cephalosporin
Penicillin

Question 15

What is anticonvulsant hypersensitivity syndrome?

Answer 15

Fever rash, lymphadenopathy

• eosinophilia
• caused by phenytoin, phenobarbital, carbamazepine, lamotrigine

Question 16

Which opiods often cause the most histamine release?

Answer 16

Phenanthrenes

Question 17

Treatment of anaphylaxis algorithm

Answer 17

Epinephrine
Oxygen
Antihistamines
Fluids
Beta agonists
Corticosteroids
Glucagon

Question 18

Which class drugs has not been shown to be effective for the acute treatment in anaphylaxis?

Answer 18

Systemic corticosteroids