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Year 6 Respiratory > Allergic disorder > Flashcards

Allergic disorder Flashcards

1
Q

What is allergic rhinitis?

A

Allergic rhinitis is an inflammatory disorder of the nose where the nose becomes sensitized to allergens such as house dust mites and grass, tree, and weed pollens.

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2
Q

What are the classifications of allergic rhinitis?

A

Allergic rhinitis may be classified as seasonal, perennial, or occupational.

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3
Q

What is seasonal allergic rhinitis?

A

Seasonal allergic rhinitis is when symptoms occur around the same time every year, often referred to as hay fever when caused by pollens.

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4
Q

What is perennial allergic rhinitis?

A

Perennial allergic rhinitis is when symptoms occur throughout the year.

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5
Q

What is occupational allergic rhinitis?

A

Occupational allergic rhinitis is when symptoms follow exposure to particular allergens within the workplace.

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6
Q

What are the features of allergic rhinitis?

A

Features include sneezing, bilateral nasal obstruction, clear nasal discharge, post-nasal drip, and nasal pruritus.

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7
Q

What is the management for mild-to-moderate allergic rhinitis?

A

Management includes allergen avoidance and oral or intranasal antihistamines.

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8
Q

What is the management for moderate-to-severe allergic rhinitis?

A

For moderate-to-severe persistent symptoms, intranasal corticosteroids are recommended, and a short course of oral corticosteroids may be needed for important life events.

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9
Q

What should be noted about topical nasal decongestants?

A

Topical nasal decongestants (e.g., oxymetazoline) may be used short-term, but prolonged use can lead to tachyphylaxis and rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa).

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10
Q

Allergy tests and notes

A
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11
Q

What is Cow’s milk protein intolerance/allergy (CMPI/CMPA)?

A

CMPI/CMPA occurs in around 3-6% of all children and typically presents in the first 3 months of life in formula-fed infants.

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12
Q

What types of reactions are associated with CMPI/CMPA?

A

Both immediate (IgE mediated) and delayed (non-IgE mediated) reactions are seen. CMPA is used for immediate reactions and CMPI for mild-moderate delayed reactions.

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13
Q

What are common features of CMPI/CMPA?

A

Features include regurgitation and vomiting, diarrhoea, urticaria, atopic eczema, ‘colic’ symptoms (irritability, crying), wheeze, and chronic cough.

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14
Q

What rare symptoms may occur in CMPI/CMPA?

A

Rarely, angioedema and anaphylaxis may occur.

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15
Q

How is CMPI/CMPA diagnosed?

A

Diagnosis is often clinical, with improvement noted after cow’s milk protein elimination. Investigations include skin prick/patch testing and specific IgE (RAST) for cow’s milk protein.

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16
Q

What should be done if symptoms are severe in CMPI/CMPA?

A

If symptoms are severe (e.g. failure to thrive), refer to a paediatrician.

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17
Q

What is the first-line replacement formula for formula-fed infants with mild-moderate symptoms?

A

Extensive hydrolysed formula (eHF) milk is the first-line replacement formula.

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18
Q

What formula should be used for infants with severe CMPA or no response to eHF?

A

Amino acid-based formula (AAF) should be used.

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19
Q

What percentage of infants are also intolerant to soya milk?

A

Around 10% of infants are also intolerant to soya milk.

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20
Q

What management should be followed for breastfed infants with CMPI/CMPA?

A

Continue breastfeeding and eliminate cow’s milk protein from the maternal diet. Consider prescribing calcium supplements for breastfeeding mothers.

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21
Q

What should be used when breastfeeding stops?

A

Use eHF milk until 12 months of age and at least for 6 months.

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22
Q

What is the prognosis for CMPI?

A

CMPI usually resolves in most children.

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23
Q

What is the prognosis for children with IgE mediated intolerance?

A

Around 55% will be milk tolerant by the age of 5 years.

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24
Q

What is the prognosis for children with non-IgE mediated intolerance?

A

Most children will be milk tolerant by the age of 3 years.

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25
Q

Why is a challenge often performed in a hospital setting?

A

A challenge is performed in the hospital setting as anaphylaxis can occur.

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26
Q

What are the two types of food allergies according to the 2011 NICE guidelines?

A

IgE mediated and non-IgE mediated allergies.

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27
Q

What does the NICE guidance not govern?

A

Food intolerance, which is not caused by immune system dysfunction.

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28
Q

What are common symptoms of IgE-mediated allergies in the skin?

A

Pruritus, erythema, urticaria, angioedema.

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29
Q

What gastrointestinal symptoms are associated with IgE-mediated allergies?

A

Nausea, colicky abdominal pain, vomiting, diarrhoea.

30
Q

What respiratory symptoms are associated with IgE-mediated allergies?

A

Upper respiratory tract symptoms: nasal itching, sneezing, rhinorrhoea or congestion. Lower respiratory tract symptoms: cough, chest tightness, wheezing or shortness of breath.

31
Q

What are the symptoms of anaphylaxis related to the skin?

A

Pruritus, erythema, atopic eczema.

32
Q

What gastrointestinal symptoms are associated with anaphylaxis?

A

Gastro-oesophageal reflux disease, loose or frequent stools, blood and/or mucus in stools, abdominal pain, infantile colic, food refusal or aversion, constipation, perianal redness, pallor and tiredness, faltering growth plus one or more gastrointestinal symptoms above (with or without significant atopic eczema).

33
Q

What should be done if the history suggests an IgE-mediated allergy?

A

Offer a skin prick test or blood tests for specific IgE antibodies to the suspected foods and likely co-allergens.

34
Q

What is the recommended approach for suspected non-IgE-mediated allergies?

A

Eliminate the suspected allergen for 2-6 weeks, then reintroduce. NICE advises consulting a dietitian about nutritional adequacies, timings and follow-up.

35
Q
A
36
Q

What are the types of hypersensitivity associated with latex allergy?

A

Type I hypersensitivity (anaphylaxis), type IV hypersensitivity (allergic contact dermatitis), irritant contact dermatitis.

37
Q

In which population is latex allergy more common?

A

Latex allergy is more common in children with myelomeningocele spina bifida.

38
Q

What is latex-fruit syndrome?

A

Many people who are allergic to latex are also allergic to certain fruits.

39
Q

Which fruits are commonly associated with latex allergy?

A

Banana, pineapple, avocado, chestnut, kiwi fruit, mango, passion fruit, and strawberry.

40
Q

What is Oral Allergy Syndrome (OAS)?

A

OAS, also known as pollen-food allergy, is an IgE-mediated hypersensitivity reaction to specific raw, plant-based foods including fruits, vegetables, nuts, and certain spices.

41
Q

What are the common symptoms of OAS?

A

Symptoms typically include mild tingling or pruritus of the lips, tongue, and mouth, with possible mild swelling and redness.

42
Q

What initiates the hypersensitivity reaction in OAS?

A

The hypersensitivity reaction is initiated by cross-reaction with a non-food allergen, most commonly birch pollen.

43
Q

How does cooking affect OAS symptoms?

A

Cooking the culprit food denatures the proteins, which prevents symptoms from occurring.

44
Q

How does OAS differ from food allergies?

A

OAS is caused by cross-sensitisation to a structurally similar allergen present in pollen, while food allergies are caused by direct sensitivity to a protein in food.

45
Q

What types of foods do not cause OAS?

A

Non-plant foods do not cause OAS because there are no cross-reactive allergens in pollen that are structurally similar to meat.

46
Q

What is the prevalence of OAS in the UK?

A

About 2% of the UK population has OAS, but it is probably under-diagnosed.

47
Q

What associations are commonly linked with OAS?

A

Common associations include birch pollen allergy, rye grass pollen allergy, and rubber latex allergy.

48
Q

What should be suspected in patients with seasonal allergy symptoms who develop symptoms after eating raw food?

A

OAS should be suspected in these patients.

49
Q

What are the signs of OAS?

A

Most patients will have no visible signs, but some may show swelling and redness of the lips, tongue, and oral mucosa.

50
Q

How is OAS diagnosed?

A

OAS is a clinical diagnosis, but further tests like IgE RAST and skin prick testing may be used to rule out food allergies.

51
Q

What is the management for OAS?

A

Avoidance of culprit foods is the primary management. Oral antihistamines can be taken if symptoms develop.

52
Q

What should patients be informed about cooked foods?

A

Patients should be informed that once cooked, culprit foods should not cause symptoms.

53
Q

What is common about penicillin allergy?

A

Allergy to penicillin-based antibiotics is common, but many patients may be describing an intolerance or side effects, such as diarrhoea, or a coincidental rash.

54
Q

What percentage of patients allergic to penicillin are also allergic to cephalosporins?

A

Around 0.5-6.5% of patients who are allergic to penicillin are also allergic to cephalosporins.

55
Q

What should patients with a history of immediate hypersensitivity to penicillin avoid?

A

Patients with a history of immediate hypersensitivity to penicillin should not receive a cephalosporin.

56
Q

What cephalosporins can be used with caution in penicillin-allergic patients?

A

Cefixime, cefotaxime, ceftazidime, ceftriaxone, or cefuroxime can be used with caution.

57
Q

Which cephalosporins should be avoided in penicillin-allergic patients?

A

Cefaclor, cefadroxil, cefalexin, cefradine, and ceftaroline fosamil should be avoided.

58
Q

Why is it important to know the types of penicillin?

A

It is important to be aware of other types of penicillin and their trade names to avoid accidental prescription.

59
Q

List some types of penicillin.

A

Types of penicillin include: phenoxymethylpenicillin, benzylpenicillin, flucloxacillin, amoxicillin, ampicillin, co-amoxiclav (Augmentin), co-fluampicil (Magnapen), piperacillin with tazobactam (Tazocin), and ticarcillin with clavulanic acid (Timentin).

60
Q

What are the two broad categories of allergic reactions to venom?

A

Allergic reactions to venom may be broadly considered as either local or systemic.

61
Q

What defines a local reaction to venom?

A

Redness, swelling, and pain limited to the skin and soft tissues directly related to the site of venom exposure, but spreading >10 cm from the site may be defined as ‘local’.

62
Q

What are systemic reactions to venom?

A

Systemic reactions may refer to cutaneous reactions that are relatively distant from the exposure site, e.g., widespread redness, itching, urticaria, and/or angioedema (not affecting the mouth or throat).

63
Q

How should anaphylaxis be managed?

A

Anaphylaxis should be managed with intramuscular adrenaline, intravenous steroids, and intravenous anti-histamines as required. Oxygen and nebulised bronchodilators may also be required.

64
Q

Who should be referred to an allergy specialist?

A

People who’ve had a systemic reaction to an insect bite should be referred to an allergy specialist.

65
Q

When is testing for venom allergy recommended?

A

Testing for venom allergy is recommended in any patient with a history of a systemic reaction causing airway compromise or haemodynamic instability.

66
Q

What should patients with a history of a systemic reaction be provided with?

A

Patients with a history of a systemic reaction should be provided with a self-management plan, including guidance on the use of anti-histamines and adrenaline auto-injectors.

67
Q

What is venom immunotherapy (VIT)?

A

Venom immunotherapy (VIT) is considered to be one of the most effective immunotherapies in use and may be recommended for patients with a history of a previous reaction which presented with airway and/or haemodynamic compromise and raised levels of venom-specific immunoglobulin E on either skin prick or in vitro testing.

68
Q

What does the British Society for Allergy and Clinical Immunology advise regarding VIT?

A

The British Society for Allergy and Clinical Immunology guidance advises that VIT should not be performed in patients without demonstrable venom-specific IgE or in those with a recent history of anaphylaxis or systemic reaction.

69
Q

What should be performed to exclude indolent mastocytosis?

A

A baseline tryptase level should also be performed to exclude indolent mastocytosis.

70
Q

What does research suggest about the success of VIT?

A

‘VIT is 95-100% and about 80% successful in preventing systemic reactions in wasp and bee sting allergy respectively… and has been shown to induce a clinically significant improvement in health-related QOL (quality of life) in patients with anaphylactic reactions as well as generalized non-life-threatening responses to yellow jacket stings…’

Year 6 Respiratory (23 decks)

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