1. Allergies Donald Trump

2. 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

3. 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

4. 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 Hypersensitivity

5. Type 4 Contact stomatitis, delayed response Toothpaste, mouth rinses, impression materials, lipsticks Tx: ID causative agent, remove, sit back and watch it clear up Hypersensitivity Type 5

6. 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?

7. 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?

8. 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)

9. 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 don’t 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*

10. Anaphylaxis -Signs and symptoms- Itching of soft palate nausea, vomiting substernal pressure shortness of breath hypotension pruritis urticaria laryngeal edema bronchospasm cardiac arrhythmias

11. 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 1:1000 epi, CPR, repeat injection

12. 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.

13. Hypersensitivity typeCauseMediated byManifestation IDust, pollen foodIGEAtopy Anaphylaxis Asthma IIBlood transfusionCytotoxic, antibody- dependent IgM or IgG erythroblastosis fetalis Goodpasture's syndrome autoimmune hemolytic anemia IIIImmune complex disease IgGSerum sickness Arthus reaction SLE IVContact with metal, perfume, chemicals TB skin test cell-mediatedContact dermatitis Tuberculosis Chronic transplant rejection Pathophysiology

14. 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

15. 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

16. Dental Algorithm – B Bleeding Aspirin inhibits platelet function and prolongs the prothrombin time (PT)

17. Dental Algorithm – C Complications systemic anaphylaxis, vasodilation, respiratory distress, hypotension, pruritus, conjunctivitis, nausea & vomiting, substernal pressure, laryngeal edema, bronchospasm, rhinitis, death itchiness & rash,

18. Dental Algorithm – C cont Cardiac tachycardia cardiovascular collapse cardiac arrythmias

19. 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

20. 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 1:1000 –epinephrine IM into tongue –provide cardiopulmonary resuscitation if needed –repeat injection of epinephrine if no response

21. Thank You You're Hired