15. RAPIDLY FORMED MASTCELL MEDIATORS BIOLOGIC ACTIVITY : VASODILATATION VASCULAR LEAKAGE SMOOTH MUSCLE CONTRACTION GLANDULAR SECRETION STIMULATION OF THE IRRITANT ( ITCH / SNEEZE ) RECEPTORS PRO –ANTI-INFLAMMATORY MEDIATOR
16. CYTOKINES NEWLY SYNTHESIZED PROTEINS THAT REGULATE IMMUNE RESPONSE POTENT PRO- INFLAMMATORY MEDIATORS GROWTH / DIFFERENTIATION OF EOSINOPHILS AND MAST CELLS
17. CYTOKINES AND ALLERGY IgE REGULATION EOSINOPHILIA MAST CELL DEV ‘T AND ACTIVATION INFLAMMATION
18. IMMUNOLOGIC MECHANISM IN ALLERGIC INFLAMMATION ALLERGEN EXPOSURE ----MAST CELL ACTIVATION---- VASOACTIVE AMINE ACTIVATION ---- IMMEDIATE REACTIONS ( VASODILATATION, EDEMA, SM CONTRACTION, MUCUS SECRETION) ------------ 3 -8 HRS LATE PHASE RESPONSE (INFILTRATION OF EOSINOPHILS MONONUCLEARS AND NEUTROPHILS) ----------- AFTER 24 -48 HRS ------ T- CELL ACTIVATION --------- CHEMOTACTIC MEDIATORS -------- CELLULAR INFILTRATION ------ INFLAMMATORY MEDIATORS ------------ EDEMA, DESQUAMATION, CELLULAR INFI;LTRATION AND MUCUS SECRETION
19. ALLERGIC RHINITIS SYMPTOMS: “ SNEEZERS AND RUNNERS” -- PAROXYSMAL SNEEZING -- WATERY RHINORRHEA -- ITCHY NOSE ---NASAL BLOCKAGE (VARIABLE) -- DIURNAL RHYTHM (WORST DAYTIME IMPROVES AT NIGHT -- OFTEN ASSOCIATED WITHJ CONJUNCTIVITIS
20. ALLERGIC RHINITIS SYMPTOMS: BLOCKERS -- LITTLE OR NO SNEEZING -- THICK NASAL MUCUS (CATARRH) MORE OFTEN POSTERIOR (POST NASAL DRIP) -- NO ITCH -- NASAL BLOCKAGE OFTEN SEVERE -- CONSTANT BUT MAYBE WORST AT NIGHT
21. RHINITIS DEFINITION NASAL DISCHARGE BLOCKAGE SNEEZE/ ITCH TWO OR MORE SYMPTOMS FOR MORE THAN ONE HOUR ON MOST DAYS
23. ASTHMA CHRONIC, RECURRENT , OCCASIONALLY FATAL CHRONIC INFLAMMATORY DISORDER OF THE AIRWAYS IN WHICH CELLS PLAY A ROLE, INCLUDING M MAST CELLS AND EOSINOPHILS WIDESPREAD BUT VARIABLE AIRFLOW OBSTRUCTION THAT IS OFTEN REVERSIBLE EITHER SPONTANEOUSLY OR WITH TREATMENT ASSSOCIATED WITH AIRWAY RESPONSIVENESS
25. PATHOPHYSIOLOGY OFASTHMA ,SEVERE ASTHMA -- MUCUS SECRETION , BRONCHOSPASM ,EDEMA ---INCREASED RESISTANCE TO AIRFLOW---HYPERINFLATION, ATELECTASIS , CNS DEPRESSION-- PULMONARY VASOCONSTRICTION--CARDIAC FAILURE AND COMA
26. ASTHMA CLINICAL MS: WHEEZING , A HIGH- PITCHED OR SQUEAKING EXPIRATORY SOUND ONSET , ACUTE /INSIDIOUS COUGH , TACHYPNEA , DYSPNEA HYPERINFLATION OF THE CHEST, TACHYCARDIS ABDOMINAL PAIN WITH VOMITING LOW GRADE FEVER HUNCHED- OVER SITTING POSITIUON
27. MANAGEMENT OFASTHMA ACHIEVE AND MAINTAIN CONTROL OF SYMPTOMS PREVENT ASTHMA EXACERBATIONS MAINTAIN PULMONARY FUNCTIONS AS CLOSE TO NORMAL LEVELS AVOID ADVERSE EFFECTS FROM ASTHMA MEDICATIONS PREVENT IRREVERSIBLE AIRWAY OBSTRUCTION PREVENT ASTHMA MORBIDITY
28. MANAGEMENT PROGRAMS FOR ASTHMA EDUCATE PATIENTS/PARENTS ASSESS AND MONITOR SEVERITY AVOID OR CONTROL TRIGGERS MEDICATION PLANS FOR CHRONIC ASTHMA PLANS FOR EXACERBATIONS PROVIDE REGULAR FOLLOW-UP
29. STATUS ASTHMATICUS SEVERE ACUTE ASTHMA LIFE-THREATENING EPISODE UNRESPONSIVE TO THE USUAL APPROPRIATE THERAPY WITH ADRENERGIC AGENT AND THEOPHYLINE LEADS TO ACUTE RESPIRATORY INSUFFICIENCY
30. ATOPIC DERMATITIS CHRONIC ,HERITABLE, DISTINCTIVE CUTANEOUS INFLAMMATORY DISEASE CHARACTERIZED BY EARLY AGE OF ONSET AND INTENSE PRURITUS SKIN LESION: DRY, IRRITATED, WEEPING, EXCORIATED LICHENIFIED LESIONS ON THE FLEXURAL AREAS IN LATE CHILDHOOD AND ADOLESCENSE WIIH GENETIC PREDISPOSITION RELAPSING CAN DEVELOP ALLERGIC RHINITIS AND ASTHMA
31. STAGES OF ATOPIC DERMATITIS INFANTILE STAGE 4TH -6TH MONTH OF AGE ERYTHEMATOUS, PRURITIC, WEEPING DERMATITIS IN THE CHEEKS WHICH SPREADS TO THE FOREHEAD AND EXTENSOR SURFACES OF THE ARMS AND LEGS CIRCUMORAL AREA AND EYELIDS ARE USUALLY SPARED
32. STAGES OF ATOPIC DERMATITIS CHILDHOOD STAGE: 2-4 YRS OF AGE PRURITIC, EXCORIATED PAPULESON THE FLEXURAL SURFACES OF EXTREMITIES AND FACE LICHENIFICATION IN THE POPLITEAL AND ANTECUBITAL FOSSAE AND ANKLES MAY DISAPPEAR BEFORE 10 YRS
33. STAGES OF ATOPIC DERMATITIS ADULT STAGE : HIGHLY PRURITIC , CONFLUENT PAPULES ON THE DORSAL ASPECT OF THE HANDS, UPPER EYELIDS AND FLEXURAL AREAS OF THE EXTREMITIES
34. STIGMAS OF ATOPICDERMATITIS LICHENIFICATION DENNIE ‘S LINE ATOPIC PALMS BUFFED NAILS WHITE DERMOGRAPHISM DELAYED BLANCHED PHENOMENON DRYNESS XEROSIS ATOPIC PERSONALITY HOUSEWIFE’S ECZEMA ATOPIC FOOT ALLERGIC SHINERS
35. CRITERIA FOR THE DIAGNOSISOF ATOPIC DERMATITIS MUST HAVE 3 OR MORE BASIC FEATURES : 1.PRURITUS 2.TYPICAL MORPHOLOGY /DISTRIBUTION 3.TENDENCY TO RECURRENCES 4.PERSONAL OR FAMILY HISTORY
36. CRITERIA FOR THE DIAGNOSIS OF ATOPIC DERMATITIS PLUS ANY THREE OR MORE OF THE FF FEATURES: ICHTHYOSIS, ELEVATED SERUM IgE , EARLY AGE ONSET CUTANEOUS INFECTION, IMPAIRED T- CELL IMMUNITY HAND/FOOT DERMATITIS , NIPPLE ECZEMA, , CHEILITIS, RECURRENT CONJUNCTIVITIS, DENNIE MORGAN INFRAORBITAL FOLD CATARACT, ORBITAL DARKENING, PITYRIASIS ALBA FOOD HYPERSENSITIVITY
37. ATOPIC DERMATITIS TREATMENT AVOID ENVIRONMENTAL FACTORS GOOD HYDRATION OF THE AFFECTED AREAS MOISTURIZERS CORTICOSTEROIDS IN THE SUBACUTE PHASE
38. URTICARIA ( HIVES) RAISED ERYTHEMATOUS SKIN LESIONS ASSOCIATED WITH MARKED PRURITUS DUE TO VASODILATATION OF SMALL VENULES AND CAPILLARIES AND EXUDATION OF FLUID INTO THE SUPERFICIAL DERMIS ANGIOEDEMA IS URTICARIA INVOLVING THE DEEPER SUBCUTANEOUS TISSUES
41. ALLERGIC CONTACT DERMATITIS COMMON DISORDER IN CHILDHOOD ERYTHEMA, PAPULES, VESICLES, SWELLING WEEPING ANG ITCHING 24 -48 HRS AFTER EXPOSURE TYPE IV
48. FOOD TOXICITY ADVERSE REACTION CAUSED BY DIRECT ACTION OF FOOD ADDITIVE/ FOOD ON THE HOST RECIPIENT WITHOUT IMMUNE MECHANISM FOUND NATURALLY IN FOOD OR SECONDARY TO CONTAMINATION BY MICROORGANISM OR PARASITES
49. RISK OF MANIFESTINGATOPY BASED ON FAMILYHISTORY OF ATOPY FAMILY HISTORY OF ATOPY RISK OF ATOPY BIPARENTAL( SAME ALLERGY) 50-80 % BIPARENTAL OR UNIPARENTAL 40-60% PLUS ONE SIBLING UNIPARENTAL OR SIBLING 20-49% NEGATIVE 5-15 %
51. ADVERSE DRUG REACTION “ AN EFFECT WHICH IS UNINTENDED AND OCCURS AT DOSES NORMALLY USED IN MAN FOR PROPHYLAXIS DIAGNOSIS AND THERAPY “ OCCURS WITHIN A REASONABLE TIME FOLLOWING ADMINISTRATION OF THE DRUG REACTIONS : INTOLERANCE, IDIOSYNCRASY, HYPERSENSITIVITY ,PSYCHOGENIC
53. CLASSIC ANTIHISTAMINICS ALKYLAMINES : CHLORPHENIRAMINE , TRIPROLIDINE, BROMPHENIRAMINE, PHENIRAMINE GENERAL COMMENTS : LOW SEDATIVE , ANTICHOLINERGIC AND GI EFFECTS , BEST GROUP FOR DAYTIME USE
57. CLASSIC ANTIHISTAMINICS PIPERIDINES : CYPROHEPTADINE , BENZOCYCLOHEPTATHIPINE AZATADINE GENERAL COMMENTS : DROWSINESS IS COMMON USEFUL IN THE TREATMENT OF URTICARIA