CPR Forth Year

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


4. 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


5. 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


8. 
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

9. 
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

11. 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:


12. 
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
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Skin reactions
contact dermatitis
drug eruption: urticaria
erythema
angioedema
Respiratory reactions
rhinitis , laryngo edema,…bronchospasm

14. 
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

15. 




as ex In typical anaphylaxis
skin manif ……..warmth
tingling of mouth, chest ,palms
Pruritus
Conjunctivitis…
Abdominal pain,…vomiting
other systems ………..

16. 
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Respiratory manifest
cough…
dyspnea
wheeze
laryngeal edema
CV manifest
pallor
palpitation , tachycardia,
hypotension….
unconsciousness…>>
anaphylactic shock

17. 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

18. 
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

19. 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



20. 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 ----


21. 


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
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

22. 
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
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

23. 



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.

24. 
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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

25. 
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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……………

26. 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

27. Allergic Delaye Rapid
man
d skin sk r
R
posit
airway
breath
circ
Bronc
sp
Laryng Gener
ed
anaph

28. 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

29. Drugs used in ttt of allergy

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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

32. 
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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

33. Observations
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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

34. 
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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…..


35. 
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 ???????

36. D/D of drug related reactions
Causes
1-????vasodepressor syncope
2-local anesthetic overdose
3- epinephrine overdose
4- drug allergy

37. D /D depends on medical history
 Age
 Sex
 onset of S/S
 History of drug administrations
S/S
 Skin appearance
 vital signs….
