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Block 9 Week 4 > Hogan > Pediatric Allergic Rhinitis & Asthma > Flashcards

Hogan > Pediatric Allergic Rhinitis & Asthma Flashcards

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1
Q

what is allergic rhinitis?

A

collection of sx from NOSE & EYES occurring when the pt inhales an allergen to which the pt is sensitized

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2
Q

T/F: sx of allergic rhinitis occur only late in the process

A

FALSE

occur early AND late

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3
Q

what are the hallmark features of allergic rhinitis?

A

itch or sneeze

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4
Q

what is asthma?

A

a chronic inflammatory disorder of the airways characterized by obstruction of airflow

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5
Q

can asthma be reversed?

A

yes

completely or partially w/ or w/o specific therapy

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6
Q

when does more than HALF of asthma develop?

A

before 3 yo

but it can happen at any age

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7
Q

what age group is having an asthma epidemic right now?

A

adults

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8
Q

T/F: multiple asthma triggers are possible, even in the same pt

A

TRUE

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9
Q

which sex is predominant in childhood and adult asthma?

A

child: male
adult: female

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10
Q

which cell types are involved in the early (asthma? allergy?) rxn?

A

tissue mast cells

peripheral blood basophils

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11
Q

which cell types are involved in the late rxn?

A

peripheral blood basophils only

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12
Q

what are the early phase mediators of inflammation?

A

congestion
sneezing
pruritis
secretions

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13
Q

what are the mediators of CELLULAR inflammation?

A

eosinophils
peripheral blood basophils
lymphocyte
neutrophils

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14
Q

what are the late phase mediators of inflammation?

A 
congestion
sneezing
pruritis
secretions 
(same as early)
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15
Q

how long does the early phase rxn take to kick in?

A

15-20 min

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16
Q

how long does the late phase rxn take to kick in?

A

4-6/8 hours

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17
Q

what cell is predominantly involved in the early phase?

A

mast cells

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18
Q

what cell is predominantly involved in the late phase?

A

eosinophils

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19
Q

what cell is predominantly involved in the chronic phase or repeated exposure?

A

lymphocytes

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20
Q

what occurs in the airway long-term in allergies/asthma?

A

airway remodeling

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21
Q

what are the immediate sx of allergic rhinitis?

A 
itch (nose, mouth, eyes, throat, ears)
anosmia
rinorrhea
sneezing
tearing eyes
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22
Q

what are the late sx of rhinitis (after the allergen is inhaled)?

A 
congestion
coughing
clogged/popping ears
anosmia
sore throat
shiners
fatigue/sleepy/malaise
HA
mouth breathing
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23
Q

what is the prevalence of allergic rhinitis in the US?

A

20%

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24
Q

what % of physician-dxed rhinitis pts have allergic rhinitis at all ages?

A

3-5.5%

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25
Q

what % of children have allergic rhinitis by 3 yo?

A

6%

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26
Q

what % of 13 yo children have allergic rhinitis?

A

44%

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27
Q

how bad are the sx of AR in the 13 yo pts who have 2 parents that have AR also?

A

1/2 have severe persistent sx

most had sx continuously for >2 mos/yr

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28
Q

about how many allergens are pediatric AR pts sensitized to?

A

3

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29
Q

when do the least amt of asthma sx occur?

A

summer

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30
Q

what is AR assoc w/ in the spring?

A

increased risk of uncontrolled asthma

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31
Q

what is uncontrolled asthma during autumn assoc w/?

A

presence of eczema

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32
Q

are children under 1 yo allergic to pollen?

A

nope

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33
Q

what is the trend of pollen allergy & age?

A

increasing #s of kids are allergic to pollen the older they get

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34
Q

what is the SINGLE most important predictive factor for incidence & persistence PAST PUBERTY for allergic rhinitis & asthma?

A

positive skin tests to outdoor allergens at baseline

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35
Q

T/F: asthma usu exists by itself

A

FALSE

36
Q

what % of asthma pts have coexistent AR?

A

60-70%

37
Q

T/F: most asthma pts have only lower airway disease

A

FALSE

lots have upper & lower

38
Q

what is the unified airway hypothesis?

A

developmentally, the nose & lung occur together. Therefore, they share pathophysiologic pathways

39
Q

what happens in allergic rhinitis pts if you give them nasal steroids?

A

improvement in BOTH rhinitis sx (expected) & bronchial reactivity/asthma sx scores

40
Q

what do you need to know to ascertain if rhinitis/asthma sx are potentially allergic?

A

knowledge of local allergens

41
Q

what allergens are linked to inner city asthma severity?

A

cockroach & mice

42
Q

how do swamp coolers affect allergies?

A

if pts have swamp coolers, they are MORE LIKELY to be allergic to mold

43
Q

why would a person have a swamp cooler?

A

they live in the desert > increases humidity

44
Q

rural area pollen counts are (higher/lower) than urban, esp for grass, ash, hazel, & plantain

A

HIGHER

45
Q

urban pollen counts are higher than rural for what?

A

ornamental trees

46
Q

what is the functional way to ascertain IgE sensitization?

A

allergy skin testing

47
Q

what is avoidance therapy?

A

removal of the allergen

48
Q

if you can employ avoidance therapy with a pt, should you also prescribe meds?

A

probably not!

49
Q

when should you start pharm therapy for allergic rhinitis?

A

PRIOR to the season w/ the pt’s allergen (bc once the mast cells get activated, AR/asthma is v hard to control)

50
Q

what are the routes for AR meds?

A

liquid
pill
nasal spray

51
Q

if you prescribe oral antihistamines & topical steroids & your pt is still not doing well, what can you do?

A

specifically identify the allergen in order to use avoidance therapy OR immunotherapy

52
Q

what is the ONLY FDA approved immunomodulatory therapy that reduced fairly permanent tolerance?

A

allergy immunotherapy

53
Q

what 2 things does immunotherapy reduce for asthma & allergies?

A

dec risk of AR progression to asthma in kids

dec risk of broadening allergic sensitization

54
Q

what are the 2 forms of immunotherapy for AR/asthma?

A

SCIT & SLIT

55
Q

what type of cells induce peripheral tolerance to allergens?

A

T reg cells

56
Q

what skewing of T cells happens in immunotherapy?

A

skewing from allergen-specific effector T cells to regulatory

57
Q

what do CD4+ CD25+ T reg cells control (generally) in immunotherapy?

A

allergen-specific immune response via suppressing various things

58
Q

what 4 things do CD4+ CD25+ T reg cells suppress in immunotherapy?

A
  1. dendritic cells
  2. TH1, TH2, & TH17 effector cells
  3. allergen-specific IgE & IgG4 induction
  4. bone marrow-derived cells moving to tissues
59
Q

what do CD4+ CD25+ T reg cells skew in immunotherapy?

A

dendritic cells towards IL-10 suppressor presentation

60
Q

what are the 5 things to consider when prescribing meds for kids w/ allergic rhinoconjunctivitis?

A
  1. ease of use
  2. likeability
  3. cost
  4. side FX
  5. relevance to disease
61
Q

what is the pathophysiology of asthma?

A

airway inflammation w/ bronchoconstriction

62
Q

what cell types drive inflammation in kids & adults?

A

eosinophilic or neutrophilic

63
Q

what most likely drives young childhood asthma?

A

viruses

64
Q

what % of asthma has an allergic trigger?

A

70%

65
Q

what are the main sx of asthma?

A

wheeze (expiratory>insp)
cough (worse at night)
chest tightness
SOB w/ colds/playing

66
Q

what environmental things can exacerbate asthma sx?

A 
allergens
thunderstorms
cold air
laughing
smoke
pollen
67
Q

T/F: the adult DDx list is the same as children when diagnosing asthma

A

FALSE

68
Q

what are the 3 categories of wheezers?

A
  1. transient early
  2. non-atopic
  3. IgE-assoc
69
Q

when do transient early wheezers peak?

A

0-3 yo

70
Q

when do non-atopic wheezers peak?

A

3-6 yo

71
Q

when do IgE-assoc wheezers/asthmatics peak?

A

6-11 yo & thru adulthood

72
Q

what are the major criteria for the asthma predictive index in a wheezing child under 3?

A
  1. parent w/ asthma
  2. atopic dermatitis
  3. inhalant allergen sensitization
73
Q

what is the asthma predictive index w/ persistent wheezing?

A

wheezing child <3yo has an increased risk of asthma if they have 1 MAJOR or 2 MINOR criteria

74
Q

what are the minor criteria for the asthma predictive index in a wheezing child under 3?

A
  1. allergic rhinitis
  2. wheezing apart from colds
  3. eosinophils (4%+)
  4. food allergen sensitization
75
Q

what is the significance of the FeNO measurement?

A

identifies eosinophilic inflammation (inc FeNO) > assesses whether chronic cough is d/t asthma or if asthma is controlled or not

76
Q

how can FeNO help w/ drug decisions?

A

can help decide the start of a controller med or decreasing the amt of controller med

77
Q

T/F: FeNO is standard for pts w/ asthma

A

FALSE

$$$$$ & not universally reimbursed, not in current asthma guidelines for controller meds

78
Q

what is essential for evaluating the status of asthmatics?

A

pulmonary fxn testing 1-2x/yr

79
Q

when can you start pulmonary fxn testing in asthmatic pts?

A

4-7 yo

80
Q

what things increase the risk for needing therapy in asthma?

A 
2+ oral steroid bursts/yr
ER visits
hospitalizations
potentially fatal asthma
poor PFTs
81
Q

what are the categories & scoring of the asthma score?

A 
each category is 0 1 or 2
0 is good, 2 is bad
1. pO2
2. cyanosis
3. insp airflow
4. accessory muscles
5. exp wheezing
6. CNS
82
Q

what happens if your asthma score is >5?

A

impending respiratory failure

83
Q

what happens if your asthma score is >7?

A

you are IN respiratory failure

84
Q

what drugs can you use for acute ICU mgmt of asthma?

A

continuous albuterol neb
terbutaline IV or SQ
heliox
glucocorticosteroid

85
Q

what 4 drugs can you use for maintenance/daily therapy?

A

inhaled steroids
leukotriene receptor antagonists
LABA
allergen avoidance

86
Q

what can you use for acute mgmt/rescue drugs?

A

SABAs as needed or before exercise

87
Q

what should you add to asthma mgmt if pt has steroid failure or seasonal issues?

A 
LABA
leukotriene antagonist
theophylline
anticholinergic-tiotropium
roflumilast

Block 9 Week 4 (5 decks)

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