Allergy

Question 1

What is an allergy

Answer 1

The body’s immune system reacting to the presence of something

Question 2

What is an intolerance

Answer 2

The direct impact of a specific food on the gut

Question 3

What causes an immediate food allergy

Answer 3

It is an IgE mediated reaction

It is an inappropriate or excessive response

Question 4

How long does an immediate food allergy take to present

Answer 4

Instant to 2 hours after eating

Question 5

What causes a delayed onset allergic response

Answer 5

It is cell mediated rather than IgE - takes longer

Question 6

How long does it take for a delayed onset allergy to present

Answer 6

It comes on hours after you eat

Question 7

Lactose intolerance is common in children - true or false

Answer 7

False - it is uncommon

Question 8

What causes lactose intolerance

Answer 8

Loss of the enzyme that breaks lactose down

Question 9

Which conditions are associated with atopy

Answer 9

Asthma, eczema, hay fever, allergy

Associated with high IgE

Question 10

List symptoms of an immediate IgE allergic response

Answer 10

Urticarial rash
Angioedema
Conjunctivitis
Can progress to anaphylaxis

Question 11

How do you diagnose an immediate IgE food allergy

Answer 11

IgE blood levels and a skin prick test (histamine response)
Not great tests for screening - can come back high if just sensitised but not allergic

The true test for food allergy is actually eating the food - food challenge

Question 12

When are you most likely to develop an allergy

Answer 12

Most common in childhood

Can occur at any time though

Question 13

Avoiding the food makes you more likely to develop the allergy - true or false

Answer 13

True

Exposure is a good thing (except in anaphylaxis cases!)

Question 14

How does anaphylaxis present

Answer 14

Pharyngeal/larygeal oedema
Bronchospasm  
Tachypnoea or wheeze
Hypotension or tachycardia
Skin and mucosal changes 
Eventual LOC

Question 15

How do you treat anaphylaxis

Answer 15

In emergency cases you give an epi-pen which contains adrenaline
Vast majority do not actually need it
What they need is an anti-histamine asap

Question 16

Anaphylaxis is the most common response to allergen exposure - true or false

Answer 16

False
It is actually quite rare
Rashes and sickness are much more common

Question 17

How do you manage allergy

Answer 17

• Avoid allergen (main one!)
  
  • Antihistamine +/- steroids
  • Adrenaline if severe

Question 18

How could immunotherapy be used to treat allergy

Answer 18

In trials in the UK for peanuts
Involves slow and controlled exposure to the allergen
Will not cure the allergy but protects you against accidental exposure
Only really useful in those with serious anaphylaxis as it can protect them from this

Question 19

Most children will grow out of an egg allergy - true or false

Answer 19

True

Question 20

Egg allergy is only in response to raw egg - true or false

Answer 20

False

Can be to raw or cooked

Question 21

How does egg allergy typically present

Answer 21

Often present with a rash or mouth symptoms following introduction to egg (common for babies to be given scrambled etc)

Question 22

Those with a peanut allergy often have an associated tree nut allergy - true or false

Answer 22

True

About 30% will have both

Question 23

Which specific allergy would you have a lower threshold for epipen use

Answer 23

Peanut allergy

Often severe

Question 24

Children often grow out of a peanut allergy - true or false

Answer 24

False

Less likely for a peanut allergy to go away

Question 25

What is oral allergy syndrome

Answer 25

When you get local allergy symptoms in the mouth after eating fruit but not on other exposure
You are allergic to the pollen on the skin of the fruit (commonly birch)
Skin or cook the fruit to avoid the reaction

Question 26

What is chronic urticaria

Answer 26

Repeated episodes of urticaria with no obvious trigger
Not an allergy - cutting out foods will not help
Can be associated with angioedema

Question 27

What can cause chronic urticaria

Answer 27

Some people experience it in response to a virus or even water

Question 28

Which food groups are common causes of delayed allergic reactions

Answer 28

• Often to big food groups like dairy soya, fish or egg

Question 29

How does a delayed onset allergic reaction present

Answer 29

Gives you GI symptoms and makes you a bit miserable

Can also make existing eczema worse

Question 30

How can you diagnose a delayed onset food allergy

Answer 30

Only real way to test for it is to avoid the food for a period and see if symptoms improve

Question 31

How do you treat a delayed onset food allergy

Answer 31

You have to avoid the allergen

Question 32

Which allergy often coexists with a dairy allergy

Answer 32

Soya

Question 33

How does a cows milk protein allergy present

Answer 33

Usually in the first year of life

Miserable baby, soft green poos, sometimes blood present

Question 34

How do you treat a cows milk protein allergy

Answer 34

Avoid cows milk
Some babies can even react to dairy protein passed in breastmilk so mum has to avoid it too
Then try reintroducing after 1 year

Question 35

What is the most common cause of fatal food anaphylaxis

Answer 35

Peanuts and tree nuts

Question 36

What is the most common clinical manifestation of allergic reaction

Answer 36

Cutaneous reactions

Question 37

What occurs first in fatal anaphylaxis respiratory or cardiac arrest

Answer 37

Respiratory failure occurs first with secondary cardiac arrest

Question 38

What other allergy is often seen alongside cows milk allergy

Answer 38

Goats milk

>90% allergic to both

Question 39

What is the best method for diagnosing a peanut allergy

Answer 39

A physician-supervised oral food challenge is recognized as the best and most reliable method

Question 40

What is a biphasic allergic reaction

Answer 40

Where there is another reaction around 8 hours after the first (been reported up to 72hrs!)