Vinnitsa National Medical University
them. Pirogov
"Approved uyu"
Vice Rector for Academic Affairs
Professor Huminskyy Yu.Y.
------------- (Signature)
"_ 2 5" ____ 0 _____
6 201 3 years
GUIDELINES
for 5 th year students of the Faculty of Dentistry
Subject number 8
Academic discipline
Module number 1
Modules № 1
Study subject
"Clinical Immunology and Allerg
Clinical Immunology and Allergolo
Rate
Faculty
Number of hours
5th
"Medicine", "Pediatrics", "Medical
4
Allergic diseases in
20 1 3
1.
Background:
dentistry - diag
In modern terms allergies (AZ) are among the most common diseases among the
population and account for a large medical and social problem. From 15.0% to 35.0% of the world
population suffering from AZ.On the background of the general rise in allergic diseases genesis
growing number of allergic reactions (AR) on uzhalennya Hymenoptera insects (bees, wasps,
hornets). Yes, 0,4-4% of the population suffers from increased sensitivity to Hymenoptera stung,
and stung by insects mortality ranged from 0.09 to 0.45 deaths per million population. In the
development of allergy to Hymenoptera venom important role played by repeated multiple
uzhalennya insects. Therefore, beekeepers and their family members are at the highest risk of AR
in uzhalennya. Prevalence of insect allergy (IA) in this population ranges from 15% to 43%.
The problem of adverse reactions, including allergic origin, and the use of diagnostic drugs is very
important. According to published data, they are found in 10-20% of the population, 3% of the
reason for going to doctors, 5% - the reason shpytalizatsiyi, 3% - leads to the ICU, 12% - resulting
in significantly longer stay hospital, 1% can cause mortality and this indicator occupy 5th place
after cardiovascular, cancer, bronchopulmonary diseases and injuries. A similar situation occurs
in the Ukraine, where, according to local researchers (official statistics on this is not), the incidence
of drug allergy (MA) population varies in the range of 1-2% and, in theory, could lead to the deaths
of 100-2000 drug-induced anaphylactic cheek (MASH) annually.
Most real causes of anaphylaxis are medicinal, insect and food allergies.
In the USSR, with poorly-functioning registration anaphylactic reactions during the period from
1970 to 1980 was officially recorded 520 you cases of anaphylactic shock, with 48 deaths (9.2%),
which accounted for about 1 in 5 million per year. Ontario (USA) recorded 4 cases of shock by 10
million people in Munich (Germany magnitude of) - 79 cases per 100 thousand population. In the
U.S., anaphylaxis registration ruyetsya 1 in 3000 patients, which causes about 500 deaths you cases
of a year.
2. Learning Objectives (main teaching and learning issues for self pozaudytornoyi).
Know how to:
1. Predict occurrence of AF in patients who have used drugs (drugs).
2. Conduct medical history, interpret clinical symptoms and laboratory signs of AI, insect
allergies.
3. To be able to formulate a diagnosis and carry out differential diagnosis between the various
forms of no tolerance of drugs (including real and apparent allergic reactions to drugs).
4. Diagnose MA and insect allergies and n vivo and in vitro.
5. Treat MA and provide immediate assistance with medical anaphylactic shock (MASH).
3. Be able to:
1. Collect allergy, pharmacological and medical history of the patient, which are administered
drugs.
2. Conduct skin testing (prick test) with solutions of drugs.
3. Provide first aid in MASH.
4. Baseline training.
The names of the preceding disciplines
1. Human Anatomy
2. Normal physiology
These skills are
Skin and mucous membranes o
Appropriate reaction to the use
3. Physiopathology
4. Pharmacology
6. Otorhinolaryngology
7. Internal Medicine
Inadequate reaction to the use
Pharmacokinetics of drugs, the
The phenomena of allergic rhin
Attack of asthma emergency c
5. Organization of the content of teaching material
The teacher introduces students to the problem of side effects of drugs and explains that, because
of the doctrine of chemotherapy disease that prevails in medicine, each destination drugs that will
make a future doctor, may pose a risk to health, "I and the life of the patient.
Then the instructor shows patients with a history or clinical signs of AI (absence - the relevant
clinical examples and pictures).
During the demonstration patients teacher points out that complications of chemotherapy could
not be if doctors previously included circumstances with appropriate patients.
The following draws attention to the different nature and mechanism of adverse reactions to drugs
that require different pihodiv to the examination and treatment of patients.
It is proposed to raise students several pharmacological allergy history of patients:
The range of questions aimed at identifying and contingent risk for AF
1.Chy taken before farmakopreparaty, passed invasive examination
2.Chy often took drugs, which was the duration of treatment
3.What drugs received (with special attention paid to the antibiotics, anesthetics, intravenous,
inhaled, Application administration of drugs)
4.Chy have undesirable effects on intake of medications (drugs) and what they manifest: special
attention should be paid to loss of consciousness, low blood pressure, sverbinya and rashes on
the skin of redness, swelling, discharge from the nose appearance, red eyes, their itching,
bronchospasm phenomena
5.Chy there were such things in the first intake of drugs (unless they had not taken ill) or it
occurred after 5-7 days of treatment and more
6.Chy he suffers allergies or hurt them his parents are blood relatives;
7.What he have other chronic diseases (particular attention should be paid to autoimmune,
kidney, liver and gall bladder, stomach and intestines, pancreas)
8.Chy a patient occupational hazard of sensitizing properties (special attention should be paid to
work in pharmacies, hospitals, biotech companies)
9.Chy are foods, food additives, which can not tolerate the patient (special attention should be
paid to animal products, additives indefinite composition and origin)
Writing in an outpatient or inpatient map that the patient aware of the manipulation, which he
shall carry out, or the nature of the treatment and drugs that he should appoint (give him the
opportunity to learn about their possible side effects and obtain the signature of informed
consent and manipulation treatment). If there is an urgent need for prescribing
pharmacotherapy patient who for various reasons can not give such consent, such consent must
be obtained from his relatives or commissions iyne prescribing or diagnostic procedures.
In a survey conducted patients should be required "necessarily tailored to suit toxic false-allergic
and allergic reactions to drugs
The next stage is conducted in sessions of manipulation, where the skin tests with solutions of
drugs. Each student can spend setting prick test with histamine solution and the partner to assess
the test.
The following lists the (better - to show it in the laboratory) laboratory methods that can be applied
to identify drug-allergen.
The final phase will be done in class where students clearly lists the steps to assist the patient with
MASH.
6. Plan and organizational structure of educational classes Allergology
(240 minutes).
Number
c/o
Stages classes
Distribution
time
*
1.
1.1.
The preparatory phase
Organizational matters.
35 min
5 min
1.2.
Formation of motivation
5 min
1.3.
Control of entry
level of training
(Standardized controls).
2.
The main stage (specify
all kinds of work that students perform under
during this phase).
Types of
Monitorin
practica
Familiarity wi
students
students with the
Structured wr
25 min
120 min
Oral survey
poll by standa
analysis of the
of objective
examination.
test control
criteria of kno
3.
The final stage
25 min
3.1.
Control endline
training.
15 min
3.2.
Overall training
student activities.
3.3.
Informing students
the topic of the next session.
5 min
5 min
Note:
* Forms of control and training tools specifically defined by the Department for each stage of training;
Theory
Controls ** theoretical and practical training of students need to be standardized.
7. Methods of educational process in the practice (seminar) class.
7.1. The preparatory phase.
Features of the clinical examination of patients with AF: complaints, allergy and
pharmacological history, progress, methods of skin and laboratory tests.
Features of the clinical examination of patients with insect allergy: complaints, allergy and
namnez, motion, methods of skin and laboratory tests.
To acquaint students with specific goals and plan lessons.
Conduct initial control level of training students in an objective examination of the patient with AF.
Determine the level of training on issues of insect allergy.
7.2. The main stage
This phase involves performing each student independently and under the supervision of the teacher
below mentioned practical work.
Task 1
Students carry out an objective medical history and examination of patients with AF and th
insect allergy. Then, students spend one single trestuvanya skin (prick test) to test the control
liquid or solution of histamine.
Task 2
Number
1.
Task
What is the likelihood of AF in patients with designated drugs?
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
The prevalence of AF in Ukraine?
Clinical manifestations of MA?
Frequently proya and in MA?
The most dangerous manifestation of MA?
The longest period that can occur due to AI?
Does the emergence of AI doses of the drug?
Do all patients MASH has the same course?
Do all patients before prescribing drugs should be should be skin tested?
Is it possible to carry out skin tests with drugs, previously called MASH in this case?
How can we interpret skin tests with solutions of drugs?
What reactions happen in inseketniy allergies?
How sick it is advisable to carry out CIT in insect allergies?
What is the diagnostic method to distinguish toxic reactions to insect uzhalennya of insect
allergy?
Task 3
Solve tests:
1. If skin testing with a solution of drugs had a positive response to all three solutions. How
can we interpret this reaction?
The answer - as unreliable.
2. Manifestation of AI with 4 type of immune response?
Answer - type of contact dermatitis
3. Is full of drugs allergens?
The answer is - no, they are bilshostoi hapten - inferior allergens which become full of character
with allergen only in "communion with serum albumin.
4. What input method is the safest drugs that - the most dangerous?
From the response - respectively, oral, dermal and inhalation
5. Is it appropriate administration of antihistamines after uzhalennya Hymenoptera?
Reply id - only with normal blood pressure.
Task 4
Challenges to self:
№/№
1.
Task
Type of immune response in allergic rhinitis as a manifestation MA
2.
3.
4.
Type of immune response in drug hemopatiyah
Parenteral antihistamine
What is lacking in adverse drug reactions psevdoalerhichnyh?
5.
What is a skin test is the most common diagnosis in skin MA?
6.
The first event in the event MASH
7.
Could be the first MA use drugs?
8.
Is there a dose-dependent MA?
9.
Can I use drugs, which have an allergy to antihistamines background?
7.3. The final stage.
We estimate the current activities of each student during class, the analysis of student
achievement, announced evaluation of each student and put in the log of visits and student
achievement. Group leader at the same time puts assessment roll of the success and attendance of
students, teacher assures them his signature.
It is advisable to briefly inform students about the topic of the next lesson and instructional
techniques to prepare for it.
8. Applications.
8.1. Theoretical questions preparatory phase:
1. Features collection allergy and pharmacological history to prevent AF.
2. The main complaint in patients with clinical signs of AI and AI.
3. Skin test as a screening method for etiologic diagnosis of MA.
4. History taking, methods of diagnosis and treatment of insect allergy.
5. Providing emergency care for MASH.
Typical task level II
Zadacha1.
The nurse complains of itching, redness, skin cracks, lihenifikatsiyu that occur one day after
exposure to antibiotics penicillin group. The diagnosis of allergic contact Derm and Titus. What
type of allergic reaction takes place?What should advise patients?
The standard answer. 1. Delayed-type hypersensitivity. 2. Change profession or go to work, not
bound with drugs.
Problem 2.
When removing a tooth in the dental office after entering lidokainu the patient appeared
the following symptoms: abrupt late and hardness of the skin, mucosal cyanosis, cold sweats,
shortness of breath. Your diagnosis? What measures should be implemented and how quickly?
The standard answer. 1. A nafilaktychnyy shock. 2.Nevidkladno should conduct protyshokovi
events.
Problem 3.
After bee sting in lopchyka's 11 years of "appeared itchy skin, hoarseness of voice, barking cough,
restlessness, swelling of the lips, eyelids, cyanosis, rash itchy blisters. Which of the drugs used in
the first place?
Key Answer. A drenalinu hydrochloride.
Problem 4.
The girl of 4 years with the introduction of penicillin there was burning sensation, redness of the
skin, anxiety, fear of death, headache, buzzing in your ears, chest pain, blood pressure - 60/30 mm
Hg .. c. The introduction of the drug stopped, provided first aid. What type of allergic reaction has
taken place?
The standard answer. EAG P and the new (immediate hypersensitivity type)
Problem 5.
The child am 15 years old, suffering from bronchial asthma and atopic dermatitis
indication in the history of drug allergy is not observed. However, after instillation into the ear 2
drops of aqueous furatsillina about joining right-otitis, 5-7 minutes. was itching, redness, swelling
of the right ear, face and neck.
From history it appeared that the girl in the past, the drug often used as a lotion on
dermatitis. ARISING to the child? Treatment and recommendations?
The standard answer.
As a child there is an acute allergic reaction in the form of angioedema in furatsillina.
Recommended: permanently abandon the use furatsillina appoint parenteral antihistamines 1st
generation, system ACS 1mh/kh rate of loss.
Problem 6.
Employee tannery was introduced tetanus serum ka. After 7 days he developed fever, increase
in lymph political units, generalized urticaria, swelling, pain in the joints.
The standard answer. Yrovatkova C disease.
Tasks III level
Zadacha1.
Against ARI in patients who received sulfa drugs, not steroid anti-inflammatory
agent, acidified beverages and Revit appeared maculopapular lesions on the skin,
accompanied by itching and difficulty breathing. Therapy should include all of the options
listed below, except:
1. Unlike all assigned agents
2.Antyhistaminnyh drugs
3. enterosorbents
4. Bronchodilators
5. Specific immunotherapy
The standard answer. Specific immunotherapy
Problem 2.
A man in '37 during pyelography using verohrafinu appeared itchy skin, swelling of the face,
dizziness, fear of death. BP 70/40 mm Hg., PS 130 beats per minute .. Noisy breathing, wheezing
heard in th e state, auscultation of breath relaxed, single dry rales. Diagnosis? What preparation is
necessary to enter the patient first?
The standard answer. 1.Anafilaktychnyy shock. 2.Adrenalin.
Problem 3.
The patient in history - angioedema after treatment with antibiotics penicillin series. When the
need for antimicrobial therapy is not recommended to prescribe the following groups:
1.
Aminoglycosides
2.
Macrolides
3.
Tsefalorsporyny
4.
Fluoroquinolones
5.
Sulfonamide
Key Answer: cephalosporins
Problem 4.
By the induction center delivered a patient 22 years old, who after extractions \ tooth swelling
appeared on his face and within 2 hours spread to the neck, chest, upper limbs. Swelling pale, tight,
am provodzhuvavsya itching and hives. After the introduction of antihistamines and
corticosteroids the patient's condition is not Better. What are the possible causes of edema?
Key Answer: C1-inhibitor deficiency of complement
4. Make yourself algorithm examination of the patient with suspected MA.
9. Suggested Reading:
General:
1. Drannyk GN Clinical ymmunolohyya and allerholohyya. - Kiev: Polyhrafplyus, 2006. - 482 p.
2. Lopatin AS Pharmaceuticals anafilakticheskom shock. - Moscow: Medicine. - 1983. - 159 p.
3.Medykamentozna allergy: the state of the problem of organization identification, diagnosis,
prevention and treatment - Guidelines. - C. 2008. - 32.
4. Novikov DK, Sergeev YV, PD Novikov Lekar stvennaya allerhyya. -M. , 2001. - 313
p. 5. Puhlyk BM Allergy. - Kiev: New Book, 2004. - 240 p.
Learn more:
1. Zmushko, Belozerov ES. Medykamentoz WIDE complications. - Ed. "Peter", 2001. - 425 p.
2. Clinical allerholohyya / P from Ed. RM Khaitov. - Moscow: MEDpressynform, 2002. - 624 p.
3. Patterson, R., Hrэmer L, Greenberg P. Allerhycheskye illness (diagnosis and Treatment). M.:
"Heotar." - 2000. - 734 p.
4. Protocols of care for patients with allergic disease. Association allergists Ukraine. - Kyiv,
Vinnytsia., 2007. - 40 p.
5. Puhlyk BM Abstract allerholoha. - Kiev: ichi, 2008. - 95.
6. . Sergeev YV C ovremennaya classification dasg allerhyy / / Lechaschyy
doctor. - 2001. - number 3. - S. 22-32.
Guidelines prepared by
IV Korytska
Guidelines approved at a meeting of
"25" 6 0 "201 3 , the protocol number 1
Loading iduvach k afedr and
MD Professor BM Puhlyk
Associate