Asthma and Allergy Flashcards
Diagnosis suggested by typical symptoms in absence of URI or structural abnormality (nasal congestion/pruritus, worse at night with snoring, mouth-breathing;
watery, itchy eyes; postnasal drip with cough; possible wheezing; headache
AR
PE of AR
______—blue-gray-purple beneath lower eyelids;
often with ______—prominent symmetric skin folds
Allergic shiners (venous stasis)
Dennie lines
DDx for AR
– Nonallergic inflammatory rhinitis (no IgE antibodies)
– Vasomotor rhinitis (from physical stimuli)
– Nasal polyps (think of CF)
– Septal deviation
– Overuse of topical vasoconstrictors
Best dxtics for AR
In vivo—skin test (best):
° Use appropriate allergens for geographic area plus indoor allergens.
° May not be positive before two seasons
First gen antihistamine examples
First generation—diphenhydramine, chlorpheniramine, brompheniramine; cross blood-brain barrier—sedating
2nd gen antihistamine examples
Second generation (cetirizine, fexofenadine, loratadine)—nonsedating (now preferred drugs); easier dosing
Oral antihistamines are more effective than ____ but significantly less than intranasal steroids; efficacy ↑ when combined with an intranasal steroid
cromolyn
_______—most effective medication, but not first-line
Intranasal corticosteroids
° Least effective
° Very safe with prolonged use
° Best for preventing an unavoidable allergen
Chromones—cromolyn and nedocromil sodium:
Decongestants—(alpha-adrenergic → vasoconstriction)—topical forms (oxymetazoline, phenylephrine) ______ when discontinued
significant rebound
Administer gradual increase in dose of allergen mixture → decreases or eliminates person’s adverse response on subsequent natural exposure
Immunotherapy:
Major indication of immunotherapy
duration and severity of symptoms are disabling in spite
of routine treatment (for at least two consecutive seasons
treatment of choice for insect venom allergy.
Immunotherapy:
Immunotherapy: Should not be used for (lack of proof)
atopic dermatitis, food allergy, latex allergy, urticaria, children age <3 years (too many systemic symptoms
Complications of allergic rhinitis
– Chronic sinusitis – Asthma – Eustachian tube obstruction → middle ear effusion – Tonsil/adenoid hypertrophy – Emotional/psychological problems
Insect Venom Allergy due to what?
Hymenoptera (yellow jackets most notorious—aggressive, ground-dwelling, linger near food)
Diagnosis—for biting/stinging insects, must pursue ______
skin testing
Tx of stinging ang biting insects
Local—cold compresses, topical antipruritic, oral analgesic, systemic antihistamine; remove stingers by scraping
Indication for venom immune therapy—______
severe reaction with + skin tests (highly
effective in decreasing risk)
Most food allergies are—________
egg, milk, peanuts, nuts, fish, soy, wheat, but any
food may cause a food allergy.
