Chapter 9: Allergies and Immunologic Diseases Flashcards
___ is a common oral lesion; clinical alterations involve varialbe fungiform papilla and likely represents a hypersentivity or allergy
transient lingual papillitis
which type of transient lingual papillitis involves one to several fungiform papilla which become enlarged and are red or yellow, appear on the anteiror dorsal tongue, and are painful?
localized transient lingual papillitis
which type of transient lingual papillitis involves a large percentage of fungiform papilla which become enlarged and red, are located on the tip and lateral dorsal tongue, are very sensitive/painful, are associated with fever and lymphadenopathy, and can spread among family members?
generalized transient lingual papillitis
which type of transient lingual papillitis involves large number of affected papilla which appear as elevated, yellow or white papules, and is asymptomatic?
diffuse, papulokeratotic variant transient lingual papillitis
which type of transient lingual papillitis is associated with fever and lymphadenopathy?
generalized transient lingual papillitis
what is the treatment of transient lingual papillitis?
all 3 forms resolve without therapy
for symptomatic forms, topical steroids may reduce pain or duration
localized transient lingual papillitis
generalized transient lingual papillitis
diffuse, papulokeratotic variant transient lingual papillitis
recurrent aphthous ulcerations are also called ___
recurrent aphthous stomatitis
___ is one of the most common oral mucosal pathoses. what is the prevalence?
recurrent aphthous ulcerations
prevalence is about 30%
what is the etiology of recurrent aphthous ulcerations?
no universal etiology; seems to be an allergy or immune dysfunction of some sort
recurrent aphthous ulcers occur exclusively on what tissue?
movable mucosa
what are the 3 clinical variations of recurrent aphthous ulcers?
- minor (85%)
- major (10%)
- herpetiform (5%)
recurrent aphthous ulcerations occur in what age patients?
first occurs in younger patients; 80% have their first ulceration before age 30
recurrent aphthous ulceration - minor
what is aphthous stomatitis?
- major aphthae
- suttons disease
- adolescence
- larger than 1cm
- can take several weeks to heal
- may cause scarring
which RAU form occurs in childhood?
minor
patients with which form of RAU have the fewest recurrences?
minor
which RAU lesions are shorter in duration than other variants?
minor
what form of RAU will patients typically have a prodrome?
minor
how do RAU minor lesions present?
erythematous macule followed by a central yellow-white, removable fibrinopurulent membrane
ulcerations are less than 1cm
which types of RAU do not cause scarring?
minor and herpetiform do NOT cause scarring
major MAY cause scarring
RAU minor lesions heal without scarring in what time frame?
1-2 weeks
there are typically ___ RAU minor lesions per episode
1-5
are RAU minor lesions more or less painful than they appear?
more
which RAU form occurs in adolescents?
major
RAU major
are RAU major lesions larger or smaller than minor aphthae?
larger
measure about 1-3cm in diameter
which RAU type demonstrates the longest duration per episode when compared to other variants, and what is the time frame?
major, takes 2-6 weeks to heal
how many lesions per episode occur with RAU major?
1-10
what tissues are most commonly involved in RAU major aphthae?
labial mucosa, soft palate, tonsillar fauces
RAU herpetiform
which RAU form occurs most commonly in adults?
herpetiform
of the three RAU types, which one has the greatest number of lesions and recurrences?
- herpetiform
- can have up to 100 ulcerations per occurrance
- may have continuous lesions for 3 years
- recurrences are closely spaced
what is the size of RAU herpetiform lesions?
smallest of the 3 variants - 1-3mm in diameter
RAU herpetiform lesions heal in what time frame?
7-10 days
RAU herpetiform aphthae is more common in males or females?
females
what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU minor?
- general size - 3-10mm
- healing time - 7-14d
- scarring - no
- lesions/episode - 1-5
- recurrence - fewest
what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU major?
- general size - 1-3cm
- healing time - 2-6w
- scarring - possible
- lesions/episode - 1-10
- recurrence - more than minor, less than herpetiform
what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU herpetiform?
- general size - 1-3mm (smallest)
- healing time - 7-10d
- scarring - no
- lesions/episode - up to 100
- recurrence - most
what is the treatment for RAU minor?
no treatment or OTC treatment
when is it appropriate to prescribe a topical corticosteroid for the treatment of RAU?
- if patient presents with multiple recurrences, many lesions, or intense pain
- 0.05% clobetasol proprionate, dispense 15mg, instruct to dry the affected area and apply a thin amount 2x/day as needed
- this is a potent steroid so re-emphasize that a little goes a long way
___ is a chronic, recurrent immune mediated disease with oral aphthous-like ulcerations, ocular inflammation, genital ulcers, and skin lesions
behcet’s syndrome
(will not be testing on pictures)
___ is a common complaint in pateints with behcet’s syndrome
joint pain - arthralgia, enlarged joints
what is the treatment of behcet’s syndrome?
systemic and topical steroids
___ is a multisystem granulomatous disorder of unknown cause
sarcoidosis
of african americans and caucasians, which population is sarcoidosis more prevalent?
african americans
what organs are most commonly involved in cases of sarcoidosis?
lungs, lymph nodes, skin, salivary glands, eyes
___ tissue is involved in almost all cases of sarcoidosis
lymphoid
90% of sarcoidosis cases will show abnormal ___
chest xray
what do the skin lesions look like in sarcoidosis patients? what percent of patients with sarcoidosis have skin lesions?
- chronic, purple, indurated lesions on head and neck, termed lupus pernio
- scattered, nonspecific, tender, red nodules on lower legs termed erythema nodosum
- 25% of patients
what are the 2 different syndrome associated with acute sarcoidosis?
- lofgren’s syndrome
- heerfordt’s syndrome (uveoparotid fever)
sarcoidosis
what are characteristics of lofgren’s syndrome?
- erythema nodosa
- bilateral hilar lymphadenopathy
- arthralgia
what are characteristics of heerfordt’s syndrome?
- parotid enlargement
- inflammation of the eye
- facial paralysis
- fever
what are the histological featuers of sarcoidosis?
- granulomatous inflammation
- schaumann bodies (degenerated lysosomes)
- asteroid bodies (entrapped collagen fragments)
- hamazaki-wesenberg bodies (large lysosomes)
how is sarcoidosis diagnosed?
- elevated serum angiotensin-converting enzyme levels
- chest xray
- kveim test - no longer used
what is the treatment/prognosis of sarcoidosis?
- 60% - symptoms resolve spontaneously in 2 years
- corticosteroids if patients have progressive disease
- 5-10% succomb to disease
what is the presentation of orofacial granulamotosis?
it is variable, but the lips are most commonly involved
describe lip involvment with orofacial granulomatosa
- labial tissue presents as a non-tender, persistent swelling
- when lips are only involved, it is termed cheilitis granulomatosa
melkersson-rosenthal syndrome is a form of ___
orofacial granulomatosis
what are the 3 characteristics of melkersson-rosenthal syndrome?
- cheilitis granulomatosa
- facial paralysis
- fissured tongue
the histology of orofacial granulomatosa is ___
granulomatous inflammation
in order to diagnose orofacial granulomatosis, other diseases causing granulomatous inflammation should be ruled out, such as ___
sarcoidosis and TB
only lips are involved
cheilitis granulomatosa (a form of orofacial granulomatosis)
patient also has facial paralysis
melkersson-rosenthal syndrome
orofacial granulomatosis
wegener’s granulomatosis
wegeners granulomatosis
is wegeners granulomatosis more common in males or females? what is the average age patient who is affected?
- male and female prevalence is equal
- average age is 40
___ is characterized by necrotizing granulomatous lesions of the respiratory tract, with necrotizing glomerulonephritis and systemic vasculitis of small arteries and veins
classic wegener’s granulomatosis
what can happen if wegener’s granulomatosis is untreated?
- rapid renal involvement develops
- renal involvement is the most common cause of death
what is limited wegener’s granulomatosis?
upper respiratory system, no renal lesions
what is superficial wegener’s granulomatosis?
lesions occur primarily on skin and mucosa
visible lesions of wegener’s granulomatosa may appear as ___
nonspecific ulcerations
___ lesions are characteristics of wegener’s granulomatosis
oral
what are the oral lesions that are characteristic of wegener’s granulomatosis?
- strawberry gingivitis
- typically an early manifestation
- affected gingiva demonstrates a florid, erythematous, granular hyperplasia
how is wegener’s granulomatosis diagnosed?
- indirect immunofluorescence detects presence of antineutrophil cytoplasm antibodies (ANCA)
- perinuclear (p-ANCA)
- cytoplasmic (c-ANCA) - most useful
what is the treatment/prognosis for classic wegener’s granulomatosis?
- untreated = 10% two year survival
- steroids are first-line tx; 75% survive
- 30% relapse
- cure can be attained if caught early and appropriately treated
concentrations of cinnamon flavoring is ___x that in the natural spice, and can cause ___
- 100x
- contact stomatitis
reactions with cinnamon flavoring are most common in products associated with prolonged/frequent contact, including what 3 products?
candy, chewing gum, toothpaste
clinical presentation of contact stomatitis from cinnamon varies according to ___
delivery medium
- toothpaste = diffuse
- gum/candy = localized
___ can cause the gingiva to appear large and red, and superficial soughing can occur (much like that seen in patients using sodium lauryl sulfate-containing toothpastes)
contact stomatitis from cinnamon
localized contact stomatitis from cinnamon lesions can appear ___
ulcerated, white, or red
signs and symptoms of contact stomatitis from cinnamon disappear within what time frame of discontinuation of cinnamon product?
1 week
angioedema is also called ___
quincke’s disease
___ causes diffuse edemetous swelling of the soft tissues
angioedema
contact stomatitis from cinnamon flavoring
contact stomatitis from cinnamon flavoring
contact stomatitis from cinnamon flavoring
angioedema
is there pain associated with angioedema?
no, but itching and erythema can be present
what is the most common cause of angioedema?
- mast cell degranulation, which leads to histamine release
- IgE-mediated hypersensitivity reactions
angioedema occurs most commonly on the ___
extremeties
angioedema resolves after how long?
1-2 days
what is the treatment for allergic angioedema?
- oral antihistamine therapy
- IM epinephrine or IV corticosteroids in severe cases
cases of angioedema that include diffuse involvement of the head and neck can be caused by ___
- angiotensin-converting enzyme inhibitors
- -prils (such as lisinopril) - medication for HTN or chronic heart failure
what population is angioedema most common in?
african americans
4x more common than in caucasians
what health care provider most commonly sees ACE inhibitor-associated angioedema?
oral health care practitioners
swelling associated with ACE inhibitor drugs does not respond well to ___
antihistamines
what is the treatment for ACE inhibitor-associated angioedema?
- avoid all medications in this class of drugs
- monitor until swelling subsides
- some respond well to C1-INH concentrate
what are the two types of angioedema?
allergic angioedema and ACE inhibitor-associated angioedema
