Rhinitis/CRS Flashcards
Environmental changes that have contributed to pollen allergy?
- Increased PM.2.5 increases asthma exacerbations and lung injury
- longer summers lead to longer pollination of oak and hickory.
- longer periods of warmth increase fungal pollination
- Increase in humidity may increase asthma exacerbations
- increase in CO2 leads to longer pollination seasons
Which dust mite is seen in tropical countries?
Blomia tropicalis
What are the dust mite allergens?
Cysteine proteases: Der p 1 and Der f 1
Serine proteases: Der p 3, 6, 9
What is the % of cross reaction between dust mite and crustacean?
5-15%
What is the cross reactive component in dust mite?
Tropomyosin (Der p 10)
What is the most important factor needed for dust mite growth?
humidity.
mites requite RH higher than 65% to prevent water loss and to thrive. Once humidity is <50% mite proliferation decreased and survival is decreased.
Dust mite belongs to which Taxonomic category?
Arachnids that below to taxonomic order called Acari
Allergen in dust mite - cysteine proteinases
Der f 1, der p 1
Allergen in dust mite - Lipid binding proteins
Der f 2, Der p 2
Dust mite allergen which is peritrophin (chitin binding)
Der p 23
dust mite allergen which cross reacts with shrimp and cockroach
Der f 10, Der p 10
(Tropomyosins)
Major cat allergen
Fel d 1
Minor cat allergens
Fel d 2 (albumin) , Fel d 3 (cystatin) and Fel d 4 (lipocalin)
Major dog allergen
Can f 1
Lipocalin cysteine protease inhibitor
found in hair, dander and saliva
Minor dog allergens
Can f 2 (lipocalin), Can f 3 (albumin), Can f 4 (dog dander)
Where is mouse allergen found?
In mouse urine - MUP - mouse urine protein
Mus m 1 - pre albumin
Cockroach allergen
Bla g 1 and Bla g 2
What is chitin
2nd most abundant polysaccharide in the world.
Present in insects, crustaceans, parasites and fungi
Define ABRS (Canadian Guidelines)
ABRS requires the presence of
1. nasal obstruction or purulence/drainage AND
2. 2 of PODS
- pain
- obstruction
- discharge
- anosmia
3. Timing: > 7 days, <4 weeks
Define recurrent ABRS
4+ episodes of ABRS a year
Gold standard for diagnosis of ABRS
sinus aspirates, however not recommended in a clinical setting bc invasive
CDC diagnostic criteria for ABRS
- Symptoms lasting at least 7 days ANS
- purulent nasal secretions AND
- 1 of the following
- maxillary pain
- tenderness in the face (esp. unilateral)
- tenderness of the teeth (esp. unilateral)
ABRS diagnosis requires the presence of at least 2 major symptoms:
P - pain (facial)
O - nasal Obstruction
D - nasal Discharge
S - Hyposmia/anosmia (smell)
one of which must be O or D, and symptom duration of > 7 days without improvement
Red flags for urgent referral in ABRS
- Alt. mental status
- HA
- Systemic toxicity
- swelling of the orbit, or changes in visual acuity
- neurological findings
- Intracranial complications
- meningitis
- intracranial abscesses
- CV thrombosis - Involvement of associated structures
- periorbital cellulitis
- pots puffy tumour
First line antibiotics in ABRS
Amoxicillin
for beta lactam allergic ppl: TMP/SMX
2nd line: Flouroquinolones or amoxi-clav
Berg prediction rule for CRS based on signs and symptoms
- Purulent rhinorrhea with unilateral predominance - 50% PPV
- Local pain with unilateral predominance - 41% PPV
- Pus in nasal cavity - 17% PPV
- Bilateral purulent rhinorrhea - 15% PPV
William prediction rule based on signs and symptoms of ABRS
- Maxillary toothache LR 2.5
- Poor response to AH/ decongestants LR 2.1
- Purulent nasal secretions LR 2.1
- Abnormal transillumination LR 1.6
- Coloured nasal discharge LR 1.5
Presence of >/= 4 symptoms has a positive LR of 6.4
What are the 2 main causative infective bacteria implemented in ABRS (AAAAI)
What are the main bugs in CRS
- Strep pneumonia
- H. influenza
Other - M. catarrhalis, s. aureus, gram neg bacilli, and oral anerobes
CRS
1. S.aureus, enterobacter, pseudomonas