Chapter 16: Allergic and Immune Disorders Flashcards
Definition of anaphylaxis
Overwhelming, immediate systemic reaction due to IgE-mediated release of mediators from tissue mast cells and peripheral blood basophils
Epidemiology of Anaphylaxis
Responsible for 500-1000 fatalities yearly
Causes can be food, medication, insect, latex, exercise, or idiopathic
Course of disease of Anaphylaxis
Mild reactions may occur with only scattered hives, puritus, and/or nausea
Significant reactions include widespread hives, tongue/lip/throat swelling, wheezing, coughing, stridor, vomiting/diarrhea, anaphylactic shock
What is biphasic reaction of anaphylaxis?
Patients have symptoms recurring 2-8 hours up to 72 hours later
Significance of asthma and anaphylaxis
Patients with asthma are at greater risk for severe reaction
Diagnosis of Anaphylaxis
Other conditions may appear similar (vasovagal reaction, flushing episode, anxiety, cardiac events)
Look for a triggering event within 2 hours of onset
If in doubt, treat for anaphylaxis to prevent serious consequences
Dental Considerations for Anaphylaxis
Identify known allergies prior to treatment
Avoid known allergens and any material/drug with cross-reactivity
Prompt recognition of anaphylaxis is critical
Appropriate emergency management drugs should be immediately available
Allergic Rhinitis Clinical Presentation
Seasonal or perennial in nature
Nasal congestion, nonpurulent rhinorrhea, sneezing
Puritis of eyes, nose and palate
Etiology of allergic rhinitis
Inflammation of nasal mucous membranes resulting from IgE-mediated allergic reaction to protein/glycoprotein of inhaled aeroallergen
Diagnosis of allergic rhinitis
Focused history
Physical exam with correlation of symptoms with positive skin-prick test
Management of allergic rhinitis
Avoid inciting allergens
Pharmacotherapy: antihistamines, intranasal corticosteroids, decongestants
Immunotherapy for patients who do note receive adequate relief from pharmacotherapy
For patients with comorbidities (asthma, chronic otitis media, sinusitis) specific treatment targeted to those medical conditions
Complications of allergic rhinitis
Acute/chronic sinusitis
Recurrent otitis media with eustachian tube dysfunction and hearing loss
Impaired speech development
Nasal polyps
Sleep apnea
Increased likelihood of developing asthma or aggravation of existing asthma
Dental considerations of allergic rhinitis
None with adequate symptom relief
In severe cases, mouth breathing may predispose to alterations of facial growth
Mouth breathing without a diagnosis should alert dentist to allergic rhinitis - refer to allergist
May consider consulting ENT if considering sedation and airway patency is a concern
Atopic Dermatitis Clinical Presentaiton
Chronic dermatitis characterized by puritis and relapsing inflammation
Typical lesions begin acutely with erythema and excoriations triggered by scratching
Uncontrolled itching and rash takes chronic appearance of lichenification and hyperpigmentation without erythema
Affects infants/young children on extremities, cheeks, forehead, neck
Affects older children in flexural areas (knee and elbow)
Etiology of Atopic Dermatitis (atopic eczema)
Distinct causal relationships are ill-defined
Sensitization to foods or aeroallergens may contribute
1/3 of cases may be exacerbated by at least one food
Strong familial atopic association exists including those with asthma and allergic rhinitis
Diagnosis of atopic dermatitis
Made by history and physical examination
90% of cases present before age 5, most resolve by puberty
Diagnostic criteria include puritis, pattern of skin involvement, history of atopic disease, age, elevated serum IgE
Many diseases present with similar lesions as atopic dermatitis
Management of atopic dermatitis
Education: trigger avoidance
SKin hydration
Itch control (antihistamines), topical steroids for flares
Newer steroid sparing anti-inflammatory therapies used with caution in children
Dental considerations for atopic dermatitis
None except for patients on high dose corticosteroids which necessitates consultation with physician
Clinical presentation of urticaria
Extremely puruitic, erythematous, raised lesions affecting the superficial dermal layers that blanch with pressure
Associated with angioedema in 40% of cases
Acute urticaria typically lasts less than 6 weeks and has a trigger, chronic is idiopathic and lasts longer
Clinical presentation of angioedema
Swelling is deeper and primarily affects face, extremities, genitalia with occasional tongue enlargement or laryngeal edema
Diagnosis of urticaria and angioedema
Depends on focused clinical history, identifying triggers and systems review
Further workup includes blood tests, biopsy
Management of urticaria and angioedema
Avoid triggers
Antihistamines
In severe refractory cases, oral steroids
Dental considerations of urticaria and angioedema
Avoid treating patients in active phase
Be aware of any medication triggers
Hereditary Angioedema
Etiology: autosomal dominant disorder resulting from deficiency in functional C1 Esterase inhiibtor
Submucous or subcutaneous edema lasting for 2-5 days before spontaneously resolving
Triggered by trauma, medical/dental, emotional stress, menstruation, infections, medication
Non-pitting, tensely swollen, painful, non-erythematous
Most common areas are lips, eyelids, tongue, genitalia, extremities