lecture 1 khan
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| most classic sx of allergic rhinitis | paroxysmal sneezing, clear & watery rhinorrhea, itching of eyes, nose and throat. associated with seasonality and triggers like freshly cut grass, dust mites or animal dander
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| factors that increase one's risk of developing allergic rhinitis | FMHx of asthma, allergic rhinitis or atopic dermatitis
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| PEx findings of pt with allergic rhinitis (although non-specific for the allergic type) | scleral injection, cobblestoning of conj, periorbital shiners ("allergic shiners"), serous otitis, drainage and cobblestoning of posterior pharynx
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| sx of vasomotor rhinitis | nasal obstruction, rhinorrhea and post-nasal drip RARELY with sneezing or itching. impetus: irritants like strong odors or weather changes
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| rhinitis medicamentosa | due to prolonged (many weeks) use of topical nasal decongestant sprays, results in a rebound nasal congestion worse than before and tachyphylaxis
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| dx of allergic rhinitis | usually adequate with careful hx taking, demonstration of specific IgE using allergic skin testing or RAST testing for in vitro detection of IgE
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| only therapy which makes pt less allergic to a substance (performed after avoidance measures and pharamcotherapy fail) | allergen immunotherapy is the only tx that will reduce underlying allergic sensitivity. requires prior allergy skin testing to guide the immunotherapy
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| anaphylaxis | IgE-mdiated, reactive clinical syndrome characterized by constellation of sx that involve cutaneous, resp, CV and GI systems in combination (@ least 2 are required for dx after exposure to probable allergen)
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| most common sx of anaphylaxis | urticaria, angioedema, dyspnea, wheezing, n/v/d and cramping pain, dizziness, syncope, MAY be hypotensive, but it's not required
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| specific marker for mast cell degranulation | serum tryptase
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| histamine's effects during anaphylaxis | smooth muscle contraction, vascular permeability, vasodilation --> flushing of skin, urticaria, angioedema, wheezing and hypotension
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| most common type of IgE-mediated anaphylaxis is due to ____________ | insect venom: yellow jackets around US, fire ants in Texas
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| anaphylactoid rxns | clinically indistinguishable from anaphylaxis but are NOT IgE-mediated reactions and thus don't require prior sensitization. usually due to complement or direct mast cell activation by some substance like blood, Ig, opiates, vanc
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| drug of choice for anaphylaxis | always epinephrine. there is never any contraindication to receiving epi if pt is having anaphylactic rxn
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| asthma | chronic inflammatory disorder of airways characterized by inflammation, reversible obstruction and hyperresponsiveness to triggers like cigarette smoke and viruses
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| sx of asthma | episodic wheezing, chest tightness, SOB and/or cough varies throughout the day based on exposure to allergens or irritants. typically is worse @ night
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| PEx of asthmatic pt | sounds of wheezing during nl breathing, prolonged expiratory phase, increased nasal secretions and mucosal swelling, atopic dermatitis/eczema or other allergic skin problems
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| how to classify severity of asthma | based on how low FEV1 or peak flow is compared to nl, interference of nl activities or limitations due to sx, how many times one awakens @ night b/c of sx, # hospitalizations required for tx. step pt up or down tx algorithm based on this classification
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| possible allergens for asthmatics | house dust mites, pets, cockroaches, indoor molds
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| preferred rescue therapy used to all levels of asthma | short-acting beta agonists, provide prompt tx of acute airflow obstruction and its accompanying sx
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| other controller therapies for persistent asthma | inhaled corticosteroids, long-acting beta agonists, leukotriene receptor agonists
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| omalizumab | anti-IgE antibody used for more persistent and severe asthmatics, in combination with oral corticosteroids
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| how pts can monitor their own dz and recognize when a physician is necessary | with action plans or set of instructions instructing pt on what to do based on severity of sx and peak flow. know to seek emergency care when certain parameters are reached
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| other reasons for collapse besides anaphylaxis | vasovagal reaction or panic disorders
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| another common cause of throat swelling besides laryngeal/pharyngeal edema | vocal cord dysfunction
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