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PHAY0010 > Hayfever and Allergies [completed] > Flashcards

Hayfever and Allergies [completed] Flashcards

1
Q

The number of hay fever sufferers is increasing by how much each year?

A

5%

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2
Q

What is an allergy?

A

The response of the immune system to a substance (allergen) that is usually harmless but the body reacts as if it’s harmful.

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3
Q

What is the immune response to allergens?

A

Production of antibodies

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4
Q

What is a serious, systemic, life threatening allergic reaction called?

A

Anaphylaxis

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5
Q

Outline what happens in an allergic reaction?

A

On first exposure the person forms IgE antibodies specific to the antigen
IgE attaches to high affinity Fc receptors on basophils and mast cells,
The immune system stores this in memory - SENSITISATION
The person may not have an allergic reaction one first contact but upon re-encountering the allergen it will bind to IgE causing cross linking between IgE and degranulation of mast cells.
The mast cells then release histamine - a chemical mediator

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6
Q

What are some common allergens?

A

Poison plants
Animal scratches
Pollen
Latex
Bee sting
Medication
Nuts and Shellfish
Dust
Mold and mildew
Animal dander

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7
Q

How often after exposure do allergic reactions occur?

A

within minutes

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8
Q

what is allergic rhinitis?

A

Inflammation of the nose - can cause runny, blocked nose and sneezing

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9
Q

What is allergic conjunctivitis?

A

Inflammation of the eyes -
IN BOTH EYES
watery, red and itchy eyes

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10
Q

What is urticaria?

A

Also known as hives or nettle rash, very itchy and red

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11
Q

What is angioedema?

A

Swelling of tissues - lips, tongue, throat and eyelids
Feels tingly at first
Can cause airway obstruction, difficulty talking or swallowing
Can be life threatening

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12
Q

What breathing difficulties may arise with allergic reactions?

A

Wheezing, chest tightness and breathlessness
Can be life threatening

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13
Q

How are mild allergies managed?

A

Person is offered advice and treatment

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14
Q

How are severe/unknown allergies managed?

A

Refer to a specialist for testing and advice on treatment?

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15
Q

What is the skin prick test?

A

A drop of liquid containing the allergen is placed on the skin as well as a drop of saline solution. The skin is then pricked with a lancet.

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16
Q

What would be a positive result in the skin prick test?

A

A raised bump (over 3mm diameter) after about 15 minutes that looks different to the control

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17
Q

What is intradermal testing for allergies?

A

A small amount of allergen is injected subcutaneously under skin to look for a reaction

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18
Q

What are patch tests for allergies?

A

The allergen is applied to a small disc placed onto the back and worn for two days.

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19
Q

What is allergy challenge testing

A

Increasing amounts of allergen given orally in order to establish if there is a reaction.
Especially good for food allergies BUT needs to be in a safe medical environment.

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20
Q

What is an example of a commercial allergy testing kit? why are they not recommended?

A

Hair analysis - has very little scientific evidence

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21
Q

What other tests may be carried out to diagnose an allergy?

A

Blood tests

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22
Q

What is a sensitivity?

A

An exaggeration of the normal effects of the substance.

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23
Q

Give an example of a sensitivity.

A

Drinking coffee –> caffeine causes palpitations and trembling

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24
Q

What is an intolerance?

A

When a substance causes unpleasant symptoms such as diarrhoea but DOES NOT involve the immune system. People with food intolerance can eat small amounts without issues

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25
Q

What are common symptoms of a food allergy

A

Itching, tingling, burning, swelling of mouth lips and throat
Vomiting
Urticaria – red raised rash
Swelling

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26
Q

How soon after eating does the allergic response begin?

A

immediately or within thirty minutes

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27
Q

What food commonly cause an allergic reaction?

A

Milk, eggs, nuts, peanuts, fish, shellfish and some fruits and vegetables

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28
Q

Can trace amount cause food allergy?

A

Yes depending on severity

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29
Q

What is the only way to prevent a reaction in a food allergy?

A

Complete avoidance

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30
Q

What are symptoms of a food intolerance?

A

Diarrhoea
Bloating
Stomach cramps

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31
Q

How soon after eating does a food intolerance occur?

A

After a few hours, caused by larger amounts of food (more food = stronger symptoms)
NOT LIFETHREATENING

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32
Q

Why does allergic rhinitis occur?

A

Nasal mucosa is exposed and sensitised to allergens to produce sneezing, nasal itching, discharge and congestion

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33
Q

What three things can allergic rhinitis be classified by:

A

Timing
Frequency
Persistence

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34
Q

What is perennial rhinitis?

A

Occurs through the entire year

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35
Q

What are some symptoms of perennial rhinitis?

A

Nose is congested
Reduced ability to smell (hyposmia)
Runny nose
Sneezing
Itchy nose

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36
Q

What are some common allergens that can cause perennial rhinitis?

A

house dust mites, animal dander, mould

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37
Q

How long should perennial rhinitis be treated for?

A

All year round and then 3-6 months after symptom control

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38
Q

What is seasonal rhinitis?

A

Occurs at the same time each year. Made worse when pollen count is higher.

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39
Q

What are the symptoms of seasonal rhinitis?

A

Blocked nose
Runny nose
sneezing
Itchy nose
Itchy red water eyes
Itchy throat
loss of smell
face pain
headache
wheezing
breathlessness
worsening/seasonal asthma

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40
Q

Who is hay fever more common in?

A

People with family members who have hay fever
People who have other allergies or asthma

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41
Q

When are the peak months for allergic rhinitis?

A

May - july

42
Q

What is one of the most common allergens for perennial rhinitis and why?

A

House dust mite as present throughout the year

43
Q

How can we distinguish between allergic and infective rhinitis

A

Discharge : watery in hay fever, mucopurulent in infections
Duration: hay fever can last months , infections 3-14 days
Symptoms: immediately on contact in hay fever but may take a few days in infections
Throat: itchy throat in hay fever sore throat in infections
Itchiness: itchy eyes and nose in hayfever, no itching in infections
Cough: cough more common in infection

44
Q

What are some red flags in allergic rhinitis that may require referral?

A

Wheezing / Shortness of breath (may be asthma)
Tightness in chest
Associated ear pain - Abx?
Painful sinuses - Abx?
Purulent eye discharge
Severe symptoms unresponsive to therapy - short course of oral steroid ?

45
Q

What are some symptoms of anaphylaxis?

A

Unconsciousness
Runny nose
Fast/slow heart rate
Itchy skin
Wheezing/cough
Swelling of lips, tongue or throat - difficulty speaking or swallowing
MAY GO INTO SHOCK - pale, clammy skin

46
Q

What should you do if you suspect someone is having an anaphylactic reaction?

A

Diagnosis - issues in airway, breathing and circulation
Call - ambulance or resuscitation team and lie the patient flat with their feet elevated or sitting up to help with breathing. If pregnant lie on left side
Treatment - IM Adrenaline - if no improvement give adrenaline again every 5 minutes

47
Q

Where is adrenaline ideally administered?

A

Intramsucularly into the middle of the patients thigh

48
Q

Do you need a prescription to administer adrenaline in an emergency situation?

A

No

49
Q

What formulations is adrenaline available as?

A

Ampoules or pre filled autoinjecter

50
Q

What is the dose of adrenaline given to adults and children over 12 years?

A

500mcg

51
Q

Anaphylaxis is medical emergency and 999 has to be called. What will happen to the patient the hospital?

A

They are given antihistamines, steroids or further testig
Observed for 6-12 hours depending on their response to treatment
May be referred to a specialist allergy service on discharge and given adrenaline injection pens

52
Q

What else may a patient have to keep on them if they are at risk of anaphylaxis?

A

Medical alert bracelet or card

53
Q

How can a patient manage an allergy?

A

Avoiding allergens
Taking medication or using it to treat an allergic reaction
Desensitisation (immunotherapy)

54
Q

When is desensitisation used to manage allergies?

A

In severe cases to wasp stings, bee stings, severe hay fever and some animal allergies BUT NOT IN MULTIPLE ALLERGIES

55
Q

What happens during allergy desensitisation?

A

Allergen given via injection
Tiny amount so allergic reaction not triggered but can teach the immune system not to produce a lot of IgE
Dose is increase at a regular interval (weeks- months)
DONE IN A SPECIALIST HOSPITAL OUTPATIENT SETTING

56
Q

What are some disadvantages to desensitisation immunotherapy?

A

Time consuming
Expensive
Risky
used as a last resort BUT TREATS DISEASE CAUSE

57
Q

What is the first line treatment for mild-moderate allergy symptoms?

A

Antihistamines

58
Q

How do antihistamines work?

A

Compete with histamine for receptor blocking the actions of histamine so allergic response is prevented or reduced

59
Q

Which allergy symptom is an antihistamine not as effective on?

A

nasal congestion

60
Q

After how long will there be relief of symptoms after using oral and topical antihistamines?

A

Oral - 1 hour
Topical - 15 minutes

61
Q

What are the two types of antihistamines?

A

1st generation sedating
2nd generation non-sedating

62
Q

What types of antihistamines are reccomended by NICE?

A

Intranasal or a second generation non sedating antihistamine taken orally

63
Q

What are some oral sedating antihistamines?

A

Chlorphenamine (Puritan)
Promethazine (Phenergen)
Diphenhydramine (Nytol)

64
Q

Which oral sedating antihistamine is not actually indicated for allergic conditions?

A

Diphenhydramine

65
Q

Why do first generation antihistamines cause drowsiness?

A

Cross the BBB and bind to H1 receptors in the brain

66
Q

What is the usual frequency of Piriton (chlorphenamine) in adults)

A

Every 4-6 hours?

67
Q

Who might sedating antihistamines not be appropriate for?

A

Elderly - risk of falls and confusion

68
Q

What advice should be given to people taking sedating antihistamines?

A

Do not drive or operate heavy machinery
Avoid alcohol as this can enhance the sedating effect

69
Q

What are some non-sedating antihistamines

A

Loratadine (Claritin)
Cetirizine (Piriteze)
Acrivastine (Benadryl)
Fexofenadine (Allevia)

70
Q

How often are non sedating antihistamines taken?

A

1 tablet once a day or THREE TIMES A DAY FOR ACRIVASTINE

71
Q

Fexofenadine used to be POM only. What strength is still POM and which one is available as a P medicine?

A

180mg - POM
120mg - P

72
Q

Why do non sedating antihistamines have less effect on the brain?

A

Less penetration of blood brain barrier

73
Q

What are some topical antihistamines?

A

Azelastine eye drops (POM - 4 years and over)

Azelastine nasal spray (Rhinolast - POM only)

Antazoline + Xylometazoline eye drops (P - 12 years and over)

74
Q

How do antazoline and xylometazoline eye drops work?

A

antihistamine AND vasoconstrictor
reduces eye redness and itching
May cause temporary local irritation

75
Q

What are some mast cell stabilisers?

A

Sodium cromoglicate eyedrops (P - 6 years and above)
Lodoxamide eye drops (P - 4 years and above)
Olopatadine drops (POM - 3 years and above)

76
Q

How often do sodium cromoglicate eye drops need to be used?

A

4 times a day

77
Q

How doe mast cell stabilisers work?

A

Stabilise mast cells preventing degranulation and the release of inflammatory mediators such as histamine.

78
Q

When is it ideal to administer mast cell stabilisers?

A

BEFORE allergen exposure

79
Q

What can happen of the first administration of a mast cell stabiliser?

A

Stinging sensation

80
Q

How soon after opening should mast cell stabiliser eye drops be discarded

A

4 weeks

81
Q

What are some examples of nasal corticosteroids?

A

Beclomethasone (beconase)
Fluticasone (Pirinase)
Budesonide (benacort)
Mometasone (Clarinaze0

82
Q

What is the usual dose frequency for nasal corticosteroids?

A

Varies from once daily to twice daily

83
Q

Can nasal corticosteroids cause systemic effects?

A

Unlikely but patient should still be aware

84
Q

True or false. Nasal corticosteroids are first line for SEVERE symptoms.

A

TRUE

85
Q

What symptoms are nasal corticosteroids good for?

A

Nasal congestion
Rhinorrhoea (runny nose)
itching
sneezing
Also eases eye symptoms

86
Q

How long does it take to see the maximum effect of nasal corticosteroids?

A

2-3 weeks

87
Q

What age group are nasal corticosteroids licensed for OTC supply?

A

18 years and above

88
Q

What is the ideal way to use nasal corticosteroids in a pollen allergy?

A

Use 1 or 2 weeks before exposure to delay onset of symptoms

89
Q

What are some examples of of nasal decongestants?

A

Xylometazoline (Otrivine)

90
Q

What is the maximum duration of use of nasal decongestant sprays and drops?

A

5-7 days

91
Q

Why should nasal decongestants only be used short term

A

They can cause rebound congestion which can be worser than before

92
Q

Why is it helpful to use a decongestant just before starting a nasal corticosteroid?

A

Congestion can stop the corticosteroid reaching the mucosa making it less effective

93
Q

What are some examples of oral decongestants?

A

Pseudoephedrine, ephedrine, phenylephrine

94
Q

What are some uses for oral decongestants?

A

Allergic Rhinitis
Common cold
Flu

95
Q

What are the limits for supply of OTC ephedrine and pseudoephedrine?

A

Pseudoephedrine 720mg
Ephedrine 180mg

They are prone to abuse.

96
Q

What comorbidities should we not supply oral decongestants in?

A

Diabetes
High blood pressure
Chronic heart failure

97
Q

What age group are oral decongestants licensed for OTC sale in?

A

12 years and over

98
Q

What is the duration of action for oral decongestants?

A

6 hours

99
Q

What are some self-management tips to help with hay fever

A
  • Nasal irrigation
  • Avoid grassy areas especially when mowed or high pollen count
  • Avoid drying washing outside when pollen count is high
  • Keep window shut
  • Vacuum regularly and use damp duster
  • Do not smoke
100
Q

What are some self-management tips to help allergies?

A

Animal allergy
- ideally do not allow animal in house :(
- wash animal and surface they may regularly come into contact with

Occupational allergies
- reduce exposure e.g. by wearing latex free gloves or a dust mask
- adequate ventilation
- avoid hazardous chemicals where possible

House dust mite allergy
- use synthetic pillows and acrylic duvets
- wash bedding and fluffy toys at least once a week on hot cycle
- wooden or hard floors instead of carpet

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