URTICARIA, ANGIOEDEMA, ALLERGIC RHINITIS Flashcards
What does atopy imply?
A. A tendency to develop autoimmune diseases like lupus or rheumatoid arthritis.
B. A propensity to manifest asthma, rhinitis, urticaria, food allergy, and atopic dermatitis, often with allergen-specific IgE.
C. A condition exclusively characterized by chronic dermatitis.
D. An allergic reaction mediated solely by mast cells.
B. A propensity to manifest asthma, rhinitis, urticaria, food allergy, and atopic dermatitis, often with allergen-specific IgE.
Which cells are the dominant effectors in urticaria, anaphylaxis, and systemic mastocytosis?
A. Basophils
B. Eosinophils
C. Mast cells
D. T cells
A. Basophils
- mast cells are key effector cells in allergic rhinitis and asthma, and the dominant effector in urticaria, anaphylaxis, and systemic mastocytosis
Which of the following best describes urticaria?
A. Localized swelling of the deeper dermis and subcutaneous tissues with pain and minimal erythema.
B. Erythematous raised wheals with serpiginous borders, lasting <24 hours and intensely pruritic.
C. Prolonged wheals that leave bruising or scarring.
D. A chronic condition triggered exclusively by viral infections.
B. Erythematous raised wheals with serpiginous borders, lasting <24 hours and intensely pruritic.
What distinguishes angioedema from urticaria?
A. Angioedema has intense pruritus, while urticaria does not.
B. Angioedema originates from the deeper dermis and subcutaneous tissues and is marked by dramatic swelling and pain.
C. Angioedema lasts less than 24 hours, while urticaria lasts more than 48 hours.
D. Angioedema is always associated with visible erythema and wheals.
B. Angioedema originates from the deeper dermis and subcutaneous tissues and is marked by dramatic swelling and pain.
- angioedema originates from the deeper dermis and subcutaneous tissues.
- Angioedema is marked by dramatic swelling with more pain than pruritus and minimal erythema, which may develop with a pruritic prodrome and takes hours to days to resolve.
Which condition is characterized by linear wheals with surrounding erythema after a brisk stroke with a firm object?
A. Cold urticaria
B. Cholinergic urticaria
C. Dermatographism
D. Pressure urticaria
C. Dermatographism
* peaks in the second to third decades * not influenced by atopy
Which type of urticaria is precipitated by fever, hot baths, or exercise?
A. Cold urticaria
B. Cholinergic urticaria
C. Solar urticaria
D. Exercise-induced anaphylaxis
B. Cholinergic urticaria
- Cholinergic urticaria is distinctive in that the pruritic wheals are of small size (1–2 mm) and are surrounded by a large area of erythema
- attacks are precipitated by fever, a hot bath or shower, or exercise and are presumptively attributed to a rise in core body temperature
A patient presents with recurrent gastrointestinal colic and episodes of laryngeal edema without pruritus or urticarial lesions. What is the likely diagnosis?
A. Vasculitic urticaria
B. Chronic idiopathic urticaria
C. Hereditary angioedema (HAE)
D. Allergic rhinitis
C. Hereditary angioedema (HAE)
- Angioedema of the upper respiratory tract may be life-threatening due to transient laryngeal obstruction, whereas gastrointestinal involvement may present with abdominal colic, with or without nausea and vomiting
- The diagnosis of HAE is suggested not only by family history but also by the lack of pruritus and of urticarial lesions, the prominence of recurrent gastrointestinal attacks of colic, and episodes of laryngeal edema
- mutation in the SERPING1 gene leading to a deficiency of C1INH (type 1) in ~85% of patients or to a dysfunctional protein (type 2)
- A third, less common type of HAE has been described in which C1INH function is normal, and the causal lesion is a mutant form of factor XII, which leads to generation of excessive bradykinin
Which treatment is effective for acute attacks of hereditary angioedema (HAE)?
A. Oral H1 antihistamines
B. Plasma-derived or recombinant C1INH protein
C. Cromolyn sodium nasal spray
D. Subcutaneous immunotherapy
B. Plasma-derived or recombinant C1INH protein
- Infusion of plasma-derived C1INH protein and lanadelumab, a monoclonal antiplasma kallikrein antibody, is approved for prophylaxis of HAE attacks
- plasma-derived or recombinant C1INH protein, a bradykinin 2 receptor antagonist (icatibant), or a kallikrein inhibitor (ecallantide) may be used for treatment of an acute attack of HAE.
Which pharmacologic agent is most effective for relieving nasal congestion in allergic rhinitis?
A. Oral H1 antihistamines
B. Intranasal high-potency glucocorticoids
C. Cromolyn sodium nasal spray
D. α-Adrenergic agents like oxymetazoline
B. Intranasal high-potency glucocorticoids
- Intranasal high-potency glucocorticoids are the most effective drugs available for the relief of established rhinitis, seasonal or perennial, and are effective in relieving nasal congestion as well as ocular symptoms
Immunotherapy is contraindicated in which group of patients?
A. Patients with significant cardiovascular disease or unstable asthma
B. Patients with perennial allergic rhinitis
C. Patients on antihistamine therapy
D. Patients with mild seasonal allergies
Patients with significant cardiovascular disease or unstable asthma
Which class of medications is beneficial for both allergic rhinitis and nonallergic vasomotor rhinitis, but may cause dysgeusia as an adverse effect?
A) Intranasal corticosteroids
B) Nasal antihistamines (e.g., azelastine, olopatadine)
C) Oral decongestants (e.g., pseudoephedrine)
D) Leukotriene receptor antagonists (e.g., montelukast)
Correct Answer: B) Nasal antihistamines (e.g., azelastine, olopatadine)
Rationale: Azelastine and olopatadine are intranasal antihistamines that are effective in both allergic and nonallergic vasomotor rhinitis. However, they can cause dysgeusia (taste perversion) as a side effect.
What is the primary concern associated with prolonged use of intranasal α-adrenergic decongestants such as oxymetazoline?
A) Increased risk of bacterial sinusitis
B) Risk of neuropsychiatric events
C) Rhinitis medicamentosa (rebound congestion)
D) Systemic immune suppression
Correct Answer: C) Rhinitis medicamentosa (rebound congestion)
Rationale: Intranasal α-adrenergic agonists like oxymetazoline and phenylephrine can cause rebound nasal congestion (rhinitis medicamentosa) if used for more than 7–14 days.
Which oral decongestant is contraindicated in patients with narrow-angle glaucoma, urinary retention, severe hypertension, marked coronary artery disease, or first-trimester pregnancy?
A) Montelukast
B) Cromolyn sodium
C) Pseudoephedrine
D) Ipratropium
Correct Answer: C) Pseudoephedrine
Rationale: Pseudoephedrine is an oral α-adrenergic agonist decongestant that can cause vasoconstriction, making it unsafe for patients with cardiovascular diseases, glaucoma, and urinary retention. It is also avoided in first-trimester pregnancy due to potential risks.
Which nasal spray acts by inhibiting mast cell degranulation and can be used prophylactically for allergic rhinitis?
A) Ipratropium
B) Cromolyn sodium
C) Olopatadine
D) Phenylephrine
Correct Answer: B) Cromolyn sodium
Rationale: Cromolyn sodium nasal spray stabilizes mast cells, preventing degranulation and release of inflammatory mediators. It is most effective when used prophylactically before allergen exposure.
Which intranasal agent is particularly useful for reducing rhinorrhea in patients with perennial nonallergic symptoms?
A) Ipratropium
B) Cromolyn sodium
C) Montelukast
D) Oxymetazoline
Correct Answer: A) Ipratropium
Rationale: Ipratropium is a topical anticholinergic agent that reduces nasal secretions, making it particularly effective for rhinorrhea in nonallergic rhinitis. It can also be used in combination with intranasal steroids for enhanced benefit.
How long should a patient remain at the treatment site after receiving an SCIT injection?
A) 10 minutes
B) 20 minutes
C) 30 minutes
D) 1 hour
Correct Answer: C) 30 minutes
Rationale: The majority of systemic reactions, including anaphylaxis, occur soon after SCIT administration. Therefore, patients are monitored for at least 30 minutes at the treatment site to manage potential adverse effects.
Which of the following allergens is approved for use in sublingual immunotherapy (SLIT)?
A) Cat dander
B) Timothy/northern grasses
C) Birch pollen
D) Mold spores
Correct Answer: B) Timothy/northern grasses
Rationale: Currently, SLIT is approved for only three allergen formulations:
Dust mites
Timothy/northern grasses
Short ragweed
Other allergens, such as cat dander, birch pollen, and mold spores, are not currently available in SLIT formulations.
Which of the following conditions is a contraindication to allergen immunotherapy (AIT)?
A) Well-controlled allergic rhinitis
B) Well-controlled asthma
C) Cardiovascular disease requiring β-blocker therapy
D) Seasonal rhinitis that responds to antihistamines
Correct Answer: C) Cardiovascular disease requiring β-blocker therapy
Rationale: Patients on β-blockers have a higher risk of severe anaphylaxis from immunotherapy, and managing anaphylactic reactions is more difficult due to β-blockers blunting the effect of epinephrine. AIT is also contraindicated in unstable asthma and significant cardiovascular disease.
Compared to SCIT, which of the following is true about SLIT?
A) SLIT is associated with a higher risk of anaphylaxis
B) SLIT must be administered in a medical setting
C) SLIT is taken at home after the first dose is given in a clinic
D) SLIT has demonstrated greater efficacy than SCIT
Correct Answer: C) SLIT is taken at home after the first dose is given in a clinic
Rationale: Unlike SCIT, which requires administration in a licensed facility, SLIT is taken at home after an initial dose in a healthcare setting. SLIT has a lower risk of anaphylaxis compared to SCIT, though it is associated with transient oral pruritus.
