Clinical Mediators
Which cells predominantly produce histamine?
Mast cells
What is the MOA of the mainstay of allergic rhinitis treatment?
Intranasal corticosteroids inhibit cytokine production, disable APCs, and inhibit mast cell degranulation.
Which is the most effective oral decongestant?
Pseudoephedrine
Anaphylaxis is which type of hypersensitivity?
Type 1
A patient comes in to your ER experiencing anaphylaxis. They are on beta blockers. What do you give them?
Glucagon
Name four actions mediated by H1 receptors
Increased vascular permeability
Flushing
Increased mucus production
Bronchoconstriction
Increased HR, CO
Chemotaxis
Adverse reactions to intranasal corticosteroids
Epistaxis and nasal irritation
What is a major side effect of topical decongestants?
Rhinitis medicamentosa
Which two organ systems does anaphylaxis affect?
CV and respiratory
What is the DOC for a two-year old with persistent, clear rhinorrhea, itchiness, but no swelling of the nasal mucosa?
A second generation antihistamine
What do H2 receptors do that H1s do not?
Increase gastric acid secretion
With which groups should be be cautious recommending benadryl or hydroxyzine?
Very young, very old, lactating mothers, BPH, glaucoma
What clinical finding is NOT a part of allergic conjunctivitis?
Pain
What are the ABC(E)s of anaphylaxis?
Airway, Breathing, Circulation, Epinephrine
We've got a pregnant lady with some bad seasonal allergies. What should be probably not give her?
Oral decongestants
What do H4 receptors do?
Mediate chemotaxis of eosinophils
First and second generation antihistamines block what kind of receptors?
H1
With what letter do combination treatments for allergic conjunctivitis usually end?
A! (Naphcon-A, Opcon-A, Visine-A)
What are the tree answers for how epinephrine works?
Alpha-1 agonist: Increased vasoconstriction
Beta-2 agonist: bronchodilation, decreased release of inflammatory mediators
80yo female comes in to your ER confused and lethargic. Her daughter says she's the picture of health except for a moderate/severe seasonal pollen allergy. What is the most likely cause of her symptoms?
Name four Leukotriene mediated actions
Increased vascular permeability
Induce wheal-and-flare reaction
Bronchoconstriction
Increase nasal secretion
Oral decongestants activate what kinds of receptors?
Alpha-1 adrenergic receptors
Which topical treatment for allergic conjunctivitis can cause vision-threatening side effects?
Glucocorticoids
Why do we give glucocorticoids in addition to epinephrine in patients experiencing anaphylaxis?
To prevent a potentially fatal delayed hypersensitivity reaction
7yoM comes in to your ER with SOB. He's coughing, rubbing his eyes, and you notice a horizontal crease across his nose. On physical exam you note boggy turbinates and green discharge. What does this kid have?
A URI, probably.