Chapter 11: Allergic Conditions in Otolaryngology Patients

Question 1

Common conditions involving the nose and sinuses

Adverse immune reactions

Answer 1

Allergies

Question 2

Type of allergy which is mediated by reagin-type antibodies

Answer 2

Atopy

Question 3

Main immunoglobulin involved in the production of atopic conditions

Answer 3

IgE

Question 4

Involve and antibody, usually IgE, attached by the Fc portion to a cell containing mediators or their precursor

Answer 4

Antibody cell-associated reactions (reagin, cytophilic, anaphylactic antibodies)

Question 5

Asthma
Anaphylaxis
Urticaria
Seasonal rhinitis

Answer 5

Antibody cell-associated reactions

Question 6

Involve an antibody, usually of the IgG and IgM variety, interacting with an antigen that is part of or associated with the cell wall
Complement-dependent can cause damage, stimulation or blockade

Answer 6

Antigen cell-associated reactions (cytotoxic, blocking and stimulation antibodies)

Question 7

Damage to cell

Answer 7

Rh-positive
Penicillin hemolytic anemia
Autoimmune thrombocytopenia

Question 8

Stimulation

Answer 8

Thyrotoxicosis

Question 9

Blocking

Answer 9

Myasthenia gravis
Insulin dependent diabetes
Bronchial asthma
Rhinitis

Question 10

Involve interaction of the antigen and antibody independent of the cell, activating the complement and other amplifying systems–>adverse reaction
Eg. Serum sickness, PSGN,

Answer 10

Antigen-Antibody reactions and cell-independent reactions (arthus reaction, immune complex)

Question 11

Antigen interacting with T lymphocytes leads to the release of various mediators
Eg. Dermatitis, transplantation reactions

Answer 11

Cell-mediated reactions

Question 12

Main in vivo method to identify IgE or reaginic antibody

Occurs within minutes after introduction of the allergen

Answer 12

Skin testing

Question 13

More sensitive but more likely to produce systemic reactions in highly sensitive individuals

Answer 13

Intradermal testing

Question 14

Most popular way to quantify IgE

Answer 14

Radioallergosorbent test (RAST)

Question 15

Indications for performing the RAST and the histamine release assay

Answer 15

1. Situations in which the patient cannot be skin rested such as the presence of dermatographism, dependence on medication that interferes with skin testing, extreme youth and age when skin testing is difficult to perform and interpret, previous extreme sensitivity to the test allergen
2. Need to confirm the significance of a positive skin test
3. Strong history of allergen sensitivity but a negative skin test

Question 16

Increased in subjects with allergic rhinitis

Answer 16

Nasal polyp and sinusitis

Question 17

Symptoms of allergic rhinitis

Answer 17

1. Nasal congestion or obstruction
2. Sneezing
3. Watering and itching of the eyes
4. Postnasal drip

Question 18

Most common complaints associated with nasal polyps

Answer 18

1. Nasal obstruction

2. Rhinorrhea

Question 19

Physical exam in subjects with allergic rhinitis

Answer 19

1. Excessive lacrimation
2. Reddening of the sclera and conjunctiva
3. Periorbital darkness (allergic shiners)
4. Moderate to marked swelling of nasal turbinates
5. Clear thin nasal secretions
6. Lateral crease of the ridge of the nose

Question 20

Most common location of nasal polyp

Answer 20

Upper part of the lateral nasal wall around the middle turbinate

Question 21

Laboratory findings compatible with immunologic reactions

Answer 21

1. Increased eosinophils in the nasal secretion and peripheral blood
2. Elevated serum IgE level

Question 22

5 major areas in treatment of allergic rhinitis, nasal polyps and sinusitis

Answer 22

1. Avoidance of the causative allergen
2. Symptomatic treatment with drugs
3. Allergen injection, immunotherapy or hyposensitization
4. Management of complications or aggravating factors
5. Surgical treatment