Allergy Flashcards

1
Q

what are physical findings suggestive of allergies

A
  1. transverse nasal bridge from allegic salute
  2. white dermatographism
  3. hyperlinearity on palms and soles
  4. Keratosis pilaris
  5. Dennis - morgan line under the eyes
  6. allergic shiners
  7. pityriasis alba
  8. cobble stoning of post pharynx
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2
Q

when would you do a RAST or cap-RAST

A
RAST - Radioallergosorbent test
Do RAST if can't do skin testing:
- pt with dermatographism or extensive dermatistis
- risk of anaphylaxis
- can't stop antihistamine
- uncooperative
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3
Q

what disorders have high Ig E

A
allergic disease
atopic dermatitis
eosinophilic esophagitis
Hyper Ig E syndrome
allergic bronchpulmonary aspergillosis
Helminthic infection
IgE leukemia
bone marrow transplant
Wishkott Aldrich syndrome
nephrotic syndrome
bullous pemphigoid
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4
Q

what is allergic bronchopulmonary aspergillosis?

A

hypersensitivity type reaction to Ag from Aspergillous mold

mainly in pt with CF or steroid dependent asthma

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5
Q

what is Atrovent?

A

anticholinergic bronchodilator
decreases mucus
decreases cough
has additive effect with b2 agonist

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6
Q

what can help you know if child needs daily inhaled steroid

A

rule of 2s:

  • more than 2 daytime symptoms per week
  • more than 2 nightime awakenings per month
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7
Q

what are SE of 1st generation antihistamines?

A
Blind as a bat (blurred vision)
Dry as a bone (dry mouth)
Red as a beet (flushing)
Mad as a hatter (confusion)
Hot as a hare (hyperthermia)
Can’t see(vision changes)
Can’t pee(urinary retention)
Can’t climb a tree
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8
Q

when do we use topical tacrolimus?

A
as second line
if older than 2 yrs
for short and intermediate 
especially if poor responders to steroid
if mainly face and neck eczema and steroids may not be appropriate
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9
Q

what is caused by a deficiency in C1 esterase inhibitor

A

hereditary angioedema , AD

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10
Q

what is a screening bld test for hereditary angioedema

A

low C4

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11
Q

what is serum sickness

A

systemic, type III immune complex–mediated hypersensitivity vasculitis classically attributed to the therapeutic administration of foreign serum proteins.

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12
Q

what are clinical features of serum sickness

A
Fever
malaise
rashes - Urticaria and morbilliform 
angioedema, EM
myalgia and arthralgia
lymphadenopathy
GI-pain, nausea, diarrhea, and melena
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13
Q

what bld test will help Dx serum sickness

A

LOW C3, C4
circulating immune complexes
high ESR

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14
Q

what are possible complications of serum sickness

A
carditis
GBS
nephritis
encephalomyelitis
peripheral neuritis
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15
Q

who requires immunotherapy for allergies

A

life threatening event post insect

+ venom skin test or RAST

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16
Q

child presents with swelling > 2 inches at site of insect bite. The swellin has gotten bigger over 24-48 hours. Dx

A

large local reaction can be mistaken for cellulitis

can give PO steroids for 4-5 days

17
Q

what percent of children with a peanut allergy will outgrow itif the manifested it before 2 yrs

A

20%

BUT most likely lifelong allergy especially is severe allergy

18
Q

what are the types of epipen and doses

A

if 15 - 30 kg - EpiPen Jr -0.15 mg

if > 30 kg - EpiPen - 0.30 mg

19
Q

what food allergies tend to get outgrown

A

milk
eggs
wheat
soy

20
Q

What food allergies tend to not get outgrown!

A

peanut
fish and shellfish
tree nuts

21
Q

what are the 3 types of drug reactions

A

1) Immediate (within 1h): anaphylaxis, hypotension,
wheezing, angioedema and laryngeal edema.

2) Accelerated (1-72h): urticarial/angioedema and/or wheezing. - derm or serum sickness
3) Late (>72h): macular/popular rashes, desquamation, SJS, TEN, hemolytic anemia and serum sickness.

22
Q

baby has recurrent urticaria when rubbed. Dx?

A

urticaria pigmentosa

usually < 2 yrs

23
Q

how do we manage urticaria?

A

H2 receptor antihistamine - non sedating
oral steroids - rarely needed
if chronic - need immune suppression

24
Q

what % of children with allergic rhinitis also have asthma/eczema?

25
what are complications of allergic rhinitis?
``` nasal polyps sinusitis ? dental malocclusion from mouth breathing sleep apnea serous otitis media ```
26
how do we manage AR
``` avoid triggers oral antihistamine intranasal steroids leukotriene receptor antagolnist - singulair allergen immunotherapy ```
27
what is the most common cause of erythema multiforme?
HSV | most often infectious
28
What are CF of erythema multiforme
target lesions dorsal hands/plams and arms fixed painless or mild burning
29
how do you manage EM
anti histamine if itchy | supportive
30
what are the most common cause of SJS?
drugs | Mycoplamsa pneumonia
31
what is the main complication of SJS
ocular damage
32
what are the most common causes of TEN
``` NSAIDS sulphonamide AED penicillin infection ```
33
who should get an epinephrine pen?
1. previous anaphylaxis 2. if had Rx with just trace allergen 3. if likely to have repeated exposure 4. if get generalized urticaria to insect venom 5. if unclear Hx 6. if live in remote areas
34
when can a baby get introduced to allergenic foods?
after 6 mo
35
what is the risk of anaphylaxis from a vaccine
0.6-1.5 per million doses
36
if pt has egg allergy, what vaccine can they not get before skin testing?
yellow fever
37
what should you do if you have a pt with an egg allergy that needs their influenza vaccine
no need for skin test observe for 30 min use same brand for booster
38
what is a large local reaction from stinging insect
``` late phase IgE develops 12-48 hr later same place as sting often > 15 cm resolves 5-10 days ```
39
when does serum sickness occur
1. 7-14 days post contact or | 2. if previous sensitization - 1-4 days