Atopic Diseases
If one parent has an atopic disease their child's risk is what? Both parents?
1-30-40% 2-60-70%
List eh percentage of anaphylaxis next to each sign and symptom cutaneous respiratory GI CV
90 70 40 35
List how often these patients use their inhaler? Mild, intermittent asthma Mild. persistent asthma
<2 a week during day, <2 a month at night Daily persistent symptoms
What are the two types of asthmas?
Allergic Nonallergic
What are the three treatment options for allergic rhinitis?
Allergic ID and avoidance Pharmacologic therapy Immunotherapy
What are some symptoms of allergic conjunctivitis?
Allergic salute- movement of hand to wipe nose (children) Nasal crease- crease as nose is constantly pushed up (children) Allergic shiners (under eyes) Dennie-Morgan lines (fold under bottom eyelid, children)
What are the two most under diagnosed diseases?
Asthma Migraines
What is the difference between asthma and COPD?
Asthma: reversible airway obstruction COPD: non reversible and chronic
A genetic predisposition toward the development of immediate hypersensitivity reactions mediated by IgE against common environmental antigens (pollens, food, animal dander, molds, and insect venoms)
Atopy
A young boy has been constantly sneezing, especially early in the morning and late at night before and after bed. His father, an exterminator, suspects dust mites due to their new dog. He puts a humidifier in the boys room. Why is this a problem?
Because dust mites drink water through their skin so this sets up an environment for them to thrive in
Why would we give someone a shot of histamine under their skin prior to a prick or intradermal test?
Because if they are on an antihistamine you need to make sure they'll react so you give them a slight shot
Why are we rethinking our avoidance of peanut and peanut oils in children?
Because we've found a rise in peanut allergies and its possible that early introduction induces protection rather than allergic immune reactions
How do we avoid oral allergy syndrome?
By cooking the food or avoiding it
How in occupational exposures do we avoid allergens?
By using a respirator others are just avoidance based
Name some times we would refer someone to an allergist or immunologist?
Children with moderate to severe AR Failure of pharm therapy for AR coexisting asthma or nasal polyposis Complications of AR (recurrent OM and sinusitis) Identify allergic triggers
Differentiate between chronic bronchitis and emphysema
Chronic bronchitis: blue bloater --> ventilation problem where they don't perfuse/ventilate all alveoli and as such have a blue appearance Emphysema: pink puffer --> loss of alveoli, they perfuse it all, but don't have a lot
Define asthma
Chronic inflammatory lung disease characterized by symptoms of cough, wheezing, dyspnea and chest tightness that occur in paroxysm connected with triggers
What is indicative of chronic bronchitis?
Coughing up phlegm everyday for 3 months
A small arachnoid like animal common in homes that feeds on animal skins
Dust mites
When do we usually see the last of the seasonal alleges in WV?
Early october with first frost
Atopic dermatitis is what? What causes it?
Eczema Overactive IgE in skin causing an autoimmune reaction to skin and over activity of Th2 cells
What is gustatory rhinitis? Where do we see this a lot?
Elderly people who eat their nose runs --> due to overstimulation of ANS and parasympathetic NS
Besides epipnehrine what else can we give anaphylaxis patients?
Epinephrine glucagon antihistamines bronchodilators Glucocorticoids vasopressors
What is the hygiene hypothesis?
Excess cleanliness in an infant's environment can lead to a decline in the number of infectious stimuli that are necessary fro proper immune system development. This triggers an imbalance between infectious response elements (Th1) and the allergic response elements (Th2) within the immune system Th2>Th1, would much rather prefer Th1
Many children have a genetic predisposition to asthma, others still can have it exacerbating by what?
Family member smoking (lung developed restricted and limited)
Food allergies can be what three categories?
Fixed Cyclical Intolerance
Where do we see eczema commonly?
Flexure in the arms and legs (creases)
A small child comes in with hives and dyspnea. His mother states that he is allergic to peanuts but she didn't see him consume any act do you do?
Give him epinephrine in .15 mg. Won't hurt him and if yo suspect anaphylaxis you always need to prescribe epinephrine
What are some pharmacologic options for allergic rhinitis?
Intranasal steroids --> best Oral antihistamines Topical nasal antihistamines Mast cell stabilizer: only works every 2-3 hours Leukotriene receptor antagonist Ipratropium: anticholinergic to dry out the nose Use in this order
What type of hypersensitivity is gluten in celiac's disease?
It isn't an allergy not mediated by IgE
Allergic rhinitis may be grown out of, what commonly then happens?
It recurs in 30s to 40s
Infectious asthma generally means we have the presence of what?
Neutrophils
A man eats a peanut and 3 hours alter has hives. Is the anaphylaxis?
No will happen sooner than this
What is vasomotor rhinitis?
Non immune mediated --> sensitivity to things like hair spray and cologne
Describe oral allergy syndrome
Patients with inhalant allergies to pollens may react to foods because of common epitopes
What are the four major allergy categories?
Pollen Insects (dust mites and cockroaches) Animals allergens Molds
Whats the difference between the prick test and intradermal testing?
Prick test: you have a 8 separate needles that you lightly prick with allergic material on them (full battery = 24) Intradermal testing: subcutaneous shot under skin
Who renders most allergy treatment?
Primary care physician
Bronchiolitis is common infancy an caused by what?
RSV- respiratory symptoms virus
What are some diagnostic tests for allergic asthma?
Reversible airflow obstruction (FEV1 and peak flow meter) Methacholine, cold air, or histamine challenges
A man presents with sneezing, rhinorrhea, nasal congestion and nasal itching. These are all symptomatic for?
Rhinitis (allergic rhinitis)
What about the dust mite makes us sick?
Saliva
Allergic rhinitis is split into two categories, what are they?
Seasonal allergic rhinitis (spring and fall normally) Perennial allergic rhinitis
What is very prominent in Eczema?
Secondary skin infections
What are the two most important methods for avoidance of allergens?
Showering at bedtime to remove pollen from hair Saline nasal spray --> washes out pollen
What is the mechanism of immunotherapy?
Silencing the disease inducing T cells by reducing their conversion of TH2 response to Th1 response (Can give people shots, but now they have them under the tongue --> insurance does not cover it)
What is the difference between Th1 cells and Th2 cells?
Th1 are pus cells that are influenced by cytokines to kill intracellular bacteria and protozoa and elicit a neutrophilic response Th2 are allergic cells that influence plasma cell to produce IgE and eosinophils
Explain the concept of the unified airway
That patients who have severe AR will also (50% of the time) have asthma. The idea is that what happens in your nose has effects down your trachea to bronchus and lungs Have to treat both the upper and lower airway (linings are same)
What is difficult with pregnancy induced rhinitis?
That the woman will have a full obstruction but cannot be given a lot of medication due to pregnancy
Why should we never give a child a peanut?
They can aspirate it and then the oil on it will induce an inflammatory response
What is the pathology of airway remodeling in asthma?
Thinking of basement membrane with Type IV collagen coupled with loss of ciliate cells in favor or goblet and squamous Edema Hypertrophy and hyperplasia of myocytes luminal plugging with inflammatory cels
What type of Hypersensitivity is atopy?
Type I
What is the most common cause of asthma exacerbation in children?
Viral illness
What are two cases where we have wheezing without asthma?
When we have CHF and a localized tumor in a bronchus
What is rhinitis medicamentosa?
When you have a patient who constantly uses medication to stop a runny nose --> become addicted and nose will run every few hours until next round of mediation is taken
How does Atopy most commonly manifest?
allergic rhinitis Bronchial asthma Atopic dermatitis Food allergies
What are the categories of atopic disease?
anaphylaxis allergic rhinoconjuctivitis Asthma GI- fixed food allergy Atopic dermatitis
For dieting and avoidance of atopic dermatitis list when each food should be introduced: fruits and veggies grains and meats fish or eggs
at 6 months at 12 months Not before 18 months
A nose that does not produce enough mucus is a ______________
atrophic nose --> causes atrophic rhinitis
Allergic rhinitis is most common in?
children (40%) Adults is anywhere from 10-30%
What are the early phase reactions for allergic rhinitis? Late phase?
early: mast cells and basophils release histamine, tryptases, heparin, leukotrienes, cytokines Late: eosinophils and TH2 lymphocytes release additional inflammatory mediators
How do we treat eczema?
emollient creams or ointments wet soaks or nonocculisve creams or lotions topical corticosteroids or systemic antibiotics
What does the epithelium of the lungs have? Why?
goblet cells to produce mucus and keep the lungs from drying gout
Individual who are having atopic reactions are generally __________
hyper allergic
Which turbinate is often seen on exam and is sometimes pale or robin's egg blue? What do we check for around it?
inferior turbinate Pus- neutrophils
In a methacholine challenge what would expect the FEV1 to be?
reduced
What are some seasonal allergic rhinitis producers? Perennial?
seasonal: trees, grass, weed pollens perennial: dust mites, cockroaches, animal protein, molds, fungi