Allergy

Question 1

Adrenaline dose for anaphylaxis

Answer 1

IM doses of 1:1000 adrenaline (repeat after 5 min if no better)
* Adult 500 micrograms IM (0.5 mL)
* Child more than 12 years: 500 micrograms IM (0.5 mL)
* Child 6 -12 years: 300 micrograms IM (0.3 mL)
* Child less than 6 years: 150 micrograms IM (0.15 mL)

Question 2

What is a type 1 allergy?

Answer 2

Type 1 hypersensitivity: anaphylaxis, IgE

Question 3

What is a type 2 allergy?

Answer 3

Antibody mediated IgG or IgM, eg blood transfusion reaction, pemphigus vulgaris

Question 4

What is type 3 allergy?

Answer 4

Immune complex mediated, rheumatoid or post strep glomerulonephritis

Question 5

What is type 4 allergy?

Answer 5

Antibodies act on hormone receptors, eg Grave’s

Question 6

What are the most common atopic conditions?

Answer 6

Eczema, food allergy, allergic rhinitis (hayfever), asthma

Question 7

Cause of eczema

Answer 7

Fillagrin gene, stratum corneum dysfunction barrier, water loss

Question 8

Food allergy Qs

Answer 8

Food, onset, symptoms, reproducibility, exclusion/reintroduction
Feeding hx, breast/bottle/weaning

Question 9

Food allergy Ix

Answer 9

Weight/height (failure to thrive)
If IgE mediated- blood test

Question 10

House dust mite avoidance

Answer 10

Avoid carpet
Coverings of pillows/duvets/matress
Washing sheets, blankets weekly at 60º
Steam cleaning carpet

Question 11

Will they grow out of their allergy?

Answer 11

Yes, esp egg/wheat
Nut/shellfish less likely

Question 12

Asthma key features

Answer 12

Cough, wheeze, SOB/exercise intolerance
Early morning symptoms
Triggers (cold air/pets/exercise/viral infection)
occupational trigger

Question 13

Diagnosis asthma

Answer 13

FeNO if age 17 or over
Spirometry with reversibility
Peak flow diary 2-4 weeks
Trial ICS

Question 14

Treatment allergic rhinitis

Answer 14

PO or intranasal antihistamine
Intranasal sodium cromoglycate
Intranasal steroid during allergen exposure
Intranasal ipratropium
Short term intransal xylometazoline decongestant
Montelukast trial if +asthma
If severe, course PO steroid/allergen immunotherapy

Question 15

When do you refer to 2ndary care for food allergies?

Answer 15

Systemic symptoms
Food allergy + uncontrolled asthma
Reaction to trace allergen (skin/air)

Question 16

When should you prescribe adrenaline auto-injector?

Answer 16

Anaphylaxis whilst waiting allergy clinic appt
If angiodema + asthma/COPD/heart disease
Angiodema with trace amounts allergen
If cannot avoid allergen (eg bee stings)

Question 17

Treatment of mod/severe eczema baby under 6m old?

Answer 17

Trial hydrolysed/AA milk
Breastfeeding then trial food exclusion with dietetic support

Question 18

Steroid potency +antimicrobial option

Answer 18

Mild
Hydrocortisone

Mild with antimicrobials
Canesten HC
Daktacort
Fucidin H

Moderate
Betnovate-RD
Eumovate

Moderate with antimicrobials
Trimovate

Potent
Betnovate
Elocon

Potent with antimicrobials
Fucibet

Very potent
Dermovate

Question 19

How do you diagnose CMPI?

Answer 19

If breastfeeding, improvement without dairy + symptoms with reintroduction 2-4 weeks after elimination

Question 20

Management CMPI

Answer 20

Once confirmed, cow milk free diet for at least 6m, until age 9-12m
Milk ladder if no active dermatitis or IgE/skin prick negative and no immediate symptoms
If immediate symptoms/positive test then may need supervised challenge
Soy not under 6m, other milks poor nutritional value

Question 21

Signs non IgE mediated CMPI

Answer 21

Constipation, perianal redness, loose stools, colic