Asthma and Allergies Flashcards
What type of allergic reaction (immune mediated pathway) is involved in hemolytic anemia?
Type II
What is first line therapy for eczema?
Emollients and moisturizers
Powerful bronchoconstrictor, sustains inflammation
Leukotriene
what does smooth muscle constriction, inflamm. mediation
Prostaglandins
– Receptors in smooth muscle, endothelium and CNS tissue lead to bronchoconstriction, bronchial smooth muscle contraction vasodilation, local pain/pruritis
Histamine
3 things involved in type I hypersensitivity? released by IgE antibodies
Histamine
Leukotriene
Postaglandins
what are 4 ways to be exposed to allergenes in type I hypersensitivity?
Ingestion
Inhalation
Injection
Contract
How soon after exposure to the allergen does a type I hypersensitivity rxn occur?
Immediate or late
late is 2-4 hours after exposure
what are some type I hypersensitivity rxns?
atopic dermatitis (eczema) urticaria hay fever (allergic rhinitis) anaphylaxis food allergies PCN allergies
Does your first rxn to an allergen indicate how bad the response will be?
No, can get a more severe rxn the second time
What is a blood test used to determine to what substances a person is allergic. This is different from a skin allergy test, which determines allergy by the reaction of a person’s skin to different substances.
A radioallergosorbent test (RAST)
an antibody response (IgM, IgG or IgA) bind to own cell surface and activating the complement pathway though the B cell response.
Type II sensitivity rxn
what can cause a type 2 rxn?
previous viral infection
another allergic rxn
how long does type II rxn take?
hours to 1 day
what are some type II hypersensitivity rxns?
hemolytic anemia thrombocytopenia graves dz rheumatic fever myasthenia graves
Antigen-antibody complex forms and via circulation deposit in tissue, blood vessels, filtering organs ( spleen, liver,kidney)
Type III hypersensitivity rxn
Post viral vasculitis. Commonly affects highly vascularized parts of body (kidneys), abdominal pains. rura is a purplish rash, typically on the lower legs and buttocks.
Henoch-Schonlein purpura
Glomeruli become inflamed after strep. Can lead to renal failure.
Post streptococcal glomerulonephritis
Allergic rxn to an injected antigen.
Serum sickness
( cellular immune mediated or delayed hypersensitivity)
Recognition of antigen by sensitized T cells
Type IV hypersensitivity rxn
what are some contact allergies that are type IV rxns?
nickel
poison ivy
lotions
detergents
what are some autoimmune conditions that are Type IV rxns?
DM1, hashimotos, MS, celiac dz
why does a Type IV rxn take so long?
Takes awhile to recruit the T cells
Chronic, relapsing, inflammatory skin condition
Atopic Dermatitis (eczema)
what % of pt with atopic dermatitis will develop asthma and allergic rhinitis
> 80%
where is eczema common in infants?
faces, neck folds, extensor surfaces
where is eczema common in toddlers?
flexor surfaces, neck folds
what is the triad with atopic dermatitis?
allergies
eczema
asthma
Pruritis! Erythematous papules assoc with excoriations, vesiculations.
Atopic dermatitis
Ddx for atopic dermatitis?
Scabies
seborrheic dermatitis (dandruff)
allergic contact dermatitis (only where irritant present)
nummular eczema (coin shaped lesions)
what can older kids with atopic dermatitis get?
Flexural lichenification
what can lead to severe infections in atopic dermatitis?
Colonization with staph aureus
treatments for atopic dermatitis?
hydration- baths followed by occlusive agent
moisturizeds and occlusives
topical corticosteroids (reduce inflammmation)
Raised, red, itchy lesions on the skin that often come and go and can coalesce together in to larger, red, itchy areas
Urticaria “hives”
where do hives occur?
superficial dermis
edema extending into deep dermis or subcutaneous tissues
Angioedema
most common cause of hives in children
viral infections
Rapid onset, serious allergic reaction in previously sensitized pt
anaphylaxis
when do you see angioedema by itself
injected allergens (bee stings, ant bites)
what do you give for HPOTN associated w/ anaphylaxis
vasopressors
what are the most common causes of cutaneous drug rxns?
Amox, Bactrim, Ampicillin
characterized by fever, rash, lymphadenopathy, myalgias and arthralgias
usually due to injected allergen.
serum sickness
how do you tx serum sickness?
antihistamines, epi, corticosteroids depending on sx
if it is a known allergic exposure how fast will serum sickness occur?
1-4 days after
how long after exposure will serum sickness appear after first receiving the drug?
7-21 days
Papular and rough rash, almost eczema like. Raised and look like sand paper.
contact dermatitis
latex allergies are an _________ hypersensitivity rxn.
immediate
latex results in allergic contact dermatitis _______ days after exposure
1-2 days
who is more sensitive to latex allergy.
people with spina bifida
when do food allergies commonly show up?
First 3 years of life
what are some common food allergies in children?
Eggs milk peanuts tree nuts soy wheat
what are common allergies in older children?
Fish
shellfish
nuts
when do food allergy rxns occur?
Minutes to 2 hours after ingestion
will get hives, facial angioedema, mouth throat itches
what allergies do most children outgrow?
milk
eggs
soy
what allergies are usually not outgrown?
peanuts
tree nuts
shellfish
what are most insect allergies due to?
almost exclusively hymenoptera stings
bees, wasps, yellow jackets, fire ants
is a bee sting or a fire ant bite worse?
Bee sting because stinger stays in there
why is allergic rhinitis more common when you get older?
Don’t get sensitized until you are older since it is seasonal
when does asthma usually peak?
around age 5 (can occur along w/ allergic rhinitis)
Does eczema get worse or better with age?
better
when do food allergies peak
first three years of life
what is an allergic shiners?
black and puff below eyes due to allergic rhinitis
good meds for itchy eyes w/ allergic rhinitis
Zyrtec
Allegra
what is good for nasal congestion
intranasal steroids
Transient Wheezing is common in __________ and ____________
infancy and during preschool
what is wheezing a symptom of?
lower airway obstruction
who are more affected by asthma
children
females
african Americans
what are upper respiratory tract issues?
Allergic Rhinitis
Adenoid/tonsillar hypertrophy
Foreing body
Sinusitis
what problems can occur in lower respiratory tract
Asthma BPD Chronic aspiration CF FB GER Viral bronchiolitis Pneumonia
if asthma associated w/ wheezing in an infant?
No
3 major factors of asthma
Inflammation
Bronchospasm
Hyperreactivity
intermittent dry cough, expiratory wheezing, shortness of breath, chest tightness, limited exercise tolerance
asthma
what do you find on the PE for asthma?
Expiratory wheezes prolonged expiration tachypnea retractions distress
3 categories of asthma symptoms
daytime
exercise
nocturnal
asthma is a ________ airway obstruction
lower
If asthma isn’t treated what can it lead to?
chronic airway remodeling and lead to chronic complications
what do you want to look for on spirometry for asthma?
FEV or tidal volume
Are FEVs done before age 5?
No
does all asthma wheeze?
No
>50% of coughs lasting longer than 3 weeks can be asthma
what meds can cause asthma exacerbations?
NSAIDs
what are you looking for on chest x-ray
hyper-inflation of the lungs (more ribs than normal)
what is the yellow zone?
child is a PEFR 50-80%
what is PEFR?
peak expiratory flow rate
what is the red zone?
PEFR below 50%- medical emergency
what will a chest x-ray often show on a kid w/ asthma
Hyperinflation Flattening of diaphram peribronchial thickening prominence of pulmonary arteries areas of patchy atelectasis( may be misdiagnoses as pneumonia)
what are the 4 components of asthma management?
- measures of asthma assessment and moniotring
- education
- control of environmental factors and comoribd conditions
- medications
symptoms < 2day/wk or 2 nights/mo
peak flows > 80% of personal best
Mild intermittent asthma
Symptoms > 2 day/wk but < qday, or > 2 nights/mo
Mild persistent asthma
tx for mild intermittent asthma
no daily med
bronchodilators PRN
tx for mild persistent asthma
daily low dose inhaled corticosteroids
cromolyn
leukotriene modifiers
nedocromil
Daily symptoms or > 1 night/week
peak flows 60-80%
Moderate persistent
tx for moderate persistent asthma
Daily low-dose inhaled corticosteroids AND
long acting inhaled beta2-agonist , or medium-dose inhaled corticosteroids
Consider pulmonology/allergy referral
Continual daytime symptoms and frequent symptoms at night
Peak flows < 60%
Severe persistent asthma
tx for severe persistent asthma
Daily high-dose inhaled corticosteroids AND
Long-acting inhaled beta2agonists AND
Oral corticosteroids with repeated attempts to wean when able.
Pulmonology/allergy consults vital
what is a side effect of a long acting inhaled beta 2 agonist
if you have an acute asthma attack, your mortality risk is higher
what else do you want to ask for severe asthma?
how many times they have had an acute attack/ hospitalized
what is frequency and intensity of symptoms functional limitations (quality of life)
impariment
what is a form used to screen for specific recent history of distinct asthma symptoms.
ACT forms
the lower the score on the ACT form indicates what?
Not controlled or more severe asthma
these are the first choice of treatment for all persistent forms of asthma - *early use does not alter natural history of asthma or prevent dev of persistent asthma
inhaled corticosteroids
potent mediators of inflammation and smooth muscle bronchoconstriction
leukotriene inhibitors
relax airway smooth muscle ( never monotherapy)
adding this to an inhaled corticosteroid therapy is more beneficial than doubling the dose of the inhaled corticosteroid
Long-acting beta agonists
what is an inhaled anticholinergic, usually used in clinic. relieves bronchoconstriction, decreases mucus hypersensitivity
Ipratropium bromide
how long should asthma be controlled before stepping down therapy?
3 months
when do you give treatment for exercise-induced bronchospasm
SABAs and LABA
encourage them to warm up prior to exercise
Severe bronchospasm, excessive mucus secretion, inflammation, and edema of airways
Not responsive to treatment
Status asthmaticus
what is the most important lab determination of status asthmaticus?
ABGs
how do you tx status asthmaticus
high flow O2 inhaled B2 agonist (albuterol) systemic corticosteroids (IV) inhaled anticholinergic bronchodilators IV beta agonists
what can be administered to decrease nighttime episodes and prevent asthma attacks.
leukotriene modifiers
first line therapy for relief of an acute asthma attack?
beta 2 adrenergic agonist (ie albuterol)
do inhaled steroid help acute exacerbation?
No
what type of corticosteroids are indicated for acute asthma?
oral/ IV
can cromolyn be used for acute asthma?
No, usually for allergies, not for acute exacerbations
how do inhaled corticosteroids work?
reduce airway inflammation
what does a leukotriene antagonist help with
allergic rhinitis
asthma
what may be the only presenting symptom in patients with asthma?
cough
A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks?
Leukoetriene modifiers
What are 6 typical causes of cough in infants?
CF RTI Aspiration Dyskinetic cilia Lung of airway malformations Edema
