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AAA-PEDIATRICS Y3S2 > ALLERGIC AND IMMUNOLOGIC DISORDERS 1.1 (AB) > Flashcards

ALLERGIC AND IMMUNOLOGIC DISORDERS 1.1 (AB) Flashcards

1
Q

What does ‘allergy’ refer to in medical terms?

A

An altered state of reactivity to common environmental antigens, often associated with IgE-mediated reactions.

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2
Q

What are common clinical manifestations of allergy due to hyperresponsiveness?

A

Bronchial asthma (lungs), atopic/seborrheic dermatitis (skin), allergic rhinitis (nose).

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3
Q

What lab findings are typically seen in allergic individuals?

A

Elevated serum IgE and eosinophilia.

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4
Q

What is the genetic risk of allergy if both parents are allergic?

A

Approximately 66%.

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5
Q

What is ‘atopy’ in the context of allergy?

A

A genetic predisposition to develop IgE-mediated allergic reactions.

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6
Q

Which T helper cell type predominates in atopic individuals?

A

CD4+ Th2 cells.

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7
Q

What cytokines are secreted by Th2 cells that promote allergy?

A

Cytokines that favor IgE synthesis and eosinophilia.

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8
Q

What is the main immune response seen in non-atopic individuals exposed to allergens?

A

Proliferation of Th1 cells producing IFN-γ and allergen-specific IgG antibodies.

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9
Q

What distinguishes atopy from allergy?

A

Atopy is a genetic predisposition to IgE-mediated allergy; allergy is a broader term including all hypersensitivity reactions.

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10
Q

What size range of allergens typically trigger IgE responses?

A

10-70 kDa.

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11
Q

Why can’t allergens <10 kDa or >70 kDa trigger allergic reactions?

A

<10 kDa: can’t bridge IgE on mast cells; >70 kDa: can’t cross mucosal barriers.

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12
Q

What role do allergens often play in their natural state?

A

They function as proteolytic enzymes that increase mucosal permeability.

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13
Q

What genes contribute to allergic diseases?

A

Genes regulating atopy (IgE, eosinophilia), barrier function (skin, lung, GI), and pattern-recognition receptors of innate immunity.

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14
Q

Why might no clinical response be seen during the first allergen exposure?

A

The body is still initiating antibody production.

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15
Q

What happens on subsequent exposures in genetically predisposed individuals?

A

Hypersensitive response and possible tissue remodeling.

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16
Q

What is the cornerstone for accurate allergy diagnosis?

A

Detailed history, environmental exposure assessment, and specific testing.

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17
Q

What increases the risk of a child developing allergies if one parent is allergic?

A

About 50%.

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18
Q

Which allergens are infants most likely sensitized to?

A

Dust mites, animal dander, and fungi.

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19
Q

What are common signs of food allergies in children?

A

Hives, mouth itchiness, GI symptoms, possibly anaphylaxis.

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20
Q

What is the ‘allergic salute’?

A

A habitual upward rubbing of the nose, leading to a transverse nasal crease.

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21
Q

What is a Dennie-Morgan fold?

A

An infraorbital fold under the eyelid often seen in allergy.

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22
Q

What causes an ‘allergic shiner’?

A

Venous congestion in the infraorbital area from nasal congestion.

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23
Q

What might persistent snoring and tonsillar hypertrophy indicate?

A

Possible obstructive sleep apnea due to allergies.

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24
Q

What is an ‘allergic cluck’?

A

A sound made by the tongue against the palate to scratch an itchy palate.

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25
What should be noted about coughing during physical examination?
The frequency and nature of coughing, and any positional increase in coughing or wheezing.
26
What should be monitored in patients with atopic dermatitis during physical examination?
Repetitive scratching and the extent of skin involvement.
27
Why should an accurate height be plotted at regular intervals in children with asthma?
To monitor for growth suppression, especially in those with severe asthma or receiving oral corticosteroids.
28
Why is blood pressure measured in children with asthma?
To evaluate for steroid-induced hypertension.
29
What tests are used to check for airway obstruction in children?
Peak flow analysis or spirometry.
30
When should pulse oximetry be performed in children?
If the child has respiratory distress.
31
What symptoms should be observed in a child with rhinitis or rhinoconjunctivitis?
Mouth breathing, paroxysms of sneezing, sniffing, or rubbing of the nose and eyes.
32
What should infants be observed for during feeding?
Nasal obstruction severe enough to interfere with feeding and evidence of aspiration or gastroesophageal reflux.
33
What is the layman's term for allergic conjunctivitis?
Sore eyes.
34
Is allergic conjunctivitis typically bilateral or unilateral?
Bilateral.
35
What does examination of the conjunctiva show in allergic conjunctivitis?
Varying degrees of conjunctival injection and edema.
36
What symptom may be observed in severe allergic conjunctivitis?
Periorbital edema, especially in the lower eyelids.
37
What kind of discharge is associated with allergic conjunctivitis?
Stringy or ropy (mucoid) discharge.
38
What eye condition may result from persistent eye rubbing in patients with atopic dermatitis?
Keratoconus.
39
Why should the external ear be examined in patients with atopic dermatitis?
To check for eczematous changes.
40
Why is pneumatic otoscopy important in allergic rhinitis patients?
To evaluate for otitis media with effusion and exclude infection.
41
What is the significance of a transverse nasal crease in allergic patients?
It is caused by frequent rubbing of the nose and suggests allergic rhinitis.
42
What structural abnormalities should be assessed in the nose of allergic patients?
Septal deviation, turbinate hypertrophy, septal spurs, or nasal polyps.
43
What nasal mucosa appearance is classic in allergic rhinitis?
Pale to purple mucosa.
44
What do thin and clear nasal secretions typically indicate?
Allergic rhinitis.
45
What do purulent nasal secretions suggest?
Another cause of rhinitis.
46
What should be palpated for tenderness to assess sinusitis?
The frontal and maxillary sinuses.
47
What condition may be suggested by cheilitis in allergic children?
Mouth breathing and repeated lip licking.
48
What findings suggest obstructive sleep apnea in children?
Tonsillar and adenoidal hypertrophy with a history of snoring.
49
What should be checked in the posterior pharynx?
Postnasal drip and posterior pharyngeal lymphoid hyperplasia.
50
What skin condition is the most common in allergic children?
Xerosis (dry skin).
51
What skin condition is characterized by keratin plugs in hair follicles?
Keratosis pilaris.
52
Where are exaggerated skin creases found in allergic children?
On the palms and feet.
53
What is the typical chest finding in a child with mild or well-controlled asthma?
The chest may appear normal between exacerbations.
54
What chest findings may be seen during an acute asthma episode?
Hyperinflation, tachypnea, cyanosis, use of accessory muscles, wheezing, and prolonged expiratory time.
55
What suggests significant air trapping in chronic asthma?
An increased anteroposterior diameter of the chest.
56
What groove may be seen in infants with significant asthma?
A groove along the lower ribs at the site of diaphragm attachment.
57
What blood count abnormality is common in allergic patients?
Eosinophilia (>450 eosinophils/μL).
58
What is the significance of eosinophils in sputum of asthmatic patients?
It is classic and supports the diagnosis.
59
What serum antibody is commonly elevated in allergic patients?
IgE.
60
What is the most widely used test for allergen-specific IgE?
Radioallergosorbent test (RAST).
61
How does RAST work?
It detects specific IgE antibodies in response to allergens added to the blood sample.
62
What is the first technique used in skin testing in children?
Prick/puncture technique.
63
How is the prick/puncture skin test done?
A drop of allergen is applied to skin and pricked with a needle to introduce it into the epidermis.
64
What technique is used if prick test is negative but history is suggestive?
Intradermal skin testing.
65
How is intradermal skin testing performed?
0.01–0.02 mL of dilute allergen extract is injected into the dermis using a 26-gauge needle.
66
Why is intradermal testing not recommended for food allergens?
Because of the risk of triggering anaphylaxis.
67
Which skin test correlates better with natural exposure symptoms?
Positive prick/puncture skin tests.
68
What does provocation testing examine?
The association between allergen exposure and the development of symptoms.
69
How are bronchial provocation challenges performed?
Patients inhale increasing concentrations of allergen and undergo pulmonary function testing.
70
What is the most commonly performed bronchial provocation test?
Methacholine challenge test.
71
What does the methacholine challenge test measure?
Bronchial hyperreactivity in suspected asthma.
72
What indicates a reactive result in methacholine testing?
A 20% or more decrease in lung function from baseline.
73
What does a non-reactive result in methacholine testing suggest?
Asthma is unlikely.
74
What is the purpose of oral food challenges?
To confirm food allergies based on history and previous tests.
75
When should oral food challenges be performed?
In a facility equipped to manage anaphylaxis, with trained personnel.
76
What is the gold standard test for food allergy diagnosis?
Double-blind, placebo-controlled food challenge.
77
How does a double-blind food challenge ensure objectivity?
Neither patient nor doctor knows which food contains the allergen.
78
What is a single-blind food challenge?
Only the allergist knows whether the food contains the allergen.
79
What are the three basic principles of the treatment of allergic disease?
1. Avoidance of allergens and irritants 2. Pharmacologic management 3. Allergen immunotherapy for selected patients
80
What is allergen immunotherapy?
The slow introduction of allergens under appropriate healthcare supervision to desensitize the patient.
81
What control measures help reduce exposure to dust mites?
Encasing bedding in airtight covers, washing bedding in water >130°F, removing wall-to-wall carpeting and upholstered furniture.
82
What control measures help reduce exposure to animal dander?
Avoid furred pets, keep animals out of the patient's bedroom.
83
What are some control measures for cockroach allergens?
Control food supply, keep surfaces dry, eliminate standing water, and exterminate professionally.
84
What are control measures to reduce exposure to mold?
Destroy moisture-prone areas, avoid high humidity, repair water leaks, check for mold in basements, attics, and crawl spaces.
85
How can exposure to pollen be minimized?
Close windows, limit outdoor exposure, use air-conditioning, and HEPA filters.
86
What is a HEPA filter and what does it remove?
High-efficiency particulate air filter; removes ≥99.97% of particles ≥0.3 microns like dust, pollen, mold, bacteria.
87
How can cat allergen exposure be minimized?
Wash cat regularly, exclude from bedrooms and common areas, use mattress covers and HEPA air filters, vacuum with HEPA-filtered double bag.
88
What are environmental irritants that should be avoided in allergic patients?
Tobacco smoke, wood-burning stoves, fireplaces, kerosene heaters.
89
What cells are involved in the late-phase allergic response?
Basophils, eosinophils, neutrophils, mast cells, mononuclear cells.
90
How do adrenergic agents work in allergic diseases?
Stimulate α- and β-adrenergic receptors to relieve symptoms such as bronchoconstriction and nasal congestion.
91
What medication should be avoided in hypertensive and cardiac patients due to hemorrhagic stroke risk?
Phenylpropanolamine and oral decongestants.
92
What happens after allergen sensitization in the allergic cascade?
Cytokines stimulate B cells to produce allergen-specific IgE, which binds to mast cells and basophils.
93
What triggers clinical symptoms on second allergen exposure?
Cross-linking of allergen-specific IgE on mast cells and basophils, leading to degranulation.
94
Which medications are used for early-phase allergic response?
Antihistamines, leukotriene modifiers, chromones (e.g., cromolyn sodium).
95
What is the first-line treatment for anaphylaxis?
Epinephrine (1:1000) IM, 0.01 mg/kg (max 0.5 mg), repeated every 5–15 min as needed.
96
What are side effects of β-adrenergic agents?
Tremor, palpitations, tachycardia, arrhythmias, CNS stimulation, hyperglycemia, hypokalemia, hypomagnesemia, transient hypoxia.
97
What is the action of anticholinergic agents in allergies?
Block muscarinic receptors, reducing vagally mediated reflexes like rhinorrhea.
98
What are the characteristics of ipratropium bromide?
Slower bronchodilation, useful in perennial nonallergic rhinitis; causes nasal dryness and epistaxis.
99
What is the primary mechanism of antihistamines?
Block H1-receptors to reduce histamine effects like vasodilation, pruritus, and mucus production.
100
Why are second-generation antihistamines preferred?
They are non-sedating and suitable for daytime use.
101
What are chromones and how do they work?
Cromolyn and nedocromil sodium; inhibit mast cell degranulation and reduce bronchial hyperresponsiveness.
102
Why must chromones be applied topically?
They are poorly absorbed orally and effective only when applied to the target mucosal surface.
103
What are the benefits of glucocorticoids in allergies?
Potent anti-inflammatory effects via inhibition of cytokines and mediator production.
104
How do leukotriene-modifying agents help in asthma?
Block leukotriene receptors or inhibit production; have mild anti-inflammatory and bronchodilator effects.
105
What is anti-IgE therapy and how does it work?
Monoclonal antibodies bind to circulating IgE, preventing attachment to mast cells and reducing allergic responses.
106
Who can receive omalizumab and for what condition?
Children ≥12 years with allergen-induced asthma not controlled with inhaled corticosteroids.
107
What is the main purpose of allergen immunotherapy?
Desensitize patients to allergens to reduce or prevent allergic responses and alter disease progression.

AAA-PEDIATRICS Y3S2 (46 decks)

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