Allergic Reactions and Respiratory Diseases

GROUP 1: D52B

AGPALASIN, Faye F.

ALDAY, Kyla

AVENA, Albert

BALANQUIT, Joyce

BASMAYOR, Jairah V.

I. Allergic Reactions
A. Background of the Disease

Allergic reaction is a hypersensitive state acquired through exposure to a particular

allergen, re-exposure to which produces a heightened capacity to react.' Allergic
reactions cover a broad range of clinical manifestations, from mild, delayed reactions
developing as long as 48 hours after exposure to the antigen, to immediate and
life-threatening reactions developing within seconds of exposure.

Types of Allergic reaction or Hypersensitivity

● Type I – also called anaphylactic reactions that happen due to production of lgE
Abs that bind to harmless allergens and activate mast cell degranulation,
leading to an allergic reaction.
● Type II – also called cytotoxic-mediated reactions. In here, antigenic
modification of body's cell surfaces causes an immune reaction against the
antigen, cell surface, and antigen-surface complex, leading to an allergic
reaction
● Type Ill – also called immune-complex mediated wherein, deposition and
accumulation of small antibody-antigen complexes (produced from normal
 immune response to infection) in different tissues incites immune reaction,
leading to an allergic reaction.
● Type IV - it is entirely T-Cell mediated; exposure to allergen causes development
of allergen-specific.

Among the 4 types of allergic reaction, type 1 and type 4 are the most common
problems associated in the dental office.

B. Pathophysiology/Etiology
● Most common etiology of allergic reactions are:
- Antibiotics
- Analgesics
- Antianxiety drugs
- Local anesthetics
- Other agents like: latex and acrylic monomer
● Pathophysiology:
C. Signs and Symptoms
● Dizziness ● wheezing
● faintness ● shortness of breath
● loss of consciousness ● chest pain
● anxiety ● Abdominal cramps
● shock ● nausea
● eye swelling (conjunctivitis) ● Vomiting
● itchy mouth ● Diarrhea
● cough ● hives, redness, or rash
● hoarse voice ● pale blue skin
● lips swelling ● swelling in the hands, feet,
● nasal congestion and genitals
● tight, itchy throat ● low blood pressure, poor
● difficulty breathing circulation, and low pulse

D. Medical Management
● Administration of Oxygen
● Epinephrine (IM, IV or Sublingually)
● Histamine-blocker (IM)
● Corticosteroids (IV or IM)
E. Dental considerations/Dental management
● Considerations:
- Thorough medical history
- Medical consultation: Referral of the patient
- Dental treatment modifications (see table below)
 ● Management:
a. Recognize the allergic reaction/s.
b. Terminate the dental procedure and activate the dental office emergency team.
c. Position the patient. If conscious, positioned them comfortably, if unconscious,
positioned them into supine with legs elevated slightly.
d. Secure the airway, breathing and circulation of the patient. If there is cyanosis,
give oxygen to the patient.
e. Definitive Care:
- Seek medical assistance.
- Administer epinephrine.
- Monitor the vital signs of the patient while waiting and give reassurance.
- Administer drug therapy. For instance, histamine-blocker and corticosteroids.

Reference:

Malamed, S. (2007). Medical Emergencies in the Dental Office (6th ed.). Elsevier.
 II. Asthma
A. Background of the Disease

Asthma is a chronic lung disease affecting people of all ages. It is caused by inflammation and
muscle tightening around the airways, which makes it harder to breathe. Symptoms can
include coughing, wheezing, shortness of breath and chest tightness. These symptoms can be
mild or severe and can come and go over time.

B. Pathophysiology / Etiology

The main pathophysiological characteristics of asthma are inflammation and airway

remodeling, which include goblet cell hyperplasia, subepithelial fibrosis, collagen deposition,
mucosal gland, hyperplasia, smooth muscle hypertrophy, and changes in the extracellular
matrix. These changes can result in immune system imbalance, eventually leading to airway
hyperresponsiveness.

The etiology of asthma remains unknown, its pathogenesis is well believed to be affected by
both genetic and environmental factors.

C. Signs and Symptoms

Symptoms of asthma can vary from person to person. Symptoms sometimes get significantly
worse. This is known as an asthma attack. Symptoms are often worse at night or during
exercise.

Common symptoms of asthma include:

· a persistent cough, especially at night

· wheezing when exhaling and sometimes when inhaling

· shortness of breath or difficulty breathing, sometimes even when resting

· chest tightness, making it difficult to breathe deeply.

Some people will have worse symptoms when they have a cold or during changes in the
weather. Other triggers can include dust, smoke, fumes, grass and tree pollen, animal fur and
feathers, strong soaps and perfume.

D. Medical Management

Asthma cannot be cured but there are several treatments available. The most common
treatment is to use an inhaler, which delivers medication directly to the lungs.

Inhalers can help control the disease and enable people with asthma to enjoy a normal, active
life.

There are two main types of inhaler:

· bronchodilators (such as salbutamol), that open the air passages and relieve symptoms; and

· steroids (such as beclometasone) that reduce inflammation in the air passages, which
improves asthma symptoms and reduces the risk of severe asthma attacks and death.

People with asthma may need to use their inhaler every day. Their treatment will depend on
the frequency of symptoms and the types of inhalers available.

E. Dental Management

· identify asthmatic patients by history and ask the patients about type of asthma,
precipitating factors, severity and frequency of attacks.

· Patient with unstable disease should be referred for medical care and dental appointment is
postponed

· Avoid aspirin, NSAIDs, Barbiturates, and narcotics Because they may precipitate an
asthmatic attack.
· Ask patient to bring his medication with him.

· Prophylactic inhalation before dental procedure is recommended

· Nitrous oxide is a recommended sedative in stressed asthmatic patient because it has no

respiratory depressing properties

References:

https://www.who.int/news-room/fact-sheets/detail/asthma#:~:text=Asthma%20is%20a%20ch
ronic%20lung,come%20and%20go%20over%20time.

III. COPD

A. Background of the Disease

Chronic obstructive pulmonary disease (COPD) is a general term for pulmonary

disorders characterized by chronic airflow limitation from the lungs that is not fully
reversible.

The two most common diseases classified as COPD are chronic bronchitis and
emphysema. The basis for obstructed airflow in these two diseases is different.

Chronic bronchitis is a condition associated with excessive tracheobronchial mucus

production (at the bronchial level) sufficient to cause a chronic cough with sputum
production for at least 3 months in at least 2 consecutive years. Emphysema is defined
as distention of the air spaces distal to the terminal bronchioles because of destruction
of alveolar walls/septa (at the acinar level).
 B. Pathophysiology / Etiology

The most important cause of COPD is cigarette smoking. Approximately 12.5% of

current smokers and 9% of former smokers have COPD. Smoking also accounts for
80% to 90% of COPD mortality in both men and women.

The risk of COPD is dose related and increases as the number of cigarettes smoked per
day and the duration of smoking increase.

Despite the increased risk, only about one in five chronic smokers develop COPD. This
suggests that genetic susceptibility to the production of inflammatory mediators (i.e.,
cytokines) in response to smoke plays an important role.

Long term exposure to occupational and environmental pollutants and the absence of
alpha1-antitrypsin are causative factors that contribute to COPD.

C. Signs and Symptoms

● Common symptoms of COPD include:

○ Shortness of breath – this may only happen when exercising at first, and you
may sometimes wake up at night feeling breathless
○ A persistent chesty cough with phlegm that does not go away
○ Frequent chest infections
○ Persistent wheezing
● Less common symptoms of COPD include:

○ weight loss

○ tiredness

○ swollen ankles from a build-up of fluid (oedema)

○ chest pain and coughing up blood – although these are usually signs of another

condition, such as a chest infection or possibly lung cancer

 D. Medical Management

● Inhaled medications
○ Bronchodilators
■ Short-acting bronchodilators
● Short-acting, or quick relief, bronchodilators can be prescribed as
needed for trouble breathing.
■ Long-acting bronchodilators
● The long-acting bronchodilators are usually given to you if you
have ongoing symptoms of COPD and should be taken regularly
– whether or not you are having trouble breathing.
○ Corticosteroids
■ Inhaled corticosteroids are also used for the treatment of COPD. Inhaled
steroids may help to reduce inflammation in the lungs.
■ Often prescribed with combination of long-acting bronchodilators
● Oral Medications
○ Phosphodiesterase-4 inhibitors (or PDE-4 inhibitors)
■ Prescribed if no relief of symptoms from other medications
■ Improve quality of life
○ Antibiotics
■ To treat bacterial lung infections, during flare ups.
○ Oral Corticosteroids
■ Should only be used during acute flare ups or acute exacerbations.
■ Should not be used on a routine basis
■ Helps the patient to get over flare ups faster
■ Lower chance of relapse
■ Lower chance of hospitalization
● Vaccines - Persons with COPD have a greater risk for complications from flu and
pneumonia
 ○ Help prevent illness
○ Lower the chance of getting a flare up and needing hospital care
● Oxygen Therapy
○ For severe COPD and oxygen levels are lower than normal, the use of
supplemental oxygen can help to breathe better and improve physical activity.
○ Oxygen has benefits to enable better sleep, provide greater exercise tolerance,
and lower the chances of dying.
● Pulmonary Rehabilitation
○ Rehabilitation may include an exercise program, disease management training,
as well as nutritional and psychological counseling.
● Surgical Interventions
○ Lung volume reduction
■ removal of damaged tissue from the lungs, helping to improve breathing
and quality of life
○ Lung Transplant
■ replacing a damaged lung with a healthy lung from a donor

E. Dental considerations/Dental management

● Dental health providers can take an important step in the management of

patients with COPD by encouraging those who smoke to quit. By providing
knowledge of the diseases associated with smoking, dental health providers
may help patients to start thinking seriously about giving up the habit.
● Before initiating dental care, clinicians should assess the severity of the patient’s
disease and the degree to which it has been controlled.
● A patient coming to the office for routine dental care who displays shortness of
breath at rest, a productive cough, upper respiratory infection, or an oxygen
 saturation level less than 91% (as determined by pulse oximetry) is unstable, and
staff should reschedule the appointment.
● If the patient is stable and the breathing is adequate, efforts should be directed
toward the avoidance of anything that could further depress respiration.
● Patients should be placed in a semi supine or upright chair position for
treatment, rather than in the supine position, to prevent orthopnea and a feeling
of respiratory discomfort.
● Pulse oximetry monitoring is advised.
● No contraindication to the use of local anesthetic has been identified. However,
the use of bilateral mandibular blocks or bilateral palatal blocks can cause an
unpleasant airway constriction sensation in some patients. This may be more
important in the management of a patient with severe COPD with a rubber dam,
or when medications are administered that dry mucous secretions. Humidified
low-flow oxygen can be provided to alleviate the unpleasant airway feeling
produced by nerve blocks, use of a rubber dam, and/or medications.
● If sedative medication is required, low-dose oral diazepam (Valium) may be used.
● Narcotics and barbiturates should not be used because of their respiratory
depressant properties.
● Anticholinergics and antihistamines generally should be used with caution in
patients with COPD because of their drying properties and the resultant increase
in mucous tenacity, and because patients with chronic bronchitis may already be
taking these types of medications; concurrent administration could result in
additive effects.
● Patients with COPD often have hypertension and coronary heart disease.
Patients taking systemic corticosteroids may require supplementation for major
surgical procedures because of adrenal suppression. Macrolide antibiotics (e.g.,
erythromycin, azithromycin) and ciprofloxacin hydrochloride should be avoided
in patients taking theophylline because these antibiotics can retard the
 metabolism of theophylline, resulting in theophylline toxicity. The dentist should
be aware of the manifestations of theophylline toxicity. Symptoms include
anorexia, nausea, nervousness, insomnia, agitation, thirst, vomiting, headache,
cardiac arrhythmias, and convulsions. Outpatient general anesthesia is
contraindicated for most patients with COPD.

References: Dental Management of the Medically Compromised Patient - 7th Edition by Little,
Falace, Miller and Rhodus