Allergy Flashcards
what are physical findings suggestive of allergies
- transverse nasal bridge from allegic salute
- white dermatographism
- hyperlinearity on palms and soles
- Keratosis pilaris
- Dennis - morgan line under the eyes
- allergic shiners
- pityriasis alba
- cobble stoning of post pharynx
when would you do a RAST or cap-RAST
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
what disorders have high Ig E
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
what is allergic bronchopulmonary aspergillosis?
hypersensitivity type reaction to Ag from Aspergillous mold
mainly in pt with CF or steroid dependent asthma
what is Atrovent?
anticholinergic bronchodilator
decreases mucus
decreases cough
has additive effect with b2 agonist
what can help you know if child needs daily inhaled steroid
rule of 2s:
- more than 2 daytime symptoms per week
- more than 2 nightime awakenings per month
what are SE of 1st generation antihistamines?
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
when do we use topical tacrolimus?
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
what is caused by a deficiency in C1 esterase inhibitor
hereditary angioedema , AD
what is a screening bld test for hereditary angioedema
low C4
what is serum sickness
systemic, type III immune complex–mediated hypersensitivity vasculitis classically attributed to the therapeutic administration of foreign serum proteins.
what are clinical features of serum sickness
Fever malaise rashes - Urticaria and morbilliform angioedema, EM myalgia and arthralgia lymphadenopathy GI-pain, nausea, diarrhea, and melena
what bld test will help Dx serum sickness
LOW C3, C4
circulating immune complexes
high ESR
what are possible complications of serum sickness
carditis GBS nephritis encephalomyelitis peripheral neuritis
who requires immunotherapy for allergies
life threatening event post insect
+ venom skin test or RAST
child presents with swelling > 2 inches at site of insect bite. The swellin has gotten bigger over 24-48 hours. Dx
large local reaction can be mistaken for cellulitis
can give PO steroids for 4-5 days
what percent of children with a peanut allergy will outgrow itif the manifested it before 2 yrs
20%
BUT most likely lifelong allergy especially is severe allergy
what are the types of epipen and doses
if 15 - 30 kg - EpiPen Jr -0.15 mg
if > 30 kg - EpiPen - 0.30 mg
what food allergies tend to get outgrown
milk
eggs
wheat
soy
What food allergies tend to not get outgrown!
peanut
fish and shellfish
tree nuts
what are the 3 types of drug reactions
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.
baby has recurrent urticaria when rubbed. Dx?
urticaria pigmentosa
usually < 2 yrs
how do we manage urticaria?
H2 receptor antihistamine - non sedating
oral steroids - rarely needed
if chronic - need immune suppression
what % of children with allergic rhinitis also have asthma/eczema?
13-38 %
what are complications of allergic rhinitis?
nasal polyps sinusitis ? dental malocclusion from mouth breathing sleep apnea serous otitis media
how do we manage AR
avoid triggers oral antihistamine intranasal steroids leukotriene receptor antagolnist - singulair allergen immunotherapy
what is the most common cause of erythema multiforme?
HSV
most often infectious
What are CF of erythema multiforme
target lesions
dorsal hands/plams and arms
fixed
painless or mild burning
how do you manage EM
anti histamine if itchy
supportive
what are the most common cause of SJS?
drugs
Mycoplamsa pneumonia
what is the main complication of SJS
ocular damage
what are the most common causes of TEN
NSAIDS sulphonamide AED penicillin infection
who should get an epinephrine pen?
- previous anaphylaxis
- if had Rx with just trace allergen
- if likely to have repeated exposure
- if get generalized urticaria to insect venom
- if unclear Hx
- if live in remote areas
when can a baby get introduced to allergenic foods?
after 6 mo
what is the risk of anaphylaxis from a vaccine
0.6-1.5 per million doses
if pt has egg allergy, what vaccine can they not get before skin testing?
yellow fever
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
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
when does serum sickness occur
- 7-14 days post contact or
2. if previous sensitization - 1-4 days
