ALLERGY

Coombs and Gell Classification of

Immunologic Hypersensitivity Reactions
• Type I = Anaphylactic or IgE mediated
• Type II = Cytotoxic
• Type III = Immune complex mediated
• Type IV = Cell mediated or delayed
 MEDICAL MANAGEMENT

• Patients with atopy may be given injections to gradually desensitize them so that
they are no longer allergic to the antigen.
• Some individuals with severe asthma may be forced to move to an area of the
Country that does not contain the antigen (e.g., in the case of allergy to pollen).
• Patients with asthma,immune complex injury, or cytotoxic immune reactions may be
treated with systemic steroids, whereas those with hay fever or urticaria are treated
with antihistamines.
DENTAL MANAGEMENT
 Local Anesthetics.
• Lidocaine that does not contain methylparaben can now be readily obtained
and should be used for patients with an allergic history to procaine
• An antihistamine (diphenhydramine [Benadryl]) can be used as the local
anesthetic
• The patient may be referred to an allergist for provocative dose testing
(PDT)
 Penicillin.

• Cephalosporins usually can be used in patients with a history of distant,

nonserious reaction to penicillin
• Patients with a negative history of allergy to penicillin can be treated with the
drug when indicated, and it should be given by the oral route. The patient is
observed for 30 minutes after the first dose, if possible, and is advised to
seek immediate care if any of the signs or symptoms of an allergic reaction
occur after he or she has left the dental office
 Analgesics.
• Aspirin may cause gastrointestinal upset, but this can be avoided if it is taken
with food or a glass of milk.
• Codeine is a narcotic analgesic that is commonly used in dentistry. Emesis,
nausea, and constipation may occur with analgesic doses of codeine. Miosis
and adverse renal, hepatic, cardiovascular, and bronchial effects are not likely
to occur with therapeutic doses, however. Most of the reported reactions to
codeine consist of nonallergic gastrointestinal manifestations; nevertheless,
these may be severe enough to preclude the use of codeine in certain
patients.
 Oral Complications and Manifestations
• Oral lesions
• Contact stomatitis
• Lichenoid Drug Eruptions.
 MANAGEMENT OF SEVERE TYPE I
HYPERSENSITIVITY REACTIONS
Angioneurotic Edema.
• Inject 0.3 to 0.5 mL of 1 : 1000 epinephrine through an IM (into the tongue) or subcutaneous
(SC) route.
• Support respiration, if indicated, by mouth-to-mouth breathing or bag and mask; the dentist
should make sure the chest moves when either of these methods is used.

• Check the carotid or femoral pulse; if a pulse cannot be detected, closed chest cardiac massage
should be initiated. By this time, someone in the office should have called a nearby physician or
hospital.
 Anaphylaxis.
• Have someone in the office call for medical aid from a nearby physician or hospital.
• Place the patient in a supine position.
• Make certain the airway is patent.
• Administer oxygen.
• Check the carotid or femoral pulse and respiration; determine whether no pulse is present and the
respiration is depressed.
• Inject 0.3 to 0.5 mL of 1 : 1000 epinephrine through an IM (into the tongue) or SC route.
• Support Circulation through closed chest cardiac massage. Support respiration by mouth-to-mouth
breathing.
• Repeat the injection of epinephrine if no response occurs.