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Allergy
Allergy
Allergy
Allergy
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Allergy

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CPR
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  • 1. Allergy & Drugs Related Objectives Dr. Adel I Abdelhady BDS, MSC, (Egypt) PhD (Egypt, USA ) Oral and Maxillofacial Surgery Dept. College of Dentistry, KSA.
  • 2. Allergy & Drugs Related Objectives Definitions  Classification of allergic reactions  Clinical picture  Dental therapy modification  management  Drugs used in ttt of allergy 
  • 3. Allergy Allergy :It is a hypersensitive response to an allergen to which the individual has been previously exposed to  Allergen: an antigen that cause allergic symptoms  Anaphylactic reaction is an allergic reaction that occurs without protection ….ie very severe allergic reaction 
  • 4. Angioedema :a non inflammatory edema involving the skin …….laryngeal edema  Atopy a hypersensitivity disease subject to hereditary influence ex asthma …. Hay fever  Urticaria a vascular reaction of the skin marked by elevated pale skin patches with severe itching 
  • 5.  Classification of allergic reactions A- on mechanism  type mechan antibo examples I Antigen-antibody Ig E anaphylaxis, urticaria II antimembr Ig G, IgM hemolysis III Immune comp Ig G Serum sickness IV Cell mediatedelayed Contact dermatitis
  • 6.  B- On time 1-Immediate r……..type I, II, III -Occurs within sec ….min as generalized anaphylaxis localized anaphylaxis 2-Delayed……….type IV - Occurs hours to days after exposure
  • 7. Clinical picture Forms of allergic reactions  - depend on organ affected -skin reaction -C V S reactions -respiratory system reactions -eye reaction -GIT reactions -generalized anaphylaxis: 
  • 8.       Skin reactions contact dermatitis drug eruption: urticaria erythema angioedema Respiratory reactions rhinitis , laryngo edema,…bronchospasm
  • 9.  Generalized Anaphylaxis: * different systems are involved as - Skin reactions……. - GIT , genitourinary reactions……. - C V S ……..collapse - Respiratory r…………resp distress *In fatal cases respi & circul reaction predominate & …….>>fatal outcome
  • 10.      as ex In typical anaphylaxis skin manif ……..warmth tingling of mouth, chest ,palms Pruritus Conjunctivitis… Abdominal pain,…vomiting other systems ………..
  • 11.           Respiratory manifest cough… dyspnea wheeze laryngeal edema CV manifest pallor palpitation , tachycardia, hypotension…. unconsciousness…>> anaphylactic shock
  • 12. Dental therapy modification When a patient is allergic to a drug …..one should never give him this drug  And should turn to…………. the substitute  Penicillin------erythromycin Aspirin--------acetaminophen Barbiturates--diazepam Acrylic---------heat-cured acrylic Latix ----------vinyl
  • 13.  Allergic reactions are usually less common after oral administration of drugs so whenever one use any drug the first route of administration is oral method unless other methods are especially indicated
  • 14. Management R recognize the allergic condition 1-If S/S of delayed allergy as skin reaction: urticaria, erythema, angioedema develop after a time ie >60  Recognize  T : terminate dental ttt  P : comfortable  A B C as needed  D definitive care  histamine blockers many drugs as  chlorpheniramine, diphenhydramine  may start by IV, IM then oral  medical consultation  
  • 15. R recognize the allergic condition  2-If S/S of rapid allergy [ develop in less than 60 min ]& other manifest .. as conjunctivitis ,rhinitis,……may be included  T : terminate dental ttt  P : comfortable  A B C as needed  D definitive care ---- 
  • 16.       D definitive care Epinephrine…..1/1000 *Histamine blockers .if no CV or RESP involv Rapid…….. I V or I M chlorpheniramine, diphenhydramine then oral chlorpheniramine * Monitoring vital signs every 5 min If hypotension-------supine position If resp dist ………… O2 *if CV or RESP involv epinephrine is recommended given I M, or I V see dose * Medical consultation
  • 17.       R recognize the allergic condition 3-If S/S of respiratory reactions as bronchospasm,…… T : terminate dental ttt P : comfortable A B C as needed D definitive care ensure removal of materials from mouth  bronchodilators:  epinephrine I M, or  Histamine blocker IM, chlorpheniramine,  diphenhydramine  Monitor vital signs  Medical consultation
  • 18.     Adrenergic Agonists These agents help maintain blood pressure, antagonize effects of released mediators, and prevent further release of mediators. Epinephrine is the drug of choice for treating anaphylaxis. It has alpha-agonist effects that include increased peripheral vascular resistance and reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Its beta-agonist effects include bronchodilatation, chronotropic cardiac activity. Positive chronotropic increase heart rate, and positive inotropic agents increase myocardial contractility.
  • 19.              R recognize the allergic condition 4-If S/S of laryngeal edema,…… T : terminate dental ttt P : comfortable A B C as needed D definitive care bronchodilators: epinephrine I M, or I V Histamine blockers IM chlorpheniramine, diphenhydramine corticosteroids Monitor vital signs Medical consultation emergency : cricothyrotomy
  • 20.              R recognize the allergic condition 5-If S/S of generalized anaphylaxis…. In which there is involvement of all systems as after penic or aspirin ttt ,…… T : terminate dental ttt P : comfortable A B C as needed D definitive care ask medical assistance bronchodilators: epinephrine I M, or I V………… Monitor vital signs …..may again epinephrine emergency team for other drugs as Histamine blockers……………
  • 21. Allergic Delaye Rapid man. d skin sk r R Bronc. spasm Laryng. Gener Ed. anaph Rec. Time 60 min Less or 60m more Wheezing R dist T termin ate termin ate termin ate termin ate Sk…. Resp… CV….. termin ate
  • 22. Allergic Delaye Rapid man d skin sk r R posit airway breath circ Bronc sp Laryng Gener ed anaph
  • 23. Allergic man monit Delayed Rapid sk Bronc. skin R r Sp. Laryng ed Gener anaph Br dil epin IM,SC his bl Br dil epin IM,SC his bl Ev 5min medic O2 drugs Hist. bl. I V Br dil I M then IM then epin Oral oral IM,SC his bl
  • 24. Drugs used in ttt of allergy          1………B-adrenergic.. epinephrine[ adrenaline] I V [difficult].. I M .3ml of 1:1000 in adult .15 ml of 1:1000 in child intralingual, sublingual….in Emerg Repeated if needed every 5-10 min May be S C …….longer time Aerosol inhalation if available NB is a drug of choice as it terminates the br spasm in 3 m , other drugs are much slower
  • 25.          2…….histamine blocker Diphenhydramine chlorpheniramine IM or IV diphenhydramine 50 mg /adult then oral for two days 3-corticosteriods : methylprednisolone Prevent relapse Needs 6 hours to act 4----- atropine
  • 26. Observations          a-oral antibiotic may cause skin reaction after 1 hour which drugs you give? give histamine blockers Diphenhydramine or chlorpheniramine IM diphenhydramine 50 mg /adult then oral for two days b- allergy with bronchospasm …… what drugs you give? start by epinephrine then histamine blockers
  • 27.      c-in generalized anaphylaxis start by epinephrine as soon as possible & no additional drugs are given until the patient improves then you can give histamine blockers … corticosteriods…….. d- laryngeal edema with generalized anaphylaxis  give epinephrine  histamine blockers …  corticosteriods……..  cricothyrotomy if failed above….  transfer to hospital….. 
  • 28.  NB :histamine blockers & corticosteriods are not indicated firstly in acute phase of allergy because they are slow  NB epinephrine & O2 are the only drugs to be given in life threatening phase of anaphylaxis ….then after control of the condition you can give other drugs ….WHY ???????
  • 29. D/D of drug related reactions Causes 1-????vasodepressor syncope 2-local anesthetic overdose 3- epinephrine overdose 4- drug allergy
  • 30. D /D depends on medical history  Age  Sex  onset of S/S  History of drug administrations S/S  Skin appearance  vital signs…. 

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