Allergy Flashcards
increase symptoms at night suggest
Bedroom Allergens
Weekend remissions suggest
School place allergens
Eosinophil level suggestive of allergy
> 700/mm3 in blood
5 ~ 10 % in cells
IgE is considered……
good negative (sensitive not specific)
لو لقيته واطي اوي هقدر ا exclude atopy
بس لو لقيته عالي مش هقدر اعتمد عليه لوحده في التشخيص عشان بيبقى عالي في حاجات تانية
skin prick test is considered +ve when…..
a wheal of ≥ 3mm appears
indicates that IgE Ab is present on mast cells
doesn’t indicate that pateint will have symptoms on exposure of allergen
Provocation test vs skin prick
Provocation is more accurate but riskier
should only be done in hospitals
M/I line of ttt of allergy
Avoidance of allergen
SCIT
not approved before 5 years
SLIT
not available for food allergy
Atopy and breastfeeding
continue breastfeeding
m/c chronic inflammatory skin disorder
atopic dermatitis
Define JIA
arthritis of unknown etiology
begins before the 16th birthday
persists for at least 6 weeks
with other known conditions excluded
type of fever in Systemic JIA
Quotidian = intermittent
criteria of Systemic JIA
arthritis in ≥ 1 joint with history of 2 weeks fever that is quotidian for at least 3 days+ one of the following:
- Serositis ( eg. Pericardial effusion)
- Hepatomegaly or splenomegaly
- Generalized lymphadenopathy
- Evanescent erythematous rash
Criteria of psoriatic JIA
Arthritis + psoriasis or Arthritis + ≥ 1 of:
- Dactylitis
- Nail pitting / onycholysis
- 1st degree relative has psoriasis
criteria of enthesitis related JIA
arthritis + enthesitis or Arthritis / enthesitis + ≥ 2 of:
- Sacroiliac tenderness / inflammatory lumbosacral pain
- onset in male > 6 years old
- HLA-B27 +ve
- Acute anterior uveitis
- +ve FH
character of pain in JIA
Aching or streching
occurs on active or passive movement
joint stiffness improves by
activity or application of heat to the affected area
arthritis in the knee is characterized by
atrophy of Vastus Medialis
peak age of Systemic JIA
1 ~ 5 years (both genders are equally affected)
at which part of the day does fever occur
any time of the day but is characteristically present in the late afternoon to evening in conjunction with the rash
M/C location of skin rash in JIA
Trunk and proximal extremities
** NON PURITIC**
- elicited by Scratching / Hot bath / Psychological stress
M/C joints involved in systemic JIA
- wrists
- Knees
- Ankles
Most devastating complication if JIA
Macrophage activation syndrome
MAS is characterized clinically by the rapid development of:
- Unremitting fever
- Hepatosplenomegaly and lymphadenopathy
- Hepatic dysfunction (and even liver failure)
- Encephalopathy
- Purpura, bruising, and mucosal bleeding
- Severe cases rapidly progress to multiorgan involvement , hypotension and shock.
peak age of oligoarticular JIA
2-4 years with female predominance.
Most common Joint involved in oligoarticular JIA
Knee
If oligoarticular JIA + +ve ANA
search for chronic uveitis
peak age of Polyarticular JIA
Rh-negative: 2-4 and 10-14 years
Rh-positive: 9-12 years
Female predominance
Most common joint affected in polyarticular JIA
small joints of the hands, feet, ankles, wrists,
and knees
TMJ arthritis leads to
Micrognathia
Rheumatoid nodules are present in
severe Rh-positive polyarthritis
Peak age of Enthesitis Related arthritis
9 ~ 12 years
male predominance
character of The peripheral arthritis in ERA
oligoarticular, asymmetrical and mainly
involves the lower extremities.
Most common joint affected in ERA
Hip
Peak age of psoriatic JIA
2~4 and 9 ~ 11
female predominance
Most common X-ray finding in Arthritis
periarticular osteopenia,
Drug-induced Lupus
- Anticonvulsants
- Antiarrhythmics
- Sulfa
** No major organ Involvement**
Maternal Ab in neonatal Lupus
- Anti Ro = Anti SSA
- Anti La = Antia SSB
- Anti RNP
the most common inflammatory
myositis in children
Juvenile dermatomyositis (JDM)
Peak age at onset of Juvenile dermatomyositis (JDM)
4 ~ 10 years
Femal predominance
Shawl sign
Photosensitive erythematous skin rash in sun-exposed area; over upper chest and neck
heliotrope rash
blue-violet discoloration
of the eyelids that may be associated with periorbital edema.
Gottron papules
bright-pink or
pale, shiny, thickened or atrophic plaques
over the proximal interphalangeal joints
and
distal interphalangeal joints and
occasionally on the knees, elbows
character of fever in Kawasaki Disease
high spiking (≥38.3°C )
unremitting
unresponsive to antipyretics
The duration of fever without treatment is generally 1-2 wk but may be as
short as 5 days or may persist for 3-4 wk
Criteria of Kawasaki disease
(1) bilateral nonexudative conjunctival injection with limbal sparing
(2) erythema of the oral and pharyngeal mucosa with strawberry tongue and red,
cracked lips
(3) edema (induration) and erythema of the hands and feet
(4) rash of various forms (maculopapular, erythema multiforme, scarlatiniform or less
often psoriatic-like, urticarial or micropustular), and
(5) nonsuppurative cervical lymphadenopathy, usually unilateral, with node size >1.5
cm.
duration of Acute phase of KD
1 ~ 2 weeks
Perineal desquamation is common
duration of Subacute phase of KD
3 Weeks
associated with desquamation, thrombocytosis, development of CAA
High risk of sudden death
duration of Convalescent phase of KD
6 ~ 8 weeks after onset
continues until ESR is back to normal
diagnosing KD requires
the presence of fever for at least 4
days
and at least 4 of 5 of the other principal characteristics of the illness
diagnosing KD should be done within
7 ~ 10 days
to improve coronary artery outcomes
CBC in KD
- ↑ TLC (Neutrophils predominant)
- Normocytic Normochromic anemia
- Platelets normal in 1st week
rapidly increasing in 2nd and 3rd week
TTT of KD
- 2 g/kg of IVIG as a single infusion,
administered over 10-12 hrs
ASAP when diagnosis is established - Aspirin
Aspirin in KD
- Moderate to High dose until patient is afebrile
- Lowered from anti-inflammatory to antithrombotic dose when afebrile for 48 h
- discontinued after 6 ~ 8 weeks of disease onset
Most common vasculitis in childhood
Henoch-Schönlein purpura
duration of rash in HSP
3 ~ 10 days
recur after 4 months
cause of FMF
AR
mutations in MEFV gene
Homozygosity for the M694V mutation with earlier onset
The hallmark cutaneous finding in FMF
erysipeloid erythematous rash that overlies the ankle or dorsum of the foot
most common cause of acquired Heart disease in developed countries
Kawasaki disease
Most significant ccc of Kawasaki disease
Coronary artery aneurysm
When to suspect SCID
ALC< 3000x103/uL at birth
❑2800x103/uL during infancy
