©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 13 Allergic Reaction

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Antibodies Antibodies are produced when a virus, bacteria, or some other foreign substance enters the body –Produced by the immune system –Different antibodies are produced for different antigens (allergen) 2

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Antigen Can produce a hypersensitive reaction Not necessarily harmful An allergic reaction occurs when the body does not protect itself from the antigen 3

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Allergic Reaction First line of defense mechanisms attempt to block the antigen from entering the system (skin; lining of nasal passages) –The immunoglobulin system goes into action if the first line mechanisms do not work –If antigen is not destroyed, an allergic reaction may result 4

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prerequisites for Reactions Person does not experience an allergic reaction during the first exposure to the antigen When exposed to the same allergen, or one chemically similar, an allergic reaction does occur –Biochemicals (histamine) are released 5

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prerequisites for Reactions Histamine can cause: –Dilation of the capillaries, increased secretion of the gastric juices, decreased blood pressure, and constriction of some of the smooth muscles Reaction depends on type and amount of allergen 6

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Importance of Medical History A person with a history of allergies to several substances is likely to experience a reaction in the dental office –Patient requires special attention during the procedures 7

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Reaction Allergic reactions vary in type and severity Can occur immediately or be delayed for several days Reactions can be: –Localized (one area of the skin) –Generalized to the entire body (as in anaphylactoid reaction) 8

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Skin Reactions Contact dermatitis: –An allergic skin reaction that occurs as a result of cutaneous exposure to a particular allergen –Can occur in the oral mucosa –First signs: redness, swelling, and blisters –Symptoms: intense itching 9

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Skin Reactions –Treatment: remove offending substance; administer antihistamine and corticosteroids Urticaria: –Known as hives –Signs and symptoms: erythema (redness) and edema (swelling) –Treatment: remove substance 10

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Skin Reactions Angioedema: –Giant form of urticaria –Signs and symptoms: Localized swelling of either the submucosa or subcutaneous tissues Usually single lesions No pain or itching 11

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Skin Reactions –Treatment: remove the cause and administer antihistamine Dentist may choose not to treat the patient in the dental office for mild reactions Dental team should observe the patient and provide follow-up treatment –Refer to an allergist or physician 12

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Respiratory Reactions Allergic reactions that affect the respiratory system may occur Most common type is asthma 13

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anaphylactic Reaction Severe allergic reaction that occurs in previously sensitized patients Develops almost immediately after the patient ingests, inhales, or is injected with an antigen or is stung by an insect Most severe allergic reaction and can be fatal without treatment 14

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Physiology Anaphylaxis occurs only in those who have been previously exposed to the allergen –Incubation period takes place and antibodies form –Patient is exposed to the same allergen and anaphylactic reaction occurs 15

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Severity Reactions that occur within the first 30 minutes after contact with the antigen are usually the most severe Reactions that occur after 30 minutes are less likely to be fatal 16

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Symptoms Can be seen in the skin, gastrointestinal, respiratory, or circulatory systems –Shock: decrease in perfusion of oxygenated blood to the organs in the body Can be a result of allergens 17

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Symptoms Skin: –Generalized pruritus (itching) –Urticaria –Angioedema Gastrointestinal: –Nausea –Vomiting –Diarrhea 18

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Symptoms Respiratory: –Laryngeal edema Most common cause of death in patients with anaphylaxis Circulatory: –Hypotension –Shock –Cardiac arrhythmias –Complete circulatory collapse 19

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Symptoms Additional symptoms: –Sweating –Anxious feeling –Nervousness 20

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Treatment for obvious symptoms: –Summon medical assistance –Place the patient in a supine position –Administer oxygen –Administer epinephrine –Administer antihistamine as needed –Perform cricothyrotomy if needed –Initiate CPR if necessary 21

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Treatment without symptoms: –Summon medical assistance –Do not administer epinephrine –Place patient in Trendelenburg position –Provide basic life support as needed –Initiate CPR if needed –Assist dentist with cricothyrotomy if necessary 22

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Epinephrine A vasopressor: has antihistaminic action; is a bronchodilator Effect is very rapid Should never be administered unless you are sure the patient is suffering from an allergic reaction 23

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Allergy to Anesthesia Fewer than one percent of all bad reactions to anesthesia are actually allergic –Dentist should explore further Majority of reactions are characterized by inflammation, papules, edema, and pruritus –Should be treated according to the type of reaction 24

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Latex Allergies Incidence has increased dramatically Reactions can range from minor skin irritations to fatal anaphylactic reactions –Minor skin reactions mimic common skin reactions; misdiagnosis may occur 25

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Individuals at Risk for Latex Allergies Individuals with a genetic history of allergies and individuals with a high exposure to latex products are at an increased risk for latex hypersensitivity –8% to 12% of health care workers with regular exposure to latex are sensitized –1% to 6% of the general public 26

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Individuals at Risk for Latex Allergies Health care workers Individuals with a genetic history of allergies Individuals with a history of surgeries Individuals with disorders requiring repeated urinary catheterization 27

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Individuals at Risk for Latex Allergies Individuals with food allergies including bananas, avocadoes, chestnuts, and kiwi 28

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms of Latex Allergy Contact dermatitis Delayed contact reaction –48 to 72 hours after exposure –Most common reaction Immediate allergic reaction –Occurs 2 to 3 minutes after contact –Coughing, wheezing, shortness of breath, and respiratory distress or anaphylactic reaction 29

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment No cure Treatment: prevention and avoidance of exposure to latex and treatment of symptoms 30

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention Sensitized dental staff members should: –Use non-latex gloves and products –Learn to recognize the signs and symptoms of latex allergy –Avoid areas where you might inhale the powder from latex gloves worn by others 31

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention –Inform employer and staff of your allergy –Wear a medical alert bracelet When treating a patient with a latex allergy: –Schedule as the first patient of the day 32

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention –Instruments should be handled with non-latex gloves –Wear non-latex gloves during treatment –Use latex-free materials and instruments 33

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary Allergic reactions in the dental office can be fatal Most treatment must be performed by the dentist Important to understand what takes place during a reaction and assist the dentist by having all drugs prepared –Help administer CPR if necessary 34