Download Allergies

Donald Trump
Allergies
What you as a DDS should know about
allergies
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Prevent med emergency
Oral soft tissue changes in an allergic reaction
Treatment planning
Recognize signs and symptoms of an acute
allergic reaction
Hypersensitivity
Type 1
• Oral manifestations: various foods, drugs, or
anesthetic agents
• Occurs rapidly
• Painless soft tissue swelling
• Itching and burning may occur
• Lesion present ~1-3 days,
• Tx: oral antihistamines
Hypersensitivity
Type 2
• No oral manifestations
Type 3
• White erythematous ulcerative lesions
• Food or drugs
• Usually occurs w/in 24 hrs of contact w/ antigen
• Tx: steroids, avoid contact with causative agent
Hypersensitivity
Type 4
• Contact stomatitis, delayed
response
• Toothpaste, mouth rinses,
impression materials,
lipsticks
• Tx: ID causative agent,
remove, sit back and watch
it clear up
• Type 5
Questions to ask the Donald
• Are you on any medications right now?
• Have you had this swelling before? (Y) when,
where, what tx?
• What happened with your previous rxn to the
anesthetic/antibiotic?
• How fast was the onset?
Questions cont.
• Was the problem treated or did it go away by itself?
• Have you ever been treated at the hospital for an
allergic reaction?
• Are you aware of any allergies that you may have?
• Has your physician diagnosed you with any
allergies?
• Have you taken penicillin or amoxicillin before?
What is His Physical Status?
• ASA PS II
If Donald required dental treatment today, what
precautions would you take?
• Antibiotic allergy
• Penicillin (-illins, cephalosporin)
• Give him something else
(erythromycin or clindamycin)
Local anesthetic allergy
• If you know what type
– give one from another chemical group
– aspirate, one drop, wait 5 min, if no signs of reaction aspirate
and give the rest
• If you don’t know what type or if Mr. Trump is allergic
to many types
a: use an antihistamine (diphenhydramine)
*May need to refer Mr. Trump to an allergist for PDT*
Anaphylaxis
-Signs and symptoms•
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Itching of soft palate
nausea, vomiting
substernal pressure
shortness of breath
hypotension
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pruritis
urticaria
laryngeal edema
bronchospasm
cardiac arrhythmias
What to do?
• Call for medical help
• Lay patient back in
supine position
• Check airway
• Administer oxygen
• Monitor pulse, BP, and
respiration
– If depressed or absent:
inject .3-.5mL 1:1000
epi, CPR, repeat
injection
Pathophysiology
• Hypersensitivity is an exaggerated response of the
immune system.
The immune system could be:
• Non specific
• Specific
– Humoral
– cellular
• Humoral involves B cells, antibodies and
hypersensitivity type I, II, and III.
• While cellular immunity involves T lymphocytes and
hypersensitivity type IV.
Pathophysiology
Hypersensitivity type
Cause
Mediated by
Manifestation
I
Dust, pollen food
IGE
Atopy
Anaphylaxis
Asthma
II
Blood transfusion
Cytotoxic, antibodydependent
IgM or IgG
erythroblastosis fetalis
Goodpasture's
syndrome
autoimmune
hemolytic anemia
III
Immune complex
disease
IgG
Serum sickness
Arthus reaction
SLE
IV
Contact with metal,
perfume,
chemicals
TB skin test
cell-mediated
Contact dermatitis
Tuberculosis
Chronic transplant
rejection
Dental Algorithm-A
• Antibiotics – Not recommended for treatment of
allergic reaction but may be causative agent of allergy
(i.e., Penicillin)
• Anesthetics – Not recommended for treatment of
allergies but may be another causative agent. Signs
and symptoms are tachycardia, apprehension,
sweating, and hyperactivity. Ester LA are most
commonly associated with allergic reactions. When
patient with past history of LA allergy presents, inject
slowly using aspiration first, place 1 drop on tissues,
withdraw and watch to see if reaction occurs
Dental Algorithm-A cont.
• Analgesics – Aspirin may cause GI upset,
• Aspirin may also provoke severe reaction in
asthmatics. Other NSAIDs may cause similar
effects
• Anxiety – Make appointment as comfortable
as possible for patient who thinks allergy to
local anesthetic is possible
Dental Algorithm – B
Bleeding
• Aspirin inhibits platelet
function and prolongs the
prothrombin time (PT)
Dental Algorithm – C
Complications
• systemic anaphylaxis,
• vasodilation,
• respiratory distress,
• hypotension,
• pruritus,
• conjunctivitis,
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nausea & vomiting,
substernal pressure,
laryngeal edema,
bronchospasm,
rhinitis,
death
itchiness & rash,
Dental Algorithm – C cont
Cardiac
• tachycardia
• cardiovascular collapse
• cardiac arrythmias
Dental Algorithm – D
Drug Interactions
• Aspirin and other NSAIDs may cause GI upset
• LA are associated with allergic reactions because of
constituents in LA suspension and metabolic byproducts of LA
• Antibiotics like Penicillin may cause allergic reaction
• Lichenoid drug eruptions may be caused by thiazides,
methyldopa, and photographic dyes
Dental Algorithm – E
Emergency
• Call for immediate medical help
• Place patient in the supine position
• Check for an open airway
• Administer oxygen
• Check pulse, BP, and respiration
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if depressed or absent, inject 0.3-0.5 mL 1:1000
epinephrine IM into tongue
provide cardiopulmonary resuscitation if needed
repeat injection of epinephrine if no response
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