Allergies

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Donald Trump
Allergies
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What you as a DDS should know about allergies

• Prevent med emergency
• Oral soft tissue changes in an allergic reaction
• Treatment planning
• Recognize signs and symptoms of an acute allergic
  reaction

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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

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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

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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

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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?

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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?

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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)

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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 dont 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

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Anaphylaxis -Signs and symptoms-

• Itching of soft palate
• nausea, vomiting
• substernal pressure
• shortness of breath
• hypotension

• pruritis
• urticaria
• laryngeal edema
• bronchospasm
• cardiac arrhythmias

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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 11000
  epi, CPR, repeat injection

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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.

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Pathophysiology
Hypersensitivity type Cause Mediated by Manifestation
I Dust, pollen food IGE Atopy Anaphylaxis Asthma
II Blood transfusion Cytotoxic, antibody-dependent 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
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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

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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

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Dental Algorithm B

• Bleeding
• Aspirin inhibits platelet function and prolongs
  the prothrombin time (PT)

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Dental Algorithm C

• Complications
• systemic anaphylaxis,
• vasodilation,
• respiratory distress,
• hypotension,
• pruritus,
• conjunctivitis,

• nausea vomiting,
• substernal pressure,
• laryngeal edema,
• bronchospasm,
• rhinitis,
• death
• itchiness rash,

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Dental Algorithm C cont

• Cardiac
• tachycardia
• cardiovascular collapse
• cardiac arrythmias

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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
  by-products of LA
• Antibiotics like Penicillin may cause allergic
  reaction
• Lichenoid drug eruptions may be caused by
  thiazides, methyldopa, and photographic dyes

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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
• if depressed or absent, inject 0.3-0.5 mL 11000
• epinephrine IM into tongue
• provide cardiopulmonary resuscitation if needed
• repeat injection of epinephrine if no response

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Thank You

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