Asthma and Allergies: Causes and Treatment - Case Study Example

Subtopic Page Thesis: 2 Introduction: 2-3 Hay Fever: 3-4 Prevention and treatment of Hay Fever: 4 Allergic Asthma: 4-5 Table 1: 5-6 Signs and Symptoms of Asthma: 6-7 Management of patients with Allergic Asthma; 7 Eczema: 7 Types of Eczema; 8-9 Medications for Eczemas Available to Medical Practitioners: 9-11 Urticaria: 11-12 Medications for Urticaria Available to Medical Practitioners; 12-13 References: 14-19 A Case Study of a Child with Asthma Thesis Working in the Children's Hospital offers challenges as well as benefits. It is important as an assistant practitioner to be able to have the necessary knowledge required in supporting patients as well as parents, through offering vital health promotion and advice. This is best illustrated throughout the following study, where Vicky, a 13 year old girl requires such advice, as she demonstrates signs of Asthma/allergies i.e. having low PLF as well as wheezy FH and SH. The Fact that she lives with her mother and a 19 year old sister, both of whom smokes, and also the fact that her father died in 1995 of Asthma attack is also to be considered. Also to be considered is the effects of having pets such as dogs and cats around her. Introduction The term "Allergy", refers to a disorder of the immune system also known as Atopy, where its reaction occurs to normally harmless environmental substances called the allergens (Krieger PJ 2004 pg 456). Allergic reactions are acquired, predictable as well as rapid; where as a form of hypersensitivity is characterized by excessive activation of white blood cells (mast cells and basophilis) by an antibody type known as IgE, resulting in a severe inflammatory response (Elisabeth NM & Tsai M 2006, pg 80). Vicky's IgE stands at 3360. This study looks into the factors that cause allergic reactions which results to conditions such as Hay Fever, Asthma, Eczema and Ulticaria. It is important to note if Vicky demonstrates signs of mild allergies such as hay fever as it is common in the human population and cause symptoms like allergic conjunctivitis, runny nose and itchiness. Also important to note is the fact that allergies are major factors for conditions such as asthma, where severe cases of allergies to medications, environmental or dietary allergens, can result in fatal anaphylactic reactions and potentially death as could have been the case with Vicky's father. To ascertain Vicky's condition, a practitioner would be obligated to carry out some tests on her so as to diagnose allergic condition(s) that she would be suffering from. These would include testing the skin for responses to known allergens or analyzing the blood for levels and presence of allergen-specific IgE. Treatment for allergies includes allergen avoidance, steroids, anti-histamines, oral medications, desensitization of the response to allergen through immunotherapy, and targeted therapy (Filberts G Will G, 2000, pg 118). There are factors that cause allergic reactions resulting in different conditions such as; Hay Fever This form of allergic reaction is triggered by pollens of specific seasonal plants. It derived the word "hay fever" from the fact that it is most prevalent during haying season (De Sward LF 2006, pg 90). However, it would not be a very reasonable conclusion that Vicky suffers from it because it is possible to suffer from the fever throughout the year. Also, the pollen which causes hay fever varies from different individuals. However, the tiny hardly visible pollens of wind pollinated plants are the most common cause. On the council property where Vicky lives, pollens of insect pollinated plants are large and cannot remain airborne to pose any risk. On the other hand, she could be getting into contact with the pollens at school, where it would be hard to tell since her mother does not engage with the school. It would therefore be important to note whether trees such as birch (betula), cedar (cedrus), alder (alnus), hazel, horn beam, horse chest nut, willow, lime, or olive are in constant touch with her as are known to have the most common allergic pollen with an approximately 15-25% of hay fever sufferers sensitive to their pollen grains (De Sward LF 2006, pg 93) Around the area that Vicky plays or spends her time with friends could also have grasses such as Family poaceae, ryegrass or timothy grass. An estimated 90% of hay fever victims are allergic grass pollen as produced from these types of grass (Gallia SJ 2004, pg 94). Also possible would be that Vicky comes into contact with weeds such as ragweed (Ambrosia), plantain, parietaria, fat hen or dock weeds that also cause allergic reactions. Besides the pollen in the air being a factor in developing hay fever symptoms, hot, dry, windy days have increased amounts of pollen in the air than cool damp, rainy days because pollen is washed to the ground. It is therefore important to note the time of the year at which Vicky demonstrates hay fever symptoms, which may vary greatly on the basis of the types of pollen to which an allergic reaction is produced i.e. to look out from mid-spring to early summer when the pollen count is known to be the highest in general.( Raj put H, Rend H 2007, pg 446). This will help to better understand Vicky's case because as an assistant practitioner, one will be able to anticipate when the symptoms are most likely to begin and end. Prevention and treatment of Hay Fever Should Vicky demonstrate the above mentioned fever symptoms, e.g. wheezing, itching, etc, a treatment would be recommended by the practitioner or the assistant practitioner with the primary goal of reducing the symptoms caused by the inflammation of affected tissues. The most effective way would be to avoid the allergen as well as irritants (Jayson A.F & Stella 2005, pg 160) Allergic Asthma At 13 years old, and her father having died from Asthma attack, it would be vital to try whether Vicky would demonstrate a strong sign of Asthma as it is known to be hereditary. Asthma is a chronic lungs inflammation in which the airways, (bronchi) are reversibly narrowed, and is known to affect 7% or 20 million of the American population, and 300 million world wide (Boehlert R, Jutting B 2001, pg 1060). To look out for is whether Vicky suffers attacks (exacerbations), where the smooth muscle cells in the bronchi constrict and the airways becomes inflamed and swollen causing breathing to become difficult. The good thing about it is that the inflammation of Asthma is reversible. On the other hand, the fact that her mother and 19 year old sister smokes in her presence, is a factor that should be considered as well. The frequency of Asthma symptoms forms the basis of severity classification as shown in the following table (Macpherson CN, Gottstein B, Greets S 2000, pg 240-241) Table 1 Scope of severe attacks Frequency of signs Signs at night Optimum rate of expiration Peak expiratory flow rate variability irregular < once a week twice per month 80% predicted < 20% Mild persistent > once per week but < once per day > twice per month 80% predicted 20-30% Moderate persistent Daily > once per week 60-80% predicted > 30% Severe persistent Daily Frequent < 60% predicted > 30% Signs and Symptoms of Asthma To better understand Vicky's situation, it is imperative to understand the fact that based on the spectrum of the severity with Asthma, there are people with Asthma who rarely experience symptoms. However, Asthma has two states, namely; Chronic Asthma which is the steady state and the acute state, and each state has different symptoms. The common symptoms of Asthma in a steady state are night time coughing, shortness of breathe, without dyspnea at rest though with exertion, a chronic clearing of the throat type of cough as well as the patient complaining of a tight feeling in the chest and throat. These symptoms may gradually get worse to a point of an acute Asthma exacerbation. Even if Vicky is known to wheeze, it is a common misconception that all Asthma patients wheeze, but the truth is that some may never wheeze, which might lead to their condition being confused with other chronic obstructive pulmonary ailments such as chronic bronchitis or emphysema. (S, Fleming J, Bromley A, Shields 2007, pg 13) According to Fleming (2007,pg 14), an "Asthma attack", is a term used to refer to an acute Asthma exacerbation, which is characterized by shortness of breath (dyspnea), chest tightness and wheezing, where the motion of the air in the air ways may be so badly impaired. During the "attack", the patient may make a cough and produce clear sputum. If Vicky has Asthma, it is indeed important to look out for an onset of an attack since it may be sudden, with a sense of constriction in the chest, and could also experience difficulty breathing as well as wheezing. (S, Fleming J, Bromley A, Shields 2007, pg 14) Management of patients with Allergic Asthma The most important thing for any practitioner to understand in the management of allergic Asthma is the routine at which the attacks occur. Anaphylaxis and hypersensitivity reactions to foods, dust, drugs, insects, pollen etc should be monitored, where food proteins with IgE binding should be avoided as it is associated with severe reactions and development of low-allergen. Exposure to insects, pets etc which are especially common in Vicky's case should be avoided, as well as wasp and bee stings. The patient should also carry with him or her inhaler or an epinephrine tablet at all times to be prepared to stop any unexpected asthma attacks (Peterson EM, & Bistros LS, 2006, pg 528) Eczema The fact that Vicky is a young girl offers a pointer that she could be vulnerable to this form of allergy. Eczema is a disease that manifests itself in form of dermatitis of the epidermis, and covers a range of persistent skin conditions. Vicky is exposed to cats and dogs. Eczema in this sense could manifest itself through dryness and skin rashes that are recurrent, blistering, flaking, oozing, cracking, or bleeding, mostly common on the flexor aspects of joints. Another factor that would have added to the possibility that she could be suffering from Eczema is that the disease has its peak at infancy, with its female predominance presentations occurring during the reproductive period of 13-49 years and also carries a higher likelihood from the fact that about one in every young people have been diagnosed with Eczema by a clinician at some point. (Regina C, & Sanford MD 2007, pg 60) Types of Eczema Vicky may as well be suffering from one type of Eczema, as the term Eczema refers to set clinical characteristics, where classification of the underlying diseases has been haphazard and unsystematic, with different synonyms used in describing the same condition. For instance, it could depend on her symptoms or location such as hand eczema, discoid eczema, or atopic eczema (Ann Horton & van Rees R 2002, pg 493). The most common types are: Atopic Eczema, which is also called infantile, flexural or atopic dermatitis, which is an allergy with hereditary component and common in families whose members have hay fever and Asthma like Vicky's whose father is in record to have died of Asthma. It is therefore vital to check if Vicky demonstrates the signs of Atopic Eczema, which would mainly manifest themselves in form of itchy rashes noticeable on head and scalp, inside of the elbows, neck, buttocks as well as behind her knees. (Ann Horton & van Rees R 2002, pg 494) Contact Dermatitis is also a type of Eczema, which has two types i.e. Allergic, which results from a delayed reaction to some allergen like nickel or poison ivy. Also irritant contact dermatitis eczema results from direct reaction to a detergent such as ungerol (sodium lauryl ether sulfate). This Eczema is curable if the clinician is able to diagnose the offending substance, which would have to be stopped as well as its traces removed from the patient's environment. This Eczema would be unlikely that 13 year old Vicky suffers from it because similar to Xerotic eczema, it is common among older population. Seborrhea dermatitis is also unlikely for Vicky because it is common in infants where it is called "cradle cap", characterized by greasy or dry peeling of the scalp, face and eyebrows and some times trunk (Bop, Edward T. Rachel, Robert E. 2005, pg 880) There are also some less common types of Eczemas such as dyshidrosis eczema, discoid eczema, venous eczema, dermatitis herpatiformis, and neurodermatitis, all of which are likely to be suffered by Vicky as they involves autoeczematization, which is an eczematous reaction to an infection with parasites such as the cats and dogs that lives around Vicky, fungi, bacteria, or viruses. The good thing if Vicky suffers from the same is the fact that it is completely curable with the clearance of the original infection that caused it. Vicky's case (if its there) would also have originated from ingestion of medications, foods, or chemicals which are also known to contribute to the condition (Tang AW 2003, pg 1330) Medications for Eczemas Available to Medical Practitioners According to (Golden DB 2007, pg 266), Corticosteroids are used in treatment of Dermatitis, but not Eczemas. However, they control or suppress Eczema symptoms. For mild-moderate Eczema, a weak steroid may be used such as hydrocortisone or desonide. More severe cases need a higher-potency steroid like clobetasol, propionate, or fluocinonide. In general, medical practitioners can only prescribe the less potent ones first before trying the more potent ones. The weak steroids are normally available over the counter such as hydrocortisone in the United States, UK, Australia, Germany, and Czech Republic, whereas the more potent ones can only be taken upon a practitioners' prescription (Plana E, Jarvis D 2007, pg 740) There is however some side effects during prolonged use of topical corticosteroids, where they increase the risk of the skin becoming thin and fragile. As a result of this, if used on the face, or other delicate skin, the practitioner should only prescribe a low-strength steroid. The practitioner should understand that high-strength steroids used over large areas or under occlusion may be considerably absorbed into the body, which may result into hypothalamic-pituitary-adrenal axis suppression. (Schafer JA, Mateo N, 2007, pg 545) Based on the risks associated with steroids, practitioners should be aware of the need for steroids of an appropriate strength, which should be sparingly applied only to control an eczema episode. Once the desired outcome has been achieved, the practitioner should order for discontinuation and instead replacing them with emollients as maintenance therapy (Schafer JA, Mateo N, 2007, pg 546). This is because corticosteroids are safe if used in the short-to medium-term to control eczema, which does not demonstrate any significant side effects, thus showing difference from treatment with non-steroidal ointment (Crooner S 2004, pg 60) There are also other available treatment options that a practitioner could choose. In severe cases, oral corticosteroids such as prenisolone or injections such as triamcinolone injections may also be prescribed, which are known to bring about rapid improvements but should not be administered over a long period of time to avoid succumbing to the possible side effects, which also requires a waiting period between treatments in the case of triamcinolone injections (Barnes KC, Dunstan GM 2007, pg 60) Immune-modulators such as pimecrolimus and tacrolimus may be used to effectively suppress the immune system in the affected area. Antibiotics may also be used together with an immunosuppressant that dampens the immune system which results in improvement in the patients' eczema. These may include cyclosporine, methotrexate and prednisone. (Marla F, Lynd L, Combos M 2006, pg 615). Still, anti-itch drugs often antihistamine, can reduce the itch during a flare up of eczema, which brings about benefits in the sense that it reduces scratching, which in turn reduces damage and irritation to the affected areas. Avoiding dryness of the patient's skin can be achieved through the use of moisturizers as self care treatments. A practitioner should therefore encourage the patient to moisturize the affected areas in order to promote skin healing and relief of symptoms (Gill PGH, Coombs RRA. 2003) Urticaria This is a form of allergy characterized by dark red skin rash, raised itchy bumps. Since Vicky does not demonstrate any of those characteristics, it is less likely that she suffers from Urticaria. Most cases of hives lasting less than six weeks are the results of allergic triggers. However, it is not known in Vicky's profile that such likelihood is possible. Most of the patients with chronic Urticaria have an idiopathic cause, i.e. 30-40% of the patients will demonstrate an autoimmune cause. Acute viral infection is also a factor causing acute Urticaria, where less common causes may include pressure, friction, extremes in temperature, sunlight and exercise, commonly so to patients with fair skins (Muller BA 2004, pg 1128) According to Jarvis (2004, pg 1220), the skin lesions of Urticaria are as a result of an inflammatory reaction in the skin that causes leakage of capillaries in the dermis which results in a persistent edema until the interstitial fluid is absorbed into the surrounding cells. The most common factor causing Urticaria is the release of histamine and other mediators of inflammation from cells in the skin, a process which can be the result of an allergic or non allergic reaction, which differs in the eliciting of histamine release. The fact that Vicky demonstrates an IgE at 3360 is an indication that her allergy does not fall into this category. This is because allergic Urticaria has histamine and other pro-inflammatory substances released from mast cells in the skin and tissues in response to the binding of allergen-bound IgE antibodies to high affinity cell surface receptors (Anderson, Potter, Strachan 1999, pg 537) Medications for Urticaria Available to Medical Practitioners Medical practitioners and their assistants should understand the mechanisms other than allergen-antibody interactions that cause histamine release from mast cells. That will be vital because they will be at a position to administer drugs such as morphine which induces direct histamine release without involving any immunoglobulin molecule. They can also administer a diverse group of signaling substances known as "neuropeptides", which are involved in emotionally inducing Urticaria. In cases of solar Urticaria, porphyrias is in direct association, where it may be a result of IgG binding and not IgE. (Duncan H. & Bardwell 2000, pg 860) In the case of scombroid food poisoning, i.e. dietary histamine poisoning, ingestion of free histamine released by decay bacteria, e.g. in decaying fish flesh, may result in a quick-onset allergic type symptoms of Urticaria which can be administered through morphine. It is also important to note that chronic Urticaria can be difficult to treat because there is no guaranteed treatment or means of controlling attacks, and the fact that some sub-populations (where Vicky might belong) are treatment -resistant, with medications administered spontaneously losing their effectiveness (Rodd Lloyd 1996, pg 1457) Medical practitioners should therefore come up with treatment plans that would mainly involve being aware of one's triggers, although they would be faced with the difficulty in form of the fact that people often exhibit more than one type of triggers. The same comes with the benefit that if one's triggers can be identified, then out breaks can often be managed by limiting one's exposure to these situations. In Vick's case, proper management would be to begin with food additive intolerance with recurrent or intermittent Urticaria-angiodema because it is known to directly contribute to Urticaria-angiodema in child hood. 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