ENT - Allergies

Question 1

What are the theories suggesting why allergies are becoming more prevalent in developed countries?

Answer 1

Diet becoming more processed.

Hygiene is better, reduced exposure to pathogens from an early age.

Question 2

SLIDE 4 IgE stuff

Answer 2

.

Question 3

What are the risk factors for allergies?

Answer 3

Host factors - hereditary, race and age.

Environmental - exposure to infectious disease in early childhood, pollution, allergen levels and dietary changes.

Occupational - flour, latex, wood dust

Question 4

What are the allergic signs of the skin?

Answer 4

Hives (urticaria) and angioedema

Question 5

What are the definitions of allergy in the upper and lower respiratory tract?
What about systemically?

Answer 5

Upper Respiratory: Rhinitis
Lower Respiratory: Asthma

Systemic: Anaphylaxis

Question 6

What are the risk factors of allergic rhinitis?

Answer 6

Risk factors include atopy, family history, 1st born Environmental factors are alterations in exposure to infectious diseases during early childhood, environmental pollution, allergen levels, and dietary changes.

Question 7

What are some of the associated conditions of allergic rhinitis?

Answer 7

Aw asthma, atopic dermatitis

Question 8

What are the symptoms of allergic rhinitis? (Both immediate and Late)

Answer 8

Immediate : sneezing, itch, nasal blockage, rhinorrhoea

Late : chronic obstruction, hyposmia, hyperreactivity

Question 9

What is the definition of allergy?

Answer 9

A hypersensitive disorder of the immune system.

Allergic reactions occur to normally harmless environmental substances known as allergens; these reactions are acquired.

Question 10

What is an allergen?

Answer 10

Antigen that causes allergic reactions. Usually they are proteins.

Question 11

What factors outline the impact an allergen can have?

Answer 11

Depending on the individual, allergen, and mode of introduction, symptoms systemic or localised.

Question 12

What is the pathophysiology of allergies?

Answer 12

Type 1 - Immediate Hypersensitivity Reaction

Sensitisation

• Plasma cells produce IgE
• Bind to mast cells

Re-exposure

• Mast cells degranulate
• Release Histamine, Leukotrienes, Prostaglandins & Chemotactic factors

Question 13

So what is an allergic reaction?

Answer 13

The allergic reaction is an exaggerated or inappropriate immune reaction and causes damage to the host.

Question 14

Mast cell degranulation has what effect on the host?

Answer 14

Release of Histamine, leukotrienes, prostaglandins, chemotactic agents. These can impact the host in a variety of ways.
such as:
Vasodilation, Vascular permeability, Smooth muscle contraction, leukocyte infiltration, esp eosinophils

Question 15

Outline the Acute Response in allergy.

Answer 15

Exposure of allergen:
(Allergen + specific IgE) –
degranulation with release of histamine, cytokines, interleukins, leukotrienes, and prostaglandins from their granules causing systemic effects, such as vasodilation, mucous secretion, nerve stimulation and smooth muscle contraction.

Question 16

What is the late-phase response of allergies?

Answer 16

This is due to the migration of other leukocytes such as neutrophils, lymphocytes, eosinophils and macrophages to the initial site.

Question 17

What is allergic rhinitis? How does it often occur?

Answer 17

Allergic rhinitis - allergic inflammation of the nasal airways.

Occurs when allergen is inhaled by an individual with a sensitised immune system.

Question 18

What is the ARIA-Classification?

Answer 18

A classification for allergic rhinitiis which was subdivided into “intermittent” or “persistent” disease, and based on severity according to QoL and symp toms.

Question 19

How can allergies be diagnosed?

Answer 19

Skin test: responses to known allergens- high NPV, upto 15% false positives

RAST (radioallergosorbent test): blood test, testing presence and levels of allergen-specific IgE. (level of IgE ranked 0-6)

Others:
Total Serum IgE
Nasal Allergen Challenge
Nasal Cytology

Question 20

How can allergies be treated?

Answer 20

Allergy avoidance (education)

Pharmacotherapy

Immunotherapy

Question 21

What is the pharmacotherapy used in allergies?

Answer 21

Topical Intranasal steroids
Systemic Steroids
Antihistamines
Sodium Cromoglycate
Allergen Immunotherapy
Anti-IgE

Question 22

Outline the treatments of those with allergic rhinitis, ranging through mild, to moderate and severe, noting the differences in intermittent and persistent symptoms.

Answer 22

INSERT PICTURE from slide 25