14 Allergies

Acute

• path: IgE mediated, exposure to trigger causes mast cell cross linking/degranulation. Histamine releases that mediates reaction

3 types for acute:

• anaphylaxis

• urticaria

• Angioedema

Anaphylaxis

• symptoms: urticaria (rash) all over body + hypotension, wheezing, loss of airway

• diagnosis: clinical

• treatment

  • epinephrine 1:1000 IM ASAP

  • H1/H2 blockers for histamine relief

  • Steroids: lessen immune reaction

Urticaria

• symptoms: wheal, whelt, erythema, no hypotension

• diagnosis: clinical

• treatment

  • usually self limiting: observe, topical antihistamines

  • rule out anaphylaxis

• Case: someone with bee sting. Treat anaphylaxis if present. Otherwise treat urticaria

Angioedema

• symptoms: Swelling airway and wheezing. No hypotension or rash

• Always with ACE I use

• diagnosis: clinical

• treatment

  • secure airway

  • H1/H2 blockers

  • Steroids

  • rule out C1 esterase deficiencies: give FFP

Chronic

• allergic rhinitis

• allergic conjunctivitis

Allergic Rhinitis

• Triggers: seasonal (weed, pollon) or perinneal (around all the time, smoking, dusts, pets)

• symptoms

  • allergic shiners and salute

  • pale, boggy mucosa; polyps in nose

  • cobblestoning from postnasal drip

• diagnosis

  • clinical only

  • RAST and skin testing only when refractory or for desensitization

• treatment

  • avoiding triggers

  • intranasal steroids

  • H2 > H1

• Allergic Rhinitis

pale, boggy mucosa, and polyps:

_

cobblestoning:

_

• Allergic rhinitis

Allergic shiners are dark circles under the eyes caused by congestion of the nose and sinuses. They're usually described as dark, shadowy pigments that resemble bruises:

_

The allergic salute is the characteristic and sometimes habitual gesture of wiping and/or rubbing the nose in an upwards

_

Allergic Conjunctivitis

• same path, diagnosis, treatment as rhinitis

• symptoms: shiners, injection, chemises (swelling)

_

Food allergies

• Usually outgrow: wheat, soy, milk, eggs

• May carry throughout life and cause anaphylaxis: shellfish, nuts

• symptoms: NVD, look for other allergy signs (asthma, atopic dermatitis). Can cause anaphylaxis

• diagnosis: food trial: withdraw all agents, introduce one at a time

• treatment: avoid triggers, epi

Milk Protein Allergy

• path allergy to soy

• symptoms: NVD, bloody bowel movement. Failure to thrive despite feeding adequate amounts

• diagnosis: clinical

• treatment: change formula to cow's milk, breastfeed, hydrolyzed formula