Allergies Flashcards
What types of reactions are allergic reactions?
IgE mediated
Non-IgE mediated
IgE Mediated Reactions
Rapid in onset Skin GI Tract Respiratory tract Anaphylaxis
What are the top 8 sources of IgE mediated responses?
Cow's milk Eggs Soybeans Wheat Peanuts Tree nuts Fish Shellfish
Which of the top 8 sources of IgE mediated responses resolve by age 5?
Cow’s milk
Eggs
Soybeans
Wheat
Which of the top 8 sources of IgE mediated responses are lifelong?
Peanuts
Tree nuts
Fish
Shellfish
Non-IgE Mediated Reactions
Hours to days after exposure
Presents in infants
Present as chronic skin conditions or GI symptoms
Common GI Symptoms for Non-IgE Mediated Reactions
Proctitis/Proctocolitis
Enteropathy
Enterocolitis
Cutaneous Symptoms of Food Induced Allergic Reactions
Erythema
Pruritus
Urticaria
Angioedema
Ocular Symptoms of Food Induced Allergic Reactions
Pruritis
Conjunctival erythema
Tearing
Periorbital edema
Upper Respiratory Symptoms of Food Induced Allergic Reactions
Nasal congestion Pruritis Rhinorrhea Sneezing Laryngeal edema Hoarseness Dry cough
Lower Respiratory Symptoms of Food Induced Allergic Reactions
Cough Chest tightness Dyspnea Wheezing Intercostal retractions
GI Oral Symptoms of Food Induced Allergic Reactions
Angioedema of the lips
Tongue or palate
Oral pruritis
Tongue swelling
Lower GI Symptoms of Food Induced Allergic Reactions
Nausea Colicky abdominal pain Reflux Vomiting Diarrhea
CV Symptoms of Food Induced Allergic Reactions
Tachycardia Hypotension Dizziness Fainting LOC
Diagnostic Tests for Food Induced Allergic Reactions
Skin prick test (SPT)
Allergen specific serum IgE
Oral food challenge
Treatment of Food Induced Allergic Reactions
Avoidance
Eli-Pen for anaphylacis
Is/are atopic dermatitis, chronic nasal congestion, or acute urticaria associated with food allergies?
Atopic dermatitis
Acute urticaria
What happens to atopic dermatitis after the elimination of the allergen?
Often improves
When do you want to consider evaluation of atopic dermatitis in infants & children?
When there is moderate to severe atopic dermatitis
History of exacerbation with eating specific foods
Causes of Acute Urticaria
Infection
Drug reaction
Food allergy
Is acute or chronic urticaria present with a food allergy?
Acute
Nasopharyngeal Symptoms with Food Allergies
Acute rhinitis
Pruritis of the throat
Angioedema
What must be continued in order to do skin prick testing?
Antihistamines
Which serum specific IgE tests need to be correlated with the patient’s clinical history?
Positive tests
Negative tests
What is the gold standard for a diagnosis of food allergies?
Oral food challenge
How does the oral food challenge work?
Patient given gradually increasing amounts of the suspected food allergen over a time period of hours to a day
Close medical supervision
What are atopy patch tests used for?
Diagnose delayed hypersensitivity T-cell mediated reactions such as contact dermatitis
Diagnostics of Food Allergies
Clinical history
Oral challenge
Skin tests
Serum specific IgE
Established Cutoff Values for Serum Specific IgE for Eggs
3-17 years: 7 kU/L
Established Cutoff Values for Serum Specific IgE for Cow’s Milk
3-17 years: 15 kU/L
Established Cutoff Value for Serum Specific IgE for Peanuts
14 kU/L
Established Cutoff Value for Serum Specific IgE for Fish
20 kU/L
Treatment of Food Allergies
Avoidance of food
Notify adult when they eat something that may contain the food
Epi-pen auto injector
Where should Epi-pens be available for the child?
Home
Daycare
School
Define pollen-food allergy syndrome (PFAS)
Occur from cross-reactivity between proteins present in pollens and those expressed by fruits & veggies
Another Name for Pollen-Food Allergy Syndrome
Oral Allergy Syndrome (OAS)
Symptoms of PFAS and OAS
Tingling & itching of the lips, tongue, and palate when eating certain raw fruits & veggies
Do symptoms of PFAS/OAS occur when the fruit or vegetable is cooked?
No
Birch Pollen Cross Reactivity is Associated with Which Fruits/Veggies
Apples Plums Peaches Nectarines Cherries Almonds
Ragweed Pollen Cross Reactivity is Associated with Which Fruits/Veggies
Melons
Bananas
Tomatoes
Grass Pollen Cross Reactivity is Associated with Which Fruits/Veggies
Melons
Kiwi fruit
Diagnosis of PFAS/OSA
Confirmed through skin prick testing to the fresh foods and pollen
Also with oral food challenges
Treatment of PFAS/OSA
Controlled with antihistamines
Avoid consumption of raw food product
Strictly avoid food in all forms if systemic symptoms
Epi-pen
What advice would you give a peanut/tree nut allergy regarding their risk of fatal anaphylaxis?
Foods may unknowingly contaminated with peanuts/tree nuts and therefore having an Epi-pen is critical at all times
Who is at a higher risk for fatal food-induced anaphylaxis?
Teenagers
Why are teenagers at a higher risk for fatal food-induced anaphylaxis than younger children?
Decreased dose with increasing age
Poor understanding when reactions are severe and when Epi-pen use is needed
Are shellfish, eggs, or peanuts more common in adults than children?
Shellfish
What are the most common food allergies in children?
Milk
Eggs
Peanuts
What are the most common food allergies in adults?
Shellfish
Peanuts
Tree nuts
Symptoms of Allergic Rhinitis
Sneezing Rhinorrhea Nasal congestion Itching of the eyes, nose, palate, ear canals Postnasal drip, cough Irritability Fatigue
Allergic Rhinitis Significant Impact on QOL & Cognitive function
Sleep disordered breathing
Fatigue
General malaise
Cognitive & psychiatric issues in children
What types of cognitive and psychiatric issues are there in children?
ADHD Lower exam scores in peak pollen season Poor concentration Impaired athletic performance Low self esteem
Diseases Associated with Allergic Rhinitis
OM Eustachian tube dysfunction Sinunsitis Asthma Sleep-related breathing disorders
Physical Findings of Allergic Rhinitis
Allergic salute Allergic shiner Dennie Morgan lines Conjunctival chemosis Cobbelstoning
Diagnosis of Allergic Rhinitis
Suggestive history
Supportive exam
Identify specific-IgE
Define Sensitization
Presence of specific IgE to an allergen
Define Allergy
Allergy symptoms
Evidence of sensitization
Treatment of Allergic Rhinitis
Environmental control
Pharmacotherapy
Immunotherapy
Pharmacotherapy Options for Allergic Rhinitis
Antihistamines Decongestants Nasal steroids Anticholinergics Mast cell stabilizers Ocular meds Leukotriene modifiers
Treatment in Children
Avoidance therapy Cromolyn nasal spray Ceterizine Fexofenadine Intranasal glucocorticoids (severe)
Treatment for Allergic Rhinitis with Mild or Episodic Symptoms
Cetirizine, loratidine, or fexofenidine Azelastine (>5 years) Olopatidine (>12 years) Intranasal glucocorticoid Intranasal cromolyn
Treatment for Allergic Rhinitis with Persistent or Severe Symptoms
Intranasal glucocorticoid Topical nasal antihistamines Oral antihistamine Decongestant Start with 1st and work down
Intranasal Glucocorticoids for Children
Memetasone (Nasonex) >2 years Fluticasone furoate (Veramyst) >2 years Fluticasone propionate (Flonase) >4 years
Topical Nasal Antihistamines for Children
Azelastine (Asteline) >5 years
Olopatidine (Patanase) >12 years
Combo azelastine & fluticasone (Dymista) >12 years
Treatment of Allergic Rhinitis with Allergic Conjunctivitis
Intranasal glucocorticoid
Topical Ophthalmic antihistamine drops
Treatment of Allergic Rhinitis with Asthma
Monteleukast (Singulair) >6 months
