Pediatric Asthma and Allergies Lecture Powerpoint

Question 1

Not all allergic reactions are… (2)

Answer 1

…atopic, and not all are IgE mediated (think non-allergic rhinitis)

Question 2

The allergic response is thought to be due to a combination of factors including (5)

Answer 2

• genetics
• age
• environment
• exposure
• sensitization

Question 3

Antigen presenting cells

Answer 3

Include cells such as dendritic, langerhan, and macrophages, induce allergic inflammation by presenting allergen to T cell on their MHC class II, priming naive T cells

Question 4

T helper cells

Answer 4

Type 2 T cells, secrete cytokines that cause IgE mediated responses as well as interleukins, thought to play a large role in asthma and allergies

Question 5

Eosinohpils

Answer 5

Help defentd against parasites, accumulate where allergic cxns take place as well and release inflammatory proteins

Question 6

Mast cells

Answer 6

Mediators of the llaergic response, do not circulate but are located around connective tissue and alongside basophils degranulate releasing histamine and cytokines, depending on where they release will see different impacts such as GI inflammation, airway congestion, and blood capillary dilation

Question 7

Early vs late phase allergic response vs chronic response

Answer 7

Early is due to mast cells degranulating massive amounts of histamine and occurs within minutes, late response occurs after hours post exposure and is associated with infiltration of neutrohpils, eosinophils, basophils, monocytes, and macrophages, chronic is continuing of this and will see tissue remodeling with irreversible damage to target organs

Question 8

Hygiene hypothesis

Answer 8

Refers to the idea that children who are in less sterile environments have a lower risk of allergic disorders compared to those that are in more sterile environments

Question 9

Symptoms of allergic dz in children (9)

Answer 9

• careful history and PE
• triggers
• age of presentation (younger more food or environment, older seasonal)
• congestion or sneezing
• wheezing or SOB
• rash
• allergic shiners
• nausea and vomiting
• frontal headache

Question 10

3 allergic behaviors

Answer 10

• allergic salute (rub nose upward with palm of hand, creates transverse nasal crease)
• allergic click (tongue against roof of mouth to scratch soft palate - I do this)
• rubbing of eyes

Question 11

Dennie morgan lines

Answer 11

exaggerations of folds under the eyelid present in patients having an allergic reaction

Question 12

2 things that can help differentiate allergic rhinitis from colds

Answer 12

• fever is infectious

- itchiness is almost always allergic

Question 13

Diagnostic testing for allergies

Answer 13

• Radioallergosorbent test (document allergen specific IgE but less sensitive than skin test)
• skin allergy testing
• methacholine challenge test (bronchial provocation, non-asthmatics do not constrict)

Question 14

Environmental control for allergies (6)

Answer 14

• dust mite feces are often source of allergen, do not survive in humidity <50%
• remove pet or at least limit space, takes 6 months to clear allergens from home
• limit pests and insects
• stop tobacco smoking
• wipe down walls and avoid mold (humidity >50%)
• keep windows closed and use AC

Question 15

Drug of choice for anaphylaxis

Answer 15

epinephrine

Question 16

Diphenhydramine (benadryl) use

Answer 16

Anticholinergic for allergic rxns including urticaria, itching, is sedating

Question 17

Ipratroprium bromide (atrovent)

Answer 17

atropine like drug that in nebulized form can be used for asthma

Question 18

examples of 1st gen antihistamines (2)

Answer 18

diphenhydramine

hydroxyzine

Question 19

Examples of 2nd gen antihistamines

Answer 19

• cetirizine (zyrtec)
• fexofenadine (allegra)
• loratadine (alavert or claratin)

Question 20

Cromolyn sodium function

Answer 20

Mast cell degranulation inhibitor that is safest of all antiallergic medications and is safe for prophylaxis of many minor allergies

Question 21

Singulair/montelukast function

Answer 21

Leukotriene inhibitors used in treatment of asthma

Question 22

Allergy shots protocol (6)

Answer 22

• check patients nae, dose, last rxn on chart
• have 2nd person check dosage
• monitor patient for time post shot
• have anaphylaxis and crash cart readily available
• educate staff in all aspects
• any questsions call the allergist

Question 23

Seasonal vs perennial allergic rhinitis

Answer 23

Seasonal only occurs sometimes but perennial is persistent, chronic, generally less severe than the seasonal version

Question 24

Unilateral nasal drainage in pediatrics should make you think ___ rather than allergies

Answer 24

Nasal obstruction (perhaps foreign body?)

Question 25

Atopic dermatitis

Answer 25

Pruritic skin disease in 10% of population, almsot all also develop allergic rhinitis and/or asthma, scratching can lead to secondary infections, typically facial or flexor surfaces

Question 26

Serum sickness

Answer 26

type iii hypersensitivity, immune complex mediated vasculitis, sees fever, malaise, rash, and joint pain 7-21 days after injection of foreign proteins, treat with antihistamines and glucocorticoids