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Pediatrics 101 > AI Asthma Allergy > Flashcards

AI Asthma Allergy Flashcards

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1
Q

Intermittent Asthma (step 1 care)

A

SABA alone

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2
Q

Mild Persistent Asthma (step 2 care)

A

Low dose ICS first choice for all ages

alternatively Cromolyn or LTRA as monotherapy but ICS preffered

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3
Q

Moderate Persistent Asthma (step 3 care) For 0-4 yr old

A

Increase the ICS to medium-dose range

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4
Q

Moderate Persistent Asthma (step 3 care) For >5 yrs and older

A

Add a LABA to low dose ICS

alternatively, a LTRA can be added, but LABA more effective

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5
Q

Moderate Persistent Asthma (step 4 care)

A

Medium dose ICS plus LABA (or LTRA)

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6
Q

Severe Persistent Asthma (step 5 care)

A

High dose ICS plus LABA (or LTRA)

Consider Omalizumab if allergies >12yr old

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7
Q

Severe Persistent Asthma (step 6 care)

A

High dose ICS plus LABA (or LTRA)

Oral CS

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8
Q

Symptoms <=1x/year
Lung Function normal
Activity normal

A

Intermittent Asthma

{FEV1 >80%
FEV1/FVC >85%}

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9
Q 
Symptoms > 2x/week 
SABA use  > 2x/week 
Night walking 1-2{3-4}x/month
Orals CS >=2x/6months{year}
{FEV1 >80%
FEV1/FVC >80%} 
Activity minor interference
A

Mild Persistent Asthma

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10
Q 
Symptoms daily 
SABA use daily
Night walking 3-4x/month {> 1x/week} 
Orals CS >=2x/6months{year}
FEV1 60-80%
FEV1/FVC 75-80% 
Activity some limitation
A

Moderate Persistent Asthma

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11
Q 
Symptoms throughout day
SABA use several times/day
Night walking > 1x/week{nightly} 
Orals CS >=2x/6months{year}
FEV1 <75% 
Activity extremely limited
A

Severe Persistent Asthma

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12
Q

When to start long-term control medication in children 0-4yr old who are well between exacerbations?

A
  1. Orals CS >=2x/6months
  2. Symptoms last >1day, Nightwalking >=4x/month
  3. positive Asthma Predictive index
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13
Q

positive Asthma predictive index

A

1 major or 2 minor
Major: Parental h/o asthma, physician dx atopic dermatitis
Minor: Allergen sensitization (skin testing), Blood Eosinopilia >4%, wheezing without a URI

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14
Q

When to refer to an allergist or pulmonologist?

A
  1. Moderate to Severe Persistent Asthma
  2. Life-threatening episode
  3. Poor control after 3-6 months of appr Rx
  4. Need for further Dx testing or education
  5. Unclear dx or complicated assoc cond.
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15
Q

Coughing/SOB/chest pain 6-8 mins after starting exercise

A

Exercise induced Asthma

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16
Q

EIA Rx

A

SABA 10 mins before exercise or

LABA or LTRA

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17
Q

EIA dx

A

15% decrease in PEFR or FEV1 during exercise challenge

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18
Q

laboratory Dx od Allergic Rhinitis (AR)

A

History history history PE
nasal smear for eosinophils best single test.
+ve if >10%eosinophils

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19
Q

Mild AR

A

Oral 2nd gen antihistamines.

Can add oral decongestant as needed in older children

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20
Q

Moderate to severe AR

A

Intranasal CS

if not tolerated use Montelukast (concurrent asthma) or oral / intranasal antihistamines

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21
Q

allergy testing SENSITIZATION

A

Ag specific IgE can be demonstrated by testing

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22
Q

allergy testing ALLERGY

A

causal relationship between exposure to allergen and clinical symptoms

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23
Q

MC used skin test, safe, low cost, minimal discomfort, results in 15 mins, multiple Ags

A

Percutaneous (prick-puncture) method. Sensitive, more specific for aeroallergens but not food

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24
Q

Skin test: painful, HR systemic reactions, more sensitive & reproducible, but less specific

A

Intradermal skin testing

Primary indication - venom sensitivity

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25
Q

Positive skin test means

A

allergy is possible, needs conformation Sx after exposure

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26
Q

Negative skin testing means

A

can exclude allergy to specific antigen

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27
Q

Contraindications to skin testing

Can do In Vitro testing for

A

HR of anaphylaxis (poorly controlled asthma, h/o severe reaction to minute exposure)
Dernatographism, Urticaria, Mastocytosis, Atopic Dermatitis.
Beta2 or ACE antagonist
within 4 weeks of severe systemic reaction to allergen

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28
Q

Sensitivity, specificity & PPV >90% for common pollens (grass,trees); dustmites, cat allergens

A

In vitro testing

Results can be both qualitative and quantitative

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29
Q

egg, milk, peanut, tree nuts, and fish

A

CAP-RAST (in vitro) testing, when results greater than minimum value

30
Q

Medications that should be stopped prior to skin testing

A

Antihistamines (3-7 days)
H2 antagonists (2 days)
TCAs (2 weeks)
Omalizumab (6 months)

31
Q

Medications that don’t affect skin testing

A

oral and inhaled CS

Topically CS may partially suppress results

32
Q

Less useful for venoms, weed pollens, latex, drugs and molds

A

In vitro skin testing

33
Q

Environmental interventions to decrease dust mite allergen exposure

A
  1. Remove carpets
  2. Keep humidity below 50%
  3. Wash bedding in hot water weekly
  4. Encase mattresses in impermeable covers
34
Q

Environmental interventions to decrease Indoor mold allergen exposure

A

decrease humidity,
regular cleaning of surfaces with dilute bleach solution,
use mold retardant paint,
fix any water leaks, remove water damaged carpet

35
Q

Cockroaches

A

Extermination
Seal cracks in walls and floors, fix water leakage.
Dont leave out food or garbage
Air filtration not effective

36
Q

Animal allergens

A

pet outdoor, or out of bedroom
HEPA filter over forced air ducts in bedroom
Remove carpeting in bedroom
replace mattress and pillow covers.
washing the pet twice weekly not realistic

37
Q

outdoor pollens and molds

A 
stay inside on dry, windy days
don't hang laundry outside to dry
brush pets if they are kept outside 
shower before bed
keep windows closed, use  AC
38
Q

Honey bee cross react with

A

wasp venom

39
Q

Immunotherapy not indicated in children with

A

only skin reactions

40
Q

Not an indication for allergy testing in children or adults

A

a large local reaction (contiguous to skin site)

Sx peak by 48hrs & can last for upto a week, (nausea + fatigue)

41
Q

with insect sting - intradermal skin test preferred over in-vitro tests because

A

of increased sensitivity

42
Q

systemic cutaneous sx only <17 yrs old

A

no skin testing

43
Q

systemic cutaneous sx only >=17 yrs old

A

Yes skin testing

44
Q

Anaphlaxis

A

Yes skin testing

45
Q

to rule out mastocytosis

A

serum tryptase 1-2 weeks after anaphylactic event

46
Q

Local reactions can be treated with

A

ice and oral antihistamine

oral CS can be given if severe

47
Q

Acute illness, skin findings AND respiratory compromise or reduced BP/Sx caused by reduced BP

A

Anaphylaxis or Anaphylactoid reactions.

48
Q

Immediate IgE mediated hypersensitivity response to an allergen.

A

Anaphylaxis

Requires previous sensitization

49
Q

Non IgE mediated. Stimulation of mast cells and basophils directly (hyperosmolar solution) or complement activation (immune complexes)

A

Anaphylactoid reaction.

No role for desensitization.

50
Q

Anaphylactoid reaction Triggers

A

exercise, cold,sunlight, RADIOCONTRAST, dyes, IVIG, transfusion reactions

51
Q

Risk of reaction to radio contrast media can be decreased by

A

Pretreatment with steroids and H1/H2 antihistamines

52
Q

Anaphylaxis or Anaphylactoid reactions. Dx

A

HnP, PE,

Serum tryptase measurement within 3 hrs of sx onset. (Not elevated in food-induced anaphylaxis)

53
Q

Anaphylaxis or Anaphylactoid reactions.RX

A

IM Epi, O2 Albuterol, IV fluid boluses, vasopressors. If refractory hypotension = Glucagon
observe for 2- 10 hrs in the ED (late phase) Refer AI

54
Q

Insect allergies indications for self injectable EPI

A

> =17 yr previous systemic reaction (cutaneous or anaphylaxis)
<16 yo previous anaphylaxis

55
Q

Indications for Venom immunotherapy

A

Must have +ve skintest or immunoassay
>=17 yr previous systemic reaction (cutaneous or anaphylaxis)
<16 yo previous anaphylaxis

56
Q

Venom intradermal (specific IgE testing) > skin testing. Who to test?

A

> =17 yr previous systemic reaction (cutaneous or anaphylaxis)
<16 yo previous anaphylaxis

57
Q

Not an Indications for Venom immunotherapy

A

large local reactions

58
Q

severe vomiting, diarrhea, toxic appearance. below birthweight, dehydrated, acidotic, low albumin, increased WBC, heme positive stools. MethHbg?

A

Food protein induced enterocollitis syndrome

FPIES

59
Q

Can be IgE mediated or Non IgE mediated (immunologically mediated)

A

Food allergy

60
Q

Non immunological mediated (toxins, Lactase deficiency)

A

adverse reaction

61
Q

Non IgE mediated

A

Food protein induced proctitis, FPIES, Dietary protein loosing enteropathy

62
Q

IgE mediated food allergy infants

A

cow’s milk, soy, egg, wheat

63
Q

IgE mediated food allergy adolescents

A

peanut, treenuts, shellfish, fish

64
Q

Sx isolated to lips, tongue, oropharynx:tingling, pruritis, occaisonal angioedema

A

Oral allergy syndrome - Immune crossreaction with specific food & environmental Ags

65
Q

Birch tree and apple

A

Oral allergy syndrome - 2 % risk of anaphylactic reaction

66
Q

ragweed and birch

A

Oral allergy syndrome - occurs in 30-40% children with allergic rhinitis

67
Q

Oral allergy syndrome Mx

A

avoid specific foods known to cross-react

68
Q

Blood streaked stools in an infant <3 months old, no frank diarrhea, no FTT

A

Food protein induced proctitis Rx switch to protein hydrolysate formula. BF moms to eliminate milk from their diet

69
Q

Risk of severe reaction upon introducing the food, should not be done in clinic

A

FPIES

70
Q

Negative skin testing wont rule out

A

FPIES as they are not IgE mediated

Pediatrics 101 (18 decks)

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