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18 Cards in this Set
- Front
- Back
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Type 1 Hypersensitivity
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IgE mediated response to foreign proteins
requires prior exposure rapid onset 20% of population affected |
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Pathophysiology of Type 1 hypersensitivity
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sensitization phase - exposer/processing/IgE production
IgE bing mast cells and basophils Clinical phase - rexposure - binds IgE - degranulation - chemotactic factors - cellular inflammatory respose |
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Hygiene Hypothesis
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lack of childhoods exposure to infectious agents increase susceptibility to allergic diseases by modulating immune system development
allergic diseases are driven by inappropriate TH2 mediated immune response bacteria and viruses elicit a TH1 response which down regulate TH2 responses |
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Case 1 - Primarily RT pollens and molds
Findings - EYES - allergic shiners, dennie lines, conjuctivitis, cobblestoning, clear/stringy discharge NOSE - pale mucosa, edamatous mucosa, THROAT - cobblestoning Symptoms - itchy eyes, redness, drainage, sneezing, post nasal drip (early) - congestion (late) DDx? |
Recurrent URI, Rhinitis, sinusitis, deviated septum, cystic fibrosis, immotile cilia, foreign body
Diagnosis - use HandP allergy skin tests, RAST tests also can measure IgE Management - avoidance of allergens, antihistamines, steroids, immunotherapy |
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Corticosteroids
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most are inhaled,
except prednisone and prednisolone |
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antihistamines
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oral
1rst gen - ends in amine or stine 2nd gen - ends in adine or zine Nasal - Azelastine |
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Other Anti Allergy Meds
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inhaled mast cell stabilizers - Cromolyn sodium
leukotriene receptor antagonists - monolukast oral decongestants - pseudophedrine, phenylephrine inhaled anticholinergic - ipratropium bromide |
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immunotherapy
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increasing amounts of allergen extract
usually effective in most people induces shift from TH2 to TH1 cytokine production |
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Case 2
Perennial AR - Indoor allergens, rarely foods |
diagnosis same for seasonal allergic rhinitis
avoid dust mites remove animal dander |
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Caae 3
Food Allergy |
Symptoms - Gi problems, Urticaria, angioedema, respiratory probs
runny nose alone does not occur in food allergy there is a connection between food allergy and dermatitis prognosis - infants usually outgrow allergies. exception: peanut allergy is life long Dx:skin testing or immunoCAP -watch out for false positives intradermal testing is CONTRAINDICATED Negative tests can be relied on Vaccines and egg allergy - MMR is not contraindicated Flu and Yellow Fever IS contraindicated Tx: strict avoidance |
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Dx for Asthma
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H and P
CXR Spirometry (w/ and w/o) Methacholine challange exercise challange |
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CXR in Asthma
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hyperinflation
widening of rib spaces flattening of diaphragm stelectasis pneumothorax |
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Asthma Classification
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mild intermittent: around 2 times a week
nocturnal symptoms no daily medication beta 2 agonist for emergencies mild persistent: 3-6 times a week nocturnal symptoms 4 times a month Low dose corticosteroids or mast stabilizers or theophyline or leukotriene inhibitors moderate persistent:5 times a month but with more severe loss in function medium dose ICS or combo with beta 2 agonist also use typical alternatives severe persistent: continual, every night symptoms, large loss in function high dose ICS or long acting beta 2 agonists, theophyline, LI |
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Case 6
Allergic Asthma |
seasonal or perennial allergies
USE immunotherapy also use anti-IgE |
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Case 7
Anaphylaxis |
multisystem mast cell mediator release
acute onset can be fatal caused by: food allergy, insect sting, medications, radio contrast, latex, immunotherapy, idiiopathic |
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Symptoms of Anaphylaxis
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tachycardia, hypotension, volume loss, MI
bronchoconstriction, rhinitis, throat edema cutaneous, GI, occular and GU symptoms |
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Mechanism of Anaphylaxis
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IgE mediated (food, medicine, insects, latex)
complement mediated (radiocontrast) direct mast cell activations (Vanc, opiates, exercise) |
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Diagnosis and treatment of Anaphylaxis
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elevated tryptase
H and P give O2, epi, IV fluids, H1 and H2 antihistamines, vasopressors corticosteroids |
