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Paediatrics > 1: Immunology, Allergy - Anaphylaxis > Flashcards

1: Immunology, Allergy - Anaphylaxis Flashcards

1
Q

Define anaphylaxis

A

Life-threatening allergic event due to immediate hypersensitivity reaction

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2
Q

What is the most common cause of anaphylaxis in children

A

Food substances

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3
Q

What food-types can cause anaphylaxis

A
  • Peanuts
  • Eggs
  • Shellfish
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4
Q

What are other triggers for anaphylaxis

A

Medication (Penicillin)
Stings, Bites
Injections - radiocontrast dye

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5
Q

Describe clinical presentation of anaphylaxis

A

Skin: Urticaria, Angioedema

Resp: Airway obstruction - bronchospasm, laryngeal oedema

GI: diarrhoea, abdo cramps

Systemic shock

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6
Q

Explain pathophysiology of anaphylaxis

A

IgE cross-link mast cells to cause release of histamine. Which causes smooth muscle contraction and peripheral vasodilation - leading to bronchospasm, abdominal cramps.

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7
Q

Describe approach to anaphylaxis patient

A
  • Contact resus team
  • A-E approach
  • Lie patient on their back with their legs raised
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8
Q

What 3 medications are given in anaphylaxis

A
  1. IM adrenaline
  2. IV chlorphenamine
  3. IV hydrocortisone
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9
Q

If adrenaline is ineffective, when can second-dose be given

A

5-minutes later

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10
Q

Aside from chlorphenamine, hydrocortisone and adrenaline - what other interventions are given for anaphylaxis

A

Remove stimulus
Oxygen
IV Fluids

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11
Q

When is salbutamol indicated for anaphylaxis

A

If individual is having bronchospasm

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12
Q

Outline management of anaphylaxis

A
  1. Contact resus team
  2. Oxygen
  3. IM adrenaline
  4. IV Fluid
  5. IV hydrocortisone
  6. IV chlorphenamine
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13
Q

What blood should be taken following anaphylaxis

A

Mast cell tryptase

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14
Q

When is mast cell tryptase taken

A

1-2h later

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15
Q

How long should patients be observed for following anaphylaxis and why

A

Observe patients for 6-hours: due to risk of biphasic attack

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16
Q

What should all individuals be trained how to do before discharge

A

Use epipen

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17
Q

What is in an epipen

A

0.3mg Adrenaline (1:1000)

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18
Q

What does of adrenaline is given 6m -6 years

A

0.15mL (150mcg)

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19
Q

How many grams of adrenaline are in 0.15mL

A

150mcg

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20
Q

What dose of adrenaline is given 6-12 years

A

0.3mL (300mcg)

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21
Q

What dose of adrenaline is given above 12 years

A

0.5 mL (500mcg)

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22
Q

What dose of hydrocortisone is used if under 6-months

A

25mcg

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23
Q

What dose of hydrocortisone is used if 6-months to 6-years

A

50mcg

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24
Q

What dose of hydrocortisone is used if 6 years to 12 years

A

100mcg

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25
Q

What dose of hydrocortisone is used if more than 12 years

A

200mcg

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26
Q

What dose chlorphenamine is given 6m-6 years

A

2.5mg

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27
Q

What dose chlorphenamine is given 6-years to 12-years

A

5mg

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28
Q

What dose chlorphenamine is given after 12-years

A

10mg

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29
Q

What is allergy

A

type I, IgE mediated reaction

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30
Q

What is true food allergy

A

IgE mediated hypersensitivity reaction to food

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31
Q

What can cause allergies

A
  • Food
  • Medication
  • Dust mite
  • Pollen
  • Fur
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32
Q

What foods commonly cause allergies

A
  • Seafood
  • Peanuts
  • Soy
  • Eggs
33
Q

What is a risk factor for allergy

A

FH of atopy

34
Q

What is atopy

A

Genetic tendency to produce IgE

35
Q

What is protective against allergy

A

Breast feeding before age-1

36
Q

What are symptoms of allergy

A
  • Mouth breathing: snoring, apnoea
  • Allergic conjunctivitis
  • Wheeze
37
Q

What is a sign of allergy

A
  • Atopic eczema
38
Q

How do food allergies usually present in children

A
  • Diarrhoea w/ blood and mucus in stools
  • Vomiting
  • GORD
  • FTT
  • Urticaria
  • Peri-oral erythematous rash
39
Q

When should food allergy be considered

A

If children with: GORD, Chronic constipation or eczema do not response to treatment

40
Q

how do allergies usually present in childhood

A

Allergic march:

  • In infancy present with rash and food allergies
  • In childhood present with conjunctivitis, asthma and rhinitis
41
Q

what is pan-allergy syndrome

A

There are pan-allergens in plants that can trigger an autoimmune reaction. These allergens are heat-labile and destroyed in stomach: hence cause limited oral symptoms

42
Q

what is false-allergy syndrome

A

Direct degranulation mast-cells without use IgE

43
Q

what is food intolerance

A

Adverse reaction to food, with no IgE mediate symptoms

44
Q

What are the 3 methods to identify allergies

A
  1. Skin Prick Test
  2. Specific IgE testing
  3. Total IgE
45
Q

What is skin-prick testing

A

A prick is made in the volar aspect of the arm and a allergen inserted

46
Q

What are two contraindications to skin-prick testing

A

Eczema

Anti-histamines

47
Q

How long should antihistamines be stopped prior to skin prick testing

A

6-7 days

48
Q

What is used as the positive control

A

Histamine

49
Q

What is used as the negative control

A

Water

50
Q

What is a positive skin prick testing in children

A

> 3mm

51
Q

What is serum-specific IgE also called

A

Radio allergen absorbent testing (RAST)

52
Q

What is the RAST test

A

Looks for proteins to specific allergens

53
Q

How is the RAST test graded?

A

0-6

6 = strongly positive

54
Q

What does it mean if the RAST test is positive

A

It means individual is sensitised to an allergen, it does NOT mean they have clinical allergy

55
Q

What does a positive total serum IgE indicate and what does this mean in practice

A

Individual is atopic. Therefore should not be used to screen for allergy

56
Q

In cases where allergens cannot be identified what is offered

A

Elimination diet

57
Q

Explain the elimination diet

A

Individuals are given a few hypoallergenic foods for 1-2W then other foods are gradually re-introduced

58
Q

What is first-line for food allergy

A

Exclude food

59
Q

What is used to manage allergy acutely

A

Anti-histamine

60
Q

If a child has had 6- 12 months symptom-free on exclusion diet what is considered

A

Food challenge (in hospital setting where anaphylaxis can be controlled for)

61
Q

When do infantile food allergies tend to resolve

A

2-years

62
Q

What allergy tends to persist

A

Peanut allergy

63
Q

Define cow’s milk protein allergy

A

IgE-mediated reaction to proteins in cow’s milk

64
Q

Define cow’s milk protein intolerance

A

Mild-moderate delayed reaction to cow’s milk

65
Q

When does cow’s milk protein allergy occur

A

0-3 months

66
Q

What is a major risk factor for cow’s milk protein allergy

A

Bottle feeding.

Cow’s milk protein allergy is extremely rare in formula fed infants

67
Q

When is cows milk protein allergy rarely seen

A

In breast-fed infants

68
Q

What are symptoms of cows milk protein allergy

A
  • Urticaria
  • Atopic eczema
  • Wheeze
  • Persistent cough
  • Itchy throat
  • Angioedema
  • Anaphylaxis
69
Q

What are symptoms of cow’s milk protein intolerance

A
  • Diarrhoea
  • Vomiting
  • regurgitation
  • colic: crying and irritability
70
Q

how is cow’s milk protein allergy usually diagnosed

A

Clinically - often on cessation of symptoms on exclusion of cows milk protein

71
Q

in formula-fed infants how are is mild-moderate CMPA managed

A

Extensively hydrolysed formula (EHF)

72
Q

in formula-fed infants, how is severe CMPA managed

A

Amino acid based formula

73
Q

What are indications for amino acid based formula

A

No response to extensively hydrolysed formula

74
Q

Explain how cow’s milk protein allergy is managed in breast-fed infants

A
  • Encourage mum to continue breast feeding but exclude dairy products from her diet
75
Q

What should be given to mum if child has cow’s milk protein allergy

A

Calcium supplementation

76
Q

When breast-feeding stops, what should an infant be put on in CMPA

A

After breast feeding put on EHF for at least 6-months

77
Q

What should be considered 6-12m after CMPA

A

CMP challenge

78
Q

What % of children with CMPA will be tolerant by 5-years

A

55%

79
Q

When will children with cows milk protein intolerance be tolerant

A

3-years

Paediatrics (61 decks)

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