Allergy

Question 1

Which diagnostic test can be used post anaphylaxis to confirm it?

Answer 1

Mast cell tryptase

Question 2

How are seasonal allergic rhinitis treated?

Answer 2

Nasal corticosteroids

Anti-histamines

Question 3

How is insect allergy treated?

Answer 3

5 years of immunotherapy

Question 4

How are symptoms related to location of exposure in non-anaphylaxis allergy?

Answer 4

Symptoms typically appear at the site of exposure

Question 5

What are the mechanisms of the chronic allergic reaction?

Answer 5

Eosinophils release of basic proteins, leukotrienes

Continued release of mast cell histamine, lipids

Neuropeptides released from Th2 cells

Question 6

How is adrenaline best administered in anaphylaxis?

Answer 6

0.5mg IM

Wait 5 minutes and give more if needed

After 3 administration considerd infusion

Question 7

What is the gold standard of allergen testing?

Answer 7

Challenge testing

Question 8

What is a non-sedative anti-histamine?

Answer 8

Cetirizine

Question 9

When are challenge tests used?

Answer 9

Usually used when RAST and SPT negative/discordant and there is a good clinic story

Question 10

What are the diagnostic tests for IgE allergy?

Answer 10

Skin prick test

Serology - CAP

Challenge test

Question 11

Who should get subcutaneous injection immunotherapy?

Answer 11

Venom allergy

Allergic rhinitis

Mild, well controlled allergic asthma

Question 12

Why do thunderstorms exascerbate allergies?

Answer 12

Storm break up pollen seeds allowing them to travel deeper into the lung

Question 13

What is the dose of adrenaline for anaphylaxis in adults and children?

Answer 13

0. 5mg in adults
1. 01mg/kg

Question 14

How does subcutaneous injection immunotherapy work?

Answer 14

Injecting allergen subcutaneously at increasing doses over longer time periods

Class switching the response to an allergen to IgG

Question 15

What are the advantages and disadvantages of in vitro assays?

Answer 15

Adv
Highly available

Safe

Specific

Standardised and quantitative

Neg

• High false positive rate
• Medicare only subsizes 4 allergen at once

Question 16

What is the new alternative to subcutaneous injection immunotherapy? What are the advantages?

Answer 16

Sublingual immunotherapy

Easier to administer

Less anaphylaxis risk

Question 17

How can you treat allergies?

Answer 17

Subcutaneous allergen immunotherapy

Question 18

What is the criteria for a positive skin prick test?

Answer 18

>3mm

Question 19

Which age group is most likely to die from anaphylaxis?

Answer 19

16-24

Question 20

What is the cardiovascular response in anaphylaxis?

Answer 20

Hypotension

Question 21

What is the mechanism of anaphylaxis?

Answer 21

Massive mediator release from mast cell and basophils

Histamine causes vasodilation, fluid extravasation, bronchial smooth muscle contraction and mucosal oedema

Question 22

What is the definition of anaphylaxis?

Answer 22

Generalised IgE-mediated response involving the cardiovascular and/or respiratory system

Question 23

How can you treat anaphylaxis?

Answer 23

Avoiding trigger

Management of inadvertent exposure

Question 24

What are some milder symptoms of anaphylaxis?

Answer 24

Pruritis

Vomiting, diarrhoea

Flashing, urticaria

Question 25

What are the major sources of fatal anaphylaxis?

Answer 25

Medications 50%

Insects 25%

Food 20%

Question 26

Define what an allergy is

Answer 26

An inappropriate or harmful immune response to foreign substances that are otherwise not harmful to the body, mediated largely, though not exclusively by immunoglobulin E (IgE)

Question 27

What are the advantages and disadvantages of the skin prick test?

Answer 27

Adv - Highly sensative (99%)

• In vivo
• Fast results

Disadv - May lack sensitivity due to sensitized but asymptomatic patients

• Potential for anaphylaxis

Question 28

How do you measure allergen specific IgE?

Answer 28

RAST (radio-allergosorbent test)

EAST