allergy

Question 1

Angioedema Mx

Answer 1

Without Anaphylaxis
- Emergency - eg rapid onset = Hospital admission + IV/ IM Chlorphenamine + Hydrocortisone

• Stable - eg has now resolved, patient well
  = if taking ACEi/ ARB - to stop
  = Antihistamine (non sedating) at least 6 weeks
  = PO Steroid if severe
  = no treatment at all
  = advise 999 if severe
  = refer Derm if no improvement after 3 months despite above
  = speak with specialist before EpiPen prescription

Question 2

Asthma Ix

Answer 2

1st - Spirometry
- Obstructive = FEV1/ FVC <0.7
- POS bronchodilator reversibility = increase of FEV1 >12%

FeNO2 - fractional exhaled nitric oxide = POS in asthma

2nd - Peak flow variability (although in practise this is easiest)
- POS = >20% variability

3rd - consider allergy testing - eg skin prick, IgE testing

Question 3

Varicella in Pregnancy risks to mother and foetus

Answer 3

Mother
- pneumonia, hepatitis, encephalitis, death

Foetus
- intellectual disability, microcephaly
- fetal varicella syndrome

Question 4

Varciella in pregnancy - “significant exposure”

Answer 4

Significant exposure includes:
Rash - exposed lesions
Timing - 48hours from exposure to crusting of lesions
closeness - same room for 15 minutes

Question 5

Varicella in pregnancy Mx

Answer 5

No Hx chickenpox or doubt = check VZ IgG antibodies
- If POS antibodies - no Tx necessary
- if NEG antibodies - discuss with specialist

Question 6

Occupational allergy Mx

Answer 6

Avoidance if possible - use of gloves
can take 8-12 weeks post avoidance for dermatitis to resolve
Emollients
Top Steroids

Question 7

Key points for allergy Hx

Answer 7

RED flags - tongue, lip swelling, SOB, difficulty breathing, unwell
PMH/ Fhx - atopy/ allergy