Family Medicine - Allergies

Front 1

what is defined as an immunoglobulin E (IgE)-mediated hypersensitivity to an antigen?

Back 1

allergen

Front 2

What type of hypersensitivity are allergies?

Back 2

Type I

rxns include: rhinitis, atopic dermatitis, conjunctivitis, asthma, food allergies, systemic anaphylaxis

Front 3

What 2 conditions often coexist and more than half of the these cases in the USA can be attributed seasonal allergies?

Back 3

allergic rhinitis and asthma

Front 4

What cells are involved in allergic rhinitis?

Back 4

mast cells

IgE binds on mast cells on the nasal mucosa of a sensitized individual, causing mast cells to degranulate releasing histamines, leukotrienes, and bradykinins which cause vasodilation, fluid transludation, and swelling.

Front 5

What are Perennial rhinitis?

Back 5

occur throughout the year
caused by primarily indoor allergens :
house dust, animal dander, and molds

Front 6

What are common skin manifestations of allergins?

Back 6

urticaria and eczema

Front 7

What are some common foods which can cause allergies?

Back 7

milk
eggs
peanuts
soy
wheat
nuts
shellfish
some fish

Front 8

This is a severe life threatening systemic allergic rxn that can occur from food allergies, bee stings, or blood transfusions?

Back 8

anaphylaxis

Front 9

What are the symptoms of allergic rhinitis?

Back 9

runny nose
nasal congestion
conjunctivitis
itchy eyes, nose
sore throat

Front 10

What type of allergies affect people most in early spring?

Back 10

tree pollens

Front 11

What type of allergies affect people in mid May to June?

Back 11

grasses

Front 12

What type of allergies affect people from August until the 1st frost?

Back 12

ragweed

Front 13

Some pts may have a nasal crease across the bridge of the nose due to the frequent nose rubing. What is this called?

Back 13

allergic salute

Front 14

What symptoms are common in children with food allergies?

Back 14

eczema and urticaria

Front 15

What are the symptoms for common cold?

Back 15

the mucosa is usually red with thickened discharge

Front 16

What are the symtoms for allergies?

Back 16

nasal passages appear pale, boggy, or bluish

Front 17

What are the symptoms for nonallergic rhinitis?

Back 17

no pruritus

Front 18

What are the symptoms for vasomotor rhinitis?

Back 18

present with chronic nasal congestion and watery rhinorrhea

Front 19

What presents primarily in elderly pts and is characterized by marked atrophy of the nasal mucosa, chronic nasal congestion, and a bad odor?

Back 19

atrophic rhinitis

Front 20

What is caused by chronic use of cocaine or topical nasal decongestants?

Back 20

rhinitis medication

Front 21

A pt presents with nasal discharge, headaches, nasal congestion, complains of facial pain, and has tenderness over the sinuses. What is the Dx?

Back 21

Sinusitis

Front 22

What are 2 rare but serious causes of nasal discharge?

Back 22

Wegner granulomatosis and Sarcoidosis

Wegner granulomatosis is granulomatosis with polyangiitis (Wegener's) (GPA), is an incurable form of vasculitis (inflammation of blood vessels) that affects the nose, lungs, kidneys, and other organs. Due to its end-organ damage, it is life-threatening and requires long-term immunosuppression. Wegener's granulomatosis is part of a larger group of vasculitic syndromes, all of which feature an autoimmune attack by an abnormal type of circulating antibody termed ANCAs (antineutrophil cytoplasmic antibodies) against small and medium-size blood vessels.

Sarcoidosis is abnormal collections of chronic inflammatory cells (granulomas) form as nodules in multiple organs, The granulomas that appear are usually of the non-necrotizing variety and are most often located in the lungs or the lymph nodes, however virtually any organ can be affected.

Front 23

A pt presents with an eczematous rash that is flat, erythematous, pruritic, and scaly. What is this?

Back 23

Atopic dermatitis

Front 24

A pt presents with a rash that formed after she got some chemicals on it. What is this?

Back 24

more of a contact dermatitis

Front 25

A pt presents with a rash she has had for a long time. It appears thick, leathery, with brownish skin. She scratches it constantly. What is this?

Back 25

lichen simplex chronicus

Front 26

What is this?

Back 26

lichen simple chronicus

Front 27

What is this?

Back 27

atopic dermatitis

Front 28

A pt presents with this rash after touching a foreign object. What is this?

Back 28

contact dermatitis

Front 29

What cells are most consistant with allergic disease?

Back 29

eosinophils

Front 30

What test tests for the presence of IgE to different allergens?

Back 30

Radioallergosorbent test
aka: RAST

Front 31

What is the problem with the RAST test?

Back 31

has a high sensitivity but low specificity

Front 32

This type of test involves injecting a small amount of allergen into the skin and looking for a local response?

Back 32

skin prick testing

Front 33

What test can be used if continued allergic symptoms persist to look for anatomic or pathologic abnormalities

Back 33

flexible naso-laryngoscopy

Front 34

What are 1st line therapy for allergic rhinitis and are also helpful for other forms of allergy?

Back 34

antihistamines

Front 35

What is the MOA for antihistamines?

Back 35

block H1 receptors
prevents release of histamine which causes sneezing, rhinorrhea, and itching

Front 36

What is the major side effect of antihistamines?

Back 36

sedation

Front 37

What is a topical antihistamine nasal spray?

Back 37

azelastine

note: expensive compared to generic oral antihistamines

Front 38

Why do nasal decongestants have a limited role in allergic rhinitis?

Back 38

tachyphylaxis and rebound congestion

Front 39

What is the tx of choice for most pts with moderate-to-severe persistent allergic rhinitis?

Back 39

Intranasal steroids
effective and have minimal side effects

Front 40

Why aren't oral corticosteroids used in allergic rhinitis?

Back 40

have more side effects that are long term
should only be used 3-7d

Front 41

How does cromyln work?

Back 41

mast cell stabilizer
OTC
very safe and well tolerated

Front 42

What is the 1st line Rx for pregnant women and children for allergic rhinitis?

Back 42

cromyln

Front 43

How do Leukotriene modifiers work?

Back 43

used to reduce allergic symptoms
very safe
block leukotriene activation which prevents the release of histamine and reduces bronchodilation

Front 44

What is the DOC for anaphylaxis?

Back 44

epinephrine

Front 45

What should be used in chronic and recalcitrant cases of allergen exposure?

Back 45

immunitherapy
pts are exposed to an allergen by subq injections of increasing conc of allergen

goal is to cause a tolerance for the specific allergen

Front 46

What is the tx of choice for most pts with moderate to severe persistance allergic rhinitis?

Back 46

intranasal steroids