Allergies & Anaphylaxis

Question 1

Clinical criteria of ANAPHYLAXIS include:
Urticaria, gen itching or flushing or edema of lips/ tongue/ uvula/ skin developing over mins-hrs & assoc w at least 1 of the ff:
1_______ OR
2______ OR
3_______

Answer 1

1 Resp distress/ hypoxia
2 Hypotension
3 Assoc sx of organ dysfx (syncope, hypotonia/ incontinence)

Question 2

Clinical criteria of ANAPHYLAXIS include:
2 or more s/sx that occur after allergen exposure:
1 _____
2_____
3_____
4_____

Answer 2

1 Skin/ mucosal involvement
2 Resp compromise
3 Hypotension or assoc sx
4 Persistent GI cramps/ vomiting

Question 3

Mediator responsible for vasodilation and inc vascular permeability, HR, cardiac contraction & glandular secretion

Answer 3

Histamine

Question 4

Mediator causing bronchoconstrictor, pulmo and coronary vasoconstrictor & peripheral vasodilator

Answer 4

Prostaglandin D2

Question 5

Mediator producig bronchoconstriction, increase in vascular permeability and promote airway remodeling

Answer 5

Leukotrienes

Question 6

Potent bronchoconstrictor and increases vascular permeability

Answer 6

Platelet activating factor

Question 7

Serum tryptase is recommended for diagnosing anaphylaxis. TRUE or FALSE?

Answer 7

FALSE. Diagnosis of anaphylaxis is CLINICAL.

Question 8

1st priority in anaphylaxis

Answer 8

Securing airway

Question 9

Gastric lavage is NOT recommended for foodborne allergens. TRUE or FALSE?

Answer 9

TRUE

Question 10

Epinephrine ia a mixed a & b receptor agent. B1 stimulation increses HR. B2 provides bronchodilation. A1 receptor stimulation does what?

Answer 10

Reduces mucosal edema & treats hypotension

Question 11

If relapse occurs, repeat IM epinpehrine every __ mins.

Answer 11

5-10

Question 12

Epi IM dose for adults

Answer 12

0.3 -0.5 mg (1:1000 dilution)

Question 13

Epi IV bolus for adults

Answer 13

100 mcg over 5-10 mins; max: 0.1 mg in 10 mL NS and infuse over 5-10 min

Question 14

Epi IV infusion for adults

Answer 14

Start 1 mcg/min (mix 1 mg in 500 mLNS and infuse at 0.5 mL/min)

Question 15

H1 antihistamine

Answer 15

Diphenhydramine 25-50 mg IV SIVP or via IM

Question 16

H2 antihistamine that should NOT be used for px who are elderly, have multiple comorbidities, haverenal or heaptic impairment

Answer 16

Cimetidine

Question 17

H2 antihistamine prolonging metabolism of B blocker use (may prolong anaphylactic state)

Answer 17

Cimetidine

Question 18

For px taking B blockers w hypotension refractory to Epi and fluids, what IV med should be used every 5 mins until hypotension resolves

Answer 18

Glucagon 1 mg IV ff by 5-15 mcg/min infusion (pedia: 50 mcg/kg)

Question 19

S/E of glucagon use

Answer 19

N/V
Hypokalmeia
Dizziness
Hyperglycemia

Question 20

IV crystalloid bolus in adults w hypotension

Answer 20

1-2 L PNSS/ PLR

Question 21

IV crystalloid bolus in pedia w hypotension

Answer 21

10-20 mL/kg

Question 22

Epi should be diluted and given over __ mins and should be stopped immediately if dysrhythmias or chest pain occurs

Answer 22

5-10 mins

Question 23

Corticosteroid in adults

Answer 23

Methylprednisolone 80-125 mg IV

Hydrocortisone 250-500 mg IV

Question 24

Corticosteroid in pedia

Answer 24

Methylprednisolone 2 mg/kg (max: 125 mg)

Hydrocortisone 5-10 mg/kg (max: 500 mg)

Question 25

LTRA is NOT effective for tx of anaphylaxis. TRUE or FALSE?

Answer 25

TRUE

Question 26

After initial IV corticosteroid dose, px may continue orally as outpatient for ___ days

Answer 26

3-5 days w/o tapering required

Question 27

How many puffs of salbutamol MDI should be given if px w bronchospasm?

Answer 27

4-6 puffs repeated q20 mins PRN

2.5-5 mg nebulized

Question 28

How many puffs of ipratropium Br MDI should be given if px w bronchospasm?

Answer 28

4-6 puffs repeated q20 mins PRN

250-500 mcg nebulized

Question 29

If bronchospasm is refractory to MDI, what IV med can be given?

Answer 29

MgSO4 2 g over 20 mins

pedia dose: 25-50 mg/kg IV over 20 mins

Question 30

Healthy px who remain sx-free after an __ hrs can be discharged (<5% of incidence)

Answer 30

1-6 hrs

Question 31

Rx for MGH px

Answer 31

Diphenhydramine 25-50 mg PO x 3-5 days

Prednisone 40-60 mg PO OD or 20-30 mg PO BID x 3-5 days

Question 32

Drug that is a common trigger for angioedema

Answer 32

ACE inhibitors

Question 33

ACE-inhibitor induced angioedema is NOT IgE mediated. TRUE or FALSE?

Answer 33

TRUE

Question 34

Which among the ff drugs is NOT effective in ACEI-induced angioedema?
A. Icatibant, braydkinin 2 antagonist
B. C1 esterase inhibitor
C. Eccalantide, a kallikrein inhibitor

Answer 34

C. Eccalantide

Question 35

Px w angioedema should be observed for ___ hrs before discharge

Answer 35

12-24 hrs

Question 36

Autosomal disorder characterized by C1 esterase inhibitor deficiency

Answer 36

Hereditary angioedema (type I: low lvl; type II: dysfx enzyme)

Question 36

Autosomal disorder characterized by C1 esterase inhibitor deficiency

Answer 36

Hereditary angioedema (type I: low lvl; type II: dysfx enzyme)

Question 37

A C4 level

Answer 37

30%

Question 38

Usual trigger for hereditary angioedema

Answer 38

Minor trauma

Question 39

Alternative for C1 esterase inhibitor

Answer 39

1-2 u FFP

Question 40

IgE mediated allergic rxn after consuming red meat containing mammalian oligosaccharide

Answer 40

Mammalian meat allergy/ alpha-gal allergy

Question 41

Epinehrine, antihistamines and corticosteroids are effective tx in hereditary angioedema. TRUE or FALSE?

Answer 41

FALSE