Term
| Predisposing factors to atopic disease: |
|
Definition
- Small family size
- Clean environment (water and food sanitation)
- Less outdoor exposure
- Urban environment
- More processed food/greater variety/less essential nutrients
- Sensitising and triggering factors
- Inappropriate diet for healthy immune system
- Low exposure to micro-organisms
- Genetic predisposition to atopy
- Extremes of maternal age?
- Environmental exposure to chemicals/industrial pollution |
|
|
Term
| Early response allergic rhinitis: |
|
Definition
- Leakage of blood vessels
- Mucosal edema
- Rhinorrhea
- Secrtion of mucoglycoconjugates
- Congestion
- Nasal itching
- Sneezing |
|
|
Term
| Risk factors for rhinitis: |
|
Definition
- asthma
- atopic dermatitis
- allergies
- FHx of allergy
- Daycare
- Viral infxn
- Occupational exposure
- Hobbies/weekend activities
- Flying |
|
|
Term
| text book classic sign of allergies: |
|
Definition
| bluish tent to nasal mucosa |
|
|
Term
|
Definition
- house dust mites
- mold/spores/fungus |
|
|
Term
| Cedar is an allergen in __ and __. |
|
Definition
|
|
Term
| Spring trees are allergens from __ to __ __. |
|
Definition
|
|
Term
| Grasses are allergens from __ to __. |
|
Definition
|
|
Term
| Weeds are allergens from__to__. |
|
Definition
|
|
Term
| Physcial changes of allergic rhinitis: |
|
Definition
- Pale blue, edematous turbinates
- Clear, watery nasal discharge
- Crease from nasal salute
- Lymphoid hyperplasia
- Watery itchy eyes
- High arched palate
- Elongated face |
|
|
Term
| Sinus x-rays are NOT needed for dx of acute rhinosinusitis. |
|
Definition
|
|
Term
| sinus x-ray to view maxillary sinus: |
|
Definition
|
|
Term
| Sinus view to to ee ethmoid and frontal sinuses: |
|
Definition
|
|
Term
| Sinus view to see sphenoid sinus: |
|
Definition
| lateral view> sphenoid sinus |
|
|
Term
| Limited Coronal CT scan is good for visualizing __ __ and __ __. |
|
Definition
- osteomeatal complex
- all sinuses |
|
|
Term
| Tmt of allergic rhinitis: |
|
Definition
Avoidance of identified allergens
Antihistamine nasal spray
Nasal steroids
Antihistamines (sedating and nonsedating)
Decongestants
Nasal sprays (limited 2-3 days)
Oral (limited by side effects)
Nasal irrigation
Leukotrienes blockers |
|
|
Term
| Step 1 tmt for mild allergic rhinitis in which symptoms occur occasionally: |
|
Definition
- Environmental control
- Saline irrigation
- Monotherapy with nasal steroid or non-sedating anthistamine or Astelazine nasal spray |
|
|
Term
| benefit of Astelazine nasal spray over steroid spray: |
|
Definition
| Astelazine doesn't have to be uesd everday |
|
|
Term
| Step 2 treatment of moderate allergic rhinitis in which symptoms lasts from months to one year: |
|
Definition
- Environmental control
- Normal saline irrigation
- Combination therapy: nasal steroid AND nonsedating antihistamine with or without decongestent OR Astelazine
- Immunotherapy |
|
|
Term
| Step 3 tmt for severe allergic rhinitis that is chronic/persistent and associated with sinuisitis, otitis media, and/or asthma: |
|
Definition
- Environmental control
- Normal saline irrigation
- Non-sedating antihistamine +/- decongestant
- Hig dose nasal steroid
- Afrin 3 days or fewer
- Oral steroids
- Immunotherapy |
|
|
Term
| Nasal steroids are indicated for both allergic and non allergic rhinitis. Side effects may include epistaxis, nasal burning, headache, changes in taste, and pruritis. No one nasal steroid appears to be superior to others. |
|
Definition
|
|
Term
|
Definition
- Flonase
- Nasonex
- Nasacort
- Rhinocort
- Vancenase
- Omnaris |
|
|
Term
| Non-steroidal nasal sprays: |
|
Definition
- Astelazine
- Atrovent- prior cold air exposure
- Nasalcrom- mast cell stabilizer
- Saline |
|
|
Term
| Immunotherapy candidates: |
|
Definition
- patients whose symptoms are not controlled adequately by medications and avoidance measures
- patients who wish to reuce the long term use of medication
- patient with history of systemic reation to Hymenoptera stings and spcefic IgE antibodies to Hymenoptera venom |
|
|
Term
| successful immunotherapy is associated with a change toward a __ __ __ profile. |
|
Definition
| - TH1 CD4+ cytokine profile |
|
|
Term
| Efficacy of immunotherapy is not dependent on reduction in specific ___ __. |
|
Definition
| - NOT dependent on reduction in specific IgE levels |
|
|
Term
| Increases in allergen specific IgG antibody titers are/are not predictive of duration and degree of efficacy of immunotherapy. |
|
Definition
|
|
Term
| immunotherapy seems to be affective for tmt of: |
|
Definition
- allergic rhinitis
- allergic conjuctivitis
- allergic asthma
- stinging insect hypersenstitivity |
|
|
Term
| Facts about safety of immunotherapy: |
|
Definition
- Local reaction do not appear to be predictive of subsequent systemic reactions
- Life threatening and fatal reactions do occur
- An assessment of pts current health status is necessary
- Timing of anaphylactic reactions to injections- pt should remain in office for 30 minutes |
|
|
Term
| Tolerance is the the relative decrease in __ __ __ due to the generation of __ and __ regulary T lymphocytes. |
|
Definition
- allergen specific responsiveness
- CD4+ and CD25+ |
|
|
Term
| Increases in allergen-specific IgG antibody titers are not predictive of the duration and degree of efficacy of immunotherapy. However, alterations in the allergen-specific IgG specificity with immunotherapy might play a role in determining clinical efficacy |
|
Definition
|
|
Term
| Patient selection for immunotherapy: |
|
Definition
- pts with evidence of IgE specifc antibodies to clinically relevant allergies
- symptoms not reduced by avoidance and medication
- amoutn and typ of medication required to conrol symptoms
- adverse affects of medications |
|
|
Term
| guidelines for asthma pts and immunotherapy: |
|
Definition
- allergen immunotherapy should NOT be initiated in athmatic patient unless the patients asthma is stable
- clinical indications for VIT trongly considered if pt has had a systemic reaction to Hymenoptera sting
- demonstrate evidenceof specific IgE antibodies |
|
|
Term
|
Definition
- admit with 1 mL syring with a 26-27 gauge half inch nonremovable needle
- should be given subcu to posterior middle third up upper arm |
|
|
Term
|
Definition
- Reduces symptoms of allergic rhinitis and asthma
- Prevents development of new allergies
- Reduces likelihood of developing future asthma
- Can be administered at home
- No needle injections |
|
|
Term
| Early wheezing child (< 3y/o) has increased risk of asthma IF: |
|
Definition
| - 1 major OR 2 minor criteria |
|
|
Term
| Major criteria used to determine if young wheezing child is at risk for asthma? |
|
Definition
Major
- Parent with asthma
- Atopic Dermatitis
- Inhalant allergen sensitization |
|
|
Term
| Minor criteria used to determine if early wheezing child is at risk for asthma? |
|
Definition
- Allergic rhinitis
- Food allergies
- Eusinophilia (> or = to 4%)
- Wheezing apart from colds
AFEW |
|
|
Term
| Acute severe LRI caused by __ or __ in first year of life are important contributors to __ and __ __ in 5 y/o children. |
|
Definition
- rhinovirus or RSV
- asthma and persisten wheezing in 5 y/o children |
|
|
Term
| Development of strategies to shield __ __ during __ may prevent __ __ __. |
|
Definition
- growing airways
- infancy
- long term asthma |
|
|
Term
| early treatment with inhaled corticosteroids not recommneded. |
|
Definition
|
|
Term
| Asthma is assessed by __ and __. __ is assessed by __ and __. Impairment is assessed by __ and __ __, while Risk is assessed by __ and __ __ __. |
|
Definition
- severity and control
- Severity is assessed by impairment and risk
- Impairment is assessed by symptoms and lung function
- Risk is assessed by exacerbations and additional control risks |
|
|
Term
|
Definition
- less than or equal to 2 daytime symptoms/week
- less than or equal to 2 treatments needed/week
- leses than or equal to 1 nighttime awakening/month
- less than or equal to 1 exacerbation/year
- No limitation on daily activities/exercise
- Normal/near normal lung function |
|
|
Term
| drug that can be used in stead of ICS in steps 2 or with ICS in step 3/4: |
|
Definition
| Leukotriene Inhibitor (Montelukast) |
|
|
Term
| __% of kids with allergic asthma also have rhinosinusitis. |
|
Definition
|
|
Term
| In pediatric pts with severe atopic dermatitis, 100% developed __ __ __ and 75% developed __ __ __. |
|
Definition
- 100% developed inhalant allergen sensitization
- 75% developed allergic respiratory response (asthma and/or rhinoconjunctivitis) |
|
|
Term
| In peds pts with mild to moderate atopic dermatitis, __% developed allergic respiratory disease. |
|
Definition
|
|
Term
| Immunotherapy may reduce development of asthma in pts with ___ __. |
|
Definition
| seasonal rhinoconjuctivitis |
|
|
Term
| If pt has difficult to control asthma, or nocturnal wheezing consider: |
|
Definition
|
|
Term
| 60-80% of pediatric asthma pts have __. |
|
Definition
|
|
Term
| Exercise induced bronchospasm indicates: |
|
Definition
|
|
Term
| Options for pre-treatment for exercise induced bronchospasm: |
|
Definition
- SABAs and LABAs effective in 80%
- LTRA effective in 50% |
|
|
Term
| life style mod for exercise induced bronchospasm: |
|
Definition
- warm up
- wear scarf or face mask in cold weather |
|
|
