Allergy Flashcards by Hazel Baconga

feature of atopic dermatitis
prominent infraorbital skin folds that extend in an arc from the inner canthus beneath and parallel to the lower lid margin.

Dennie-Morgan folds (Dennie lines)

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unique feature of atopy and APCs

Presence of allergen-specific IgE on the cell surfaces of Antigen presenting cells

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location of mast cells

adjacent to blood vessels and beneath epithelial surfaces that are exposed to the external environment, such as the respiratory tract, gastrointestinal tract, and skin

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early-phase response

immediate response after allergen is introduced
characterized by mast cell degranulation and release of preformed mediators, occurring within an immediate time frame of between 1 and 30 min after allergen exposure and resolving within 1-3 hr

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late-phase response

can occur within hours of allergen exposure, reaching a maximum at 6-12 hr and resolving by 24 hr

Late- phase responses are characterized in the skin by edema, redness, and induration; in the nose by sustained nasal blockage; and in the lung by airway obstruction and persistent wheezing

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third phase/chronic allergic disease

tissue inflammation can persist for days to years.

recurrent exposure to allergens and microbial agents contribute

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a single-gene disorder associated with erythroderma, food allergy, and high serum IgE levels

serine protease inhibitor

Netherton disease

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fetus capable of producing igE at

11th wk AOG

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igE levels peak at

10 years old

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presence of IgE specifc for a particular allergen can be documented ]by the measurement of allergen-specific IgE (sIgE) levels in the serum

radioallergosorbent test RAST previously but now automated enzymatic sIgE immunoassays

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intradermal test not used for food allergies because of risk of

anaphylaxis

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how long should antihistamines be stopped prior to skin test

3-10 days

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performed to document the presence and degree of bronchial hyperreactivity in a patient in whom asthma is suspected

Methacholine challenge

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isomer of salbutamol developed to reduce adverse effects

levalbuterol

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moa of anticholinergic drugs ie ipratropium

antagonize acteylcholine at muscarinic receptors

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ETHYLENEDIAMINES

First-generation

Antazoline, pyrilamine, tripelennamine

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TYPE II ETHANOLAMINES

First-generation

Carbinoxamine, clemastine, diphenhydramine

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TYPE III ALKYLAMINES

First-generation

Brompheniramine, chlorpheniramine, triprolidine

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TYPE III ALKYLAMINES

Second-generation

Acrivastine

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TYPE IV PIPERAZINES

First-generation

Cyclizine, hydroxyzine, meclizine

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TYPE IV PIPERAZINES

Second-generation

Cetirizine, levocetirizine

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TYPE V PIPERIDINES

First-generation

Azatadine, cyproheptadine, ketotifen

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TYPE V PIPERIDINES

Second-generation

Fexofenadine, loratadine, desloratadine

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TYPE VI PHENOTHIAZINES

First-generation

Methdilazine, promethazine

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toxic effect of theophylline when

exceed 20mcg/ml

moa of theophylline

phosphodiesterase inhibitor

laba used in kids. _ yrs old

>4yrs old

Allergen immunotherapy is reserved for patients with

an allergic disease demonstrated to respond to this form of therapy, such as sea-sonal or perennial allergic rhinoconjunctivitis, asthma triggered by allergen exposures, and insect venom sensitivity

allergen immunotherapy is not used for

treatment of food allergy, atopic dermatitis, latex allergy, and acute or chronic urticaria

risk factors for allergic rhinitis

family history of atopy serum immunoglobulin > 100 IU/mL before age 6 yr mothers smoke heavily heavy exposure to indoor allergens.

occurence of __ or more episodes of rhinorrhea in first year of life is associated with AR at _ yrs old

3 times | 7 yrs old

to avoid false negative skin test for allergy | how long should meds be stopped

montelukast should be withheld for 1 day most sedating antihistamine preparations for 3-4 days and nonsedating antihistamines for 5-7 days

most common cause of visit to ER

asthma

worlwide asthma prevalence is inc or dec

increasing

80% of asthmatic report symptoms prior to _yrs old

aside from allergens, what else can trigger asthma

hyperventilation (laughing, exercise) cold or dry air airway irritants urti

onset of exercise induced asthma

within 15 mins | resolve in 30-60mins

true or false | asthma severity is assessed only once

true

true or false | asthma control is assessed only once

false

how often should we evaluate asthmatics

every 2-6 weeks

asthmatic patient must exhibit good control for __ months before you can step down treatment

3 months

if a child has very poorly controlled asthma, how to manage?

go 2 steps up short course oral steroids reassess after 2 weeks

most commmon side effects of ICS

oral candidiasis | dysphonia

which is the active form: prednisone or prednisolone

prednisolone Prednisone is an inactive prodrug that requires biotransformation via firrst-pass hepatic metabolism to prednisolone

which drugs increase the metabolism of steroids

phenytoin phenobarbital carbamazepine

which drugs decrease the metabolism of steroids

ketoconazole | oral contraceptive

drugs that can delay theophylline clearance

``` macrolide cimetidine oral antifungal agent oral contraceptive, eukotriene synthesis inhibitor ciprofloxacin ```

criteria for discharging patient from ER after asthma exacerbation

sustained improvement in symptoms, normal physical ndings, PEF >70% of predicted or personal best, an oxygen saturation >92% while the patient is breathing room air for 4 hr

discharge instructions patient from ER after asthma exacerbation

inhaled β-agonist up to every 3-4 hr plus a 3-7 day course of an oral corticosteroid

what is starting MV settings in respi failure due to asthma (volume)

short inspiratory and long expiratory times, 10-15 mL/kg tidal volume, 8-15 breaths/min, peak pressures <60 cm H2O, and without positive end-expiratory pressure

asthma severity by the ages of _ yr is predictive of asthma persistence in adulthood

7-10 years old

atopic dermatitis presents in infancy | __% in 1st year of life

50%

fibrotic papules

prurigo nodularis

3 features of atopic dermatitis

pruritus eczema relapsing or chronic

high potency corticosteroids should not be used

on face | intertriginous areas

rank by potency most potent to least potent mometasone ointment, mometasone cream, betamethasone, fluticasone ointment, desonide, hydrocortisone ointment, hydrocortisone cream

``` 1 betamethasone 2 mometasone ointment 3 fluticasone ointment 4 mometasone cream 5 hydrocortisone ointment 6 desonide 7 hydrocortisone cream ```

recurrent viral skin infection caused by HSV eruption of multiple itchy vesicopostular lesions that are umbilicated and tend to crop

kaposi varicelliform eruption | or eczema herpeticum

withdrawal of systemic glucocorticoid used to control severe AD causes generalized redness, scaling, weeping, crusting, systemic toxicity, lymphadenopathy, and fever,

exfoliative erythroderma

transient yellow white spots in Allergic conjunctivitis

trantas dost - in limbus | horner points - conjunctivae

life threatening form of edema deficient c1 inhibitor activity deep seated edema laryngeal edema with ab pain

hereditary angioedema

small, yellow-tan to reddish brown macules or raised papules that urticate on scratching

Darier sign -> Urticaria pigmentosa -> mastocytosis manifestation

dominantly inherited conditions associated with recurrent urticaria-like lesions, arthritis and joint pain that usually appears in adolescence, progressive nerve deafness, recurrent fever, elevated ESR, hypergammaglobulinemia, renal amyloidosis, and a poor prognosis

Muckle-Wells syndrome | familial cold autoinflammatory syndrome

lab test in anaphylaxis

plasma B tryptase

__% of biphasic reactions in anaphylaxis occur in _ hrs

90% | 4 hours

which complement implicated in serum sickness

c3a | c5a

complications of serum sickness

carditis glomerulonephritis guillain barre syndrome peripheral neuritis

milk allergies develop by

12 months

egg allergies develop by

18 months

peanut allergies develop by

14 months

allergy that typically manifests in the first several months of life as irritability, intermittent vomiting and protracted diarrhea, and may result in dehydration

food protein–induced enterocolitis syndrome (FPIES)

allergy that manifests in the first several months of life as diarrhea, often with steatorrhea and poor weight gain

Food protein–induced enteropathy

allergy that presents in the first few mo of life as blood-streaked stools in otherwise healthy infants

Food protein-induced proctocolitis

most common cause of Food protein–induced enteropathy

cows milk allergy

may appear from infancy through adolescence, more frequently in boys cell mediated chronic GER intermittent emesis, food refusal, abdominal pain, dysphagia, irritability, sleep disturbance, and failure to respond to medications

eosinophilic esophagitis

what food allergies will you not outgrow

peanut, seafood, nut

most common drugs that cause rash

ampicillin amoxicillin cotrimoxazole penicillin

epidermal detachment of __% is suggestive of SJS, ___% detachment suggests TEN, and ___% detachment suggests overlap

10% SJS 30% TEN 10-30 overlap

skin biopsy difference between TEN and SSSS

TEN- subepidermal cleavage | SSSS - intraepidermal cleavage

``` fever, maculopapular rash, facial edema, eosinophilia, generalized lymphadenopathy, and potentially life-threatening damage of 1 or more organs, usually renal or hepatic delayed onset (usually weeks) ```

Drug-induced hypersensitivity syndrome | DRESS

drugs implicated in DRESS

Phenytoin, carbamazepine, phenobarbital, sulfonamides, allopurinol, minocycline, nitrofurantoin, terbinafine, vancomycin, dapsone, abacavir, nevirapine, nonsteroidal antiin ammatory drugs (NSAIDs)