allergy Flashcards
Breast feeding reduces the risk for what diseases?
Nothing!!! It only delays onset of allergies
What is the proper way to diagnos a toddler with atopic dermatitis ?
Food allergy testing
What is the most important risk factor for development of allergic disease ?
One parent with atopy = 50% risk
Two parents with atopy = 70% risk
What 2 environmental exposures increase asthma risk?
Dust mites and smoking
You suspect allergic rhinitis, How can you confirm the diagnosis?
Nasal smear shows eosinophils
What condition presents with eosinophils on nasal smear but negative skin test?
Non allergic rhinitis with eosinophilia syndrome (NARES)
What is the first step in treating allergic rhinitis and the first line treatment?
Eliminate offending agent
Nasal steroid
What is the diagnosis in a patient with nasal congestion, rhinorrhea and post nasal drainage triggered by emotions or weather?
Vasomotor rhinitis
What is rhinitis medicamentosa?
Rebound nasal congestion after adrenergic nose drops
What is required for the diagnosis of hay fever?
Repeated exposure to pollen , child usually > 3 y/o
Which childhood allergies are typically NOT outgrown?
Peanuts
Tree nuts
Seafood
What type of oils are okay for patients with peanut allergy?
Hot pressed peanut oil
Sunflower oil
What is the dose for epinephrine in anaphylaxis?
If >30 kg, 0.3 mg
If <30 kg, 0.15 mg
How do you treat a child with hx milk allergy who complains of stomach ache after lunch?
Epinephrine
When is urticaria considered chronic?
6 weeks
How should you manage chronic urticaria?
2nd/3rd generation antihistamines
Benadryl for breakthrough
No allergy testing or steroids
A patient with chronic urticaria has positive skin test for dogs , what should you do?
Nothing. Skin test does not predict cause of chronic urticaria
What should you do in a patient with shrimp allergy who needs IV contrast ?
Nothing. There is no correlation between shellfish allergy and contrast
What is the mechanism of an allergic reaction to contrast media?
Osmolality hypertonicity triggers de granulation of mast cells (not IgE mediated)
What do you do for a patient with radio contrast allergy who needs contrast?
Premedicate with antihistamines and prednisone
What should you do for a child with a mild systemic reaction to bee sting?
Referral to allergist
What should you do for a child with life threatening reaction to a bee sting and why?
Venom immunotherapy is 98% effective in preventing future reactions
What type of allergic reaction is antibody mediated ?(type 1-4)
Type 2
What type of allergic reaction is immune complex mediated ?
Type 3
How should penicillin allergy be tested for?
skin igE testing which must show reaction within 24 hours
In what situations is skin testing falsely negative?
Antihistamines
Antidepressants
What is the difference between management of a milk allergy that develops urticaria vs eczema rash?
Urticarial rash needs referral to allergist but eczema rash is T cell related and does not require referral
What is RAST testing and what is te benefit ?
In vitro and not impacted by antihistamines
What disease may be the diagnosis in a patient with awkward gait and frequent sinus infections?
Ataxia telangiectasia
What should you consider in a child with a new infection every month?
Reassure the mother - unless recurrent infections are coupled with poor growth
What type of immunodeficiency is being presented in a patient with recurrent Pyogenic infections?
B cell dysfunction
What type of immunodeficiency presents with recurrent candida infection?
T cell dysfunction
What condition causes eczema and thrombocytopenia?
Wiskott-Aldrich syndrome
What is the genetic defect associated with digeorge syndrome?
Deletion of the long arm of chromosome 22
What are the signs of digeorge syndrome?
Cardiac defects Abnormal facies Thymic hypoplasia Cleft palate Hypocalcemia (no parathyroid)
What is the best therapeutic approach to treatment of digeorge syndrome?
Thymic transplant
How night a child with digeorge syndrome present?
With infections
Diarrhea
Tetany
What may be the presenting signs in a child with SCID and what defect do they have?
Defect in B and T cell function causes dermatitis, diarrhea, FTT and life threatening infection
What is the treatment for SCID?
Bone marrow transplant
What might labs show in a patient with SCID?
WBC can be low, normal or high
B cell count might be normal
Absent T cell function
How is wiskott Aldrich inherited?
X linked
What is the cause of immunodeficiency in Wiskott-Aldrich syndrome ?
Low IgM causing humoral and cellular immunodeficiency
What condition has a lack of B cells with decrease lymphoid tissue?
Briton disease (x linked agamnaglobulinemia)
What is the typically presentation of a child with bruton disease?
Infant male with recurrent infection from encapsulated Pyogenic bacteria (pseudomonas, h flu or strep pneumo)
How do you diagnose bruton disease?
Low immunoglobulin levels - confirmed by B and T cell subsets (t calls may be elevated)
How do you treat brutons disease?
IVIG to protect from recurrent bacterial infections
What are children with brutons disease at increased risk for?
Bronchiectasis and chronic pulmonary insufficiency
What is the treatment for CVID?
IVIG
What diseases are children with CVID at increased risk for?
Autoimmune conditions (RA, thyroid dz) and lymphoma
What types of infections are recurrent in children with CVID?
Upper and lower respiratory tract infx, herpes and zoster
What is the pathophysiology of CVID?
Defective antibody response - B cells do not differentiate into plasma cells ; also T cell defect in most patients
What is the genetic inheritance of hyper IgM? What is the cellular defect?
X linked / absence of CD40 ligand and T cell abnormality which prevents conversion of IgM to IgG
What are the presenting signs of hyper IgM syndrome ?
Frequent otitis and sinopulmonary infx, diarrhea and opportunistic infections
What lab findings are present in hyper IgM?
Low IgA, IgG and IgE
High IgM
In what immunodeficiency is Ig replacement appropriate?
X linked hyper IgM syndrome
A patient without HIV presents with pcp pneumonia, what syndrome should you consider?
Hyper IgM
What’s the most common immunodeficiency and what does it cause?
IgA deficiency - recurrent sinopulmonary infections
What is job syndrome and it’s symptoms ?
Hyper IgE - eosinophilia, eczema and recurrent sinopulmonary infections, skeletal abnormalities and abnormal facies
In what condition does decreased helper T cell function lead to low IgG and IgA?
Transient hypogammaglobulinemia of infancy
What is the genetic transmission of chronic granulomatous disease?
2/3 are x linked and 1/3 autosomal recessive
What is the disorder in which phagocyte dysfunction prevents respiratory burst?
Chronic granulomatous disease
What organs are involved in chronic granulomatous disease?
Skin, GI, lungs, liver, lymph nodes and spleen
What are common infections in patients with chronic granulomatous disease?
Staph aureus Abscess
Serratia UTI
Fungal infection
How do you diagnose chronic granulomatous disease?
Nitro blue tetrazolium which assays phagocytic oxidase activity
How would you treat a patient who presents with chronic granulomatous disease and an infection?
Aggressive antibiotics and interferon gamma
What are common infections/problems found in leukocyte adhesion deficiency?
Peri-rectal abscess
Indolent skin infections
Omphalitis
Delayed umbilical separation
What is characteristic of the wound infections found in patients with LAD?
Delayed wound healing
No pus and little inflammation (poor chemo taxis of wbc)
How do you treat leukocyte adhesion deficiency?
Bone marrow transplant
How are complement deficiencies inherited?
Autosomal recessive except properdin deficiency which is x linked
What should you consider in a patient with overwhelming meningococcal infection?
Complement deficiency
What immunological labs would be abnormal in a child with HIV ?
Decreased C4 but infants may present with elevated immunoglobulin
What 3 conditions should you consider in a child with fever, weight loss, night sweats and malaise ?
HIV, malignancy and TB
Which T cells are helper cells and which are suppressor cells?
Cd4 = helper T cell Cd8 = suppressor T cell
What type of medication is zidovudine?
Nucleoside analog reverse transcriptase inhibitor (NRTI)
What type of medication is nevirapine?
Non-nucleoside reverse transcriptase inhibitor (NNRTI)
What type of medication is indinavir?
Protease inhibitor
What test would you get in an infant with recurrent infections that started after age 6 months?
Immunoglobulin levels
What is considered a normal nitroblue tetrazolium test?
If normal neutrophil activity the test turns blue
What test is specific for leukocyte adhesion deficiency?
rebuck skin window - tests the ability of cells to migrate
