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2019 RC Specialties > Allergy > Flashcards

Allergy Flashcards

1
Q

What allergies respond to immunotherapy:

A
  • venom sensitivity (sting)
  • seasonal allergic rhino conjunctivitis
  • asthma triggered by allergen
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2
Q

Can treated by immunotherapy?

  • food allergy
  • bee sting
  • pen allergy
  • atopic dermatitis
  • cholinergic urticaria
A

Bee Sting

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3
Q

T or F: allergen immunotherapy is recommended for kids < 5.

A

False.

  • increased risk of systemic rxn and difficulty treating anaphylaxis in this age
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4
Q

List 3 contraindication to immune therapy

A
  • Beta blocker
  • ACEI
  • Allergic bronchopul aspergillosis
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5
Q

What is the interval btwn IVIG and live vaccination?

A

11 month.

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6
Q

IVIG can be given in EXCEPT:

  • ITP
  • bone marrow transplant
  • nephrotic syn
  • KD
  • GBS
A

? Nephrotic syn

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7
Q

What is RAST?

A

Radioallergosorbent test
= Allergen specific IgE

Skin test has low (+) predictive value so definitive test= quantitive IgE= RAST.

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8
Q

T or F: skin testing is more sensitive than RAST.

A

True.

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9
Q

T or F: RAST is preferred for food allergies.

A

False

(-) skin test R/O IgE form of food allergy= prefer as more sensitive.

BUT most (+) do not react when ingested so definitive testing followup.

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10
Q

T or F: RAST false (+) can occurs in kids with hyper-IgE states.

A

True.

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11
Q

What is the benefit of RAST compared to skin testing:

A
  • no risk allergic rxn
  • not affected by med
  • no reliant on skin integrity

Limit: only certain allergen (food, insect, venom, environment, med)

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12
Q

13 month old with rash + diarrhea w/ intro of new foods. Most likely?

A

Carb intolerance.

  • loose stool, abdo pain
  • typically w/ onset new food (fruit)
  • sucrase-isomaltase deficiency (milk fine but sucrose and start get symptoms. Rx sacrosidase/ Sucraid)
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13
Q

Kid w/ peanut rxn. IgE test ordered. Why:

  • RAST more sensitive
  • RAST good predictor of future
  • don’t have to stop montelukast
  • prevent systemic rxn that could happen w/ skin
A

Prevent systemic rxn that could result from skin test.

  • you don’t have to stop montelukast for either; antihistamine do affect skin
  • denote sensitized state but NOT equivalent to severity
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14
Q

2 advantage for skin test and 1 disadvantage:

A

Adv:

  • fast
  • good sensitivity

Disadv:

  • affected by antihistamine
  • affected by extensive dermatitis
  • risk of allergic rxn
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15
Q

T or F: Long term F/U show allergic rhinitis persist into adulthood.

A

True.

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16
Q

T or F: indoor mould is NOT a trigger for allergic rhinitis.

A

False.

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17
Q

T or F: most kids with allergic rhinitis will develop asthma.

A

False.

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18
Q

T or F: perennial rhinitis due to ingested rather than inhaled allergen.

A

False.

Mainly inhaled.

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19
Q

Best therapy for perennial allergic rhinitis:

A

Avoid exposure to allergy

Hamilton: best therapy- intranasal steroid chosen over avoidance as not always easy.

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20
Q

Best med for allergic rhinitis:

A

intranasal steroids (most effective)

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21
Q

list 3 signs off P/E expected to see with kid with runny nose and itchy eyes in summertime:

A
  1. Allergic Shiners
  2. Dennie Lines
  3. Transverse nasal crease
  4. Pale boggy nasal turbinates (compared to beefy red)
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22
Q

Name two adv to 2nd generation anti-histamine:

A

= less likely CNS effect (less sedating)
= quick onset
= longer acting

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23
Q

Mom worried about allergic rhinitis- 4 things on hx that suggest this?

A
  • seasonal
  • specific environmental trigger (dust, dander)
  • (+) fhx
  • maneuver= allergic salute (rubbing), allergic cluck , allergic conjunctivitis
  • (+) pmhx atopy
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24
Q

What is the definition of anaphylaxis?

A
  1. Acute w/ skin or mucosa AND one of:
    - resp
    - low BP

OR

  1. **Two after likely allergen:
    - Skin/mucosal
    - Resp
    - Low BP
    - persistent GI

OR

  1. reduce BP after KNOWN exposure (low systole or > 30% drop systolic)
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25
Q

What is dose for epi in anaphylaxis?

A

1: 1 000
0.01 mg/kg IM lateral thigh.
q5-15 minute.

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26
Q

What is the CPS anaphylaxis algorithm:

A
  1. Epi 1 in 1K 0.01mg/kg IM thigh. Max 0.5mg. Repeat q5
  2. ABC- O2, monitor, IV access x 2
    > Airway concern= prep intubation
    > Circulatory concern= bolus NS 20 cc/kg
  3. 2nd line med:
    > PO/IV H1 and H2 antagonist
    > IV steroids
    > Salbutamol
  4. Reassess.
    Must observe min. 4-6 hour.
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27
Q

Why give epi IM thigh?

A
  • higher peak plasma than arm
  • IM faster
  • SC may cause local vasoconstrictor = inhibit absorption
  • IV dosing can be off and cause significant AE
28
Q

T or F: benadryl can be given IV, IM, PO

A

True.

29
Q

Which route should you always give epi in anaphylaxis?

A

IM

Lateral thigh.

30
Q

Most common cause of anaphylaxis out of hosp? In hospital?

A

Food

  • most common= milk, egg
  • most potent= peanut, tree nut

> bee wasp

> Med

In hosp= med, latex

31
Q

T or F: plasma tryptase is reliable BW for anaphylaxis.

A

False.
No reliable BW

Tryptase will stay elevated but not in food-induced.

32
Q

List 4 preventive recommendation for anaphylaxis to cow’s milk:

A
  1. Allergen avoidance
  2. Education re: anaphylaxis symptoms
  3. Epi-Pen
  4. Emergency Plan
33
Q

Name 4 Patient RF for anaphylaxis:

A
  1. infant or teen
  2. asthma
  3. beta blocker or ACEI
  4. exercise or fever
34
Q

What is acute versus chronic urticaria def’n?

A

Acute < 6 wk
- likely food, med, sting, infection

Chronic > 6 wk

  • like idiopathic, physical (inducible like dermatographism, cold, solar), AI (thyroid, SLE, JIA)
  • CBC, U/A, LFT, thyroid, ESR +/- other
35
Q

What is main treatment for urticaria:

A
  1. Remove trigger
  2. Histamine blocker
    1st choice= Cetirizine
  3. Max out H1 then H2 (ranitidine)
  4. Steroids if severe angioedema or not responsive to H1, H2
36
Q

What is tx of chronic urticaria if failed h1 antihistamine?

A

H2 antihistamine.

37
Q

Recurrent facial + ear swelling. FHX of same. Non pruritic. Likely Dx?

A

C1 esterase deficiency

= hereditary angioedema
- AD
- swell over 1.5 day
OR bout of abdo pain
- low C4 level
Dx: C1 level
Tx: replenish C1 inhibitor
38
Q

Which is true of pen anaphylaxis:

  • IgG against major determinant
  • IgG against minor
  • IgE against minor
  • IgE against major
  • IgM against major
A

IgE against major

39
Q

13 mon. diarrhea + diaper rash.

  • cow’s milk protein allergy
  • carb intolerance
  • immunodeficiency
A

Carb intolerance

40
Q

T or F: all milk allergy develop by 12 months of age.

A

True.

41
Q

Describe food protein (FP) induced enterocolitis syndrome versus FP induced protocolitis versus FP induced enteropathy?

A

FP induced enterocolitis:

  • 1 wk-3 mo; up to 1yr
  • hr after cow’s milk
  • V/D, bloody stool, edema, FTT
  • casein hydrolysate
  • symp. improve 3-10d
  • resolve by 2 y.o.

FP induced enteropathy:

  • cows milk sensitivity common till 2 y.o.
  • diarrhea, FTT, low alb
  • rarely bloody stool
  • celiac most severe
  • Protein elimination; symp clear in 1-3 weeks
  • rechallenge in 1-2 yr; most resolve by 2-3 y.o.

FP induced protocolitis:

  • seen in first 6 mo.
  • only bloody stool
  • bloody streak food
  • casein hydrolysate
  • resolve by 9-12
  • reintroduce over 2 wk
42
Q

What is toddler’s diarrhea:

A 
9-24 mo.
explosive stool w/ flecked food particle
no blood
excessive juice, low fat, low fibre
clinical dx
limit fluid, increase dietary fat
43
Q

How do you treat poison ivy?

A
  1. Wash skin and other items that may be contact
  2. Systemic antihistamine
  3. Topical steroids (mild-moderate typically)
44
Q

List 2 cutaneous skin findings in anaphylaxis:

A

Urticaria
Angioedema
Pruritus
Flushing

45
Q

List 2 resp skin findings in anaphylaxis:

A 
Rhinorrhea
Congestion
Hoarseness
Stridor
Cough
Wheeze
SOB
46
Q

List 2 GI skin findings in anaphylaxis:

A

Vomiting
Diarrhea
Abdo Pain

47
Q

List 2 CVS skin findings in anaphylaxis:

A

Tachy HR
Low BP
Lethargy
LOC

48
Q

When would you give IV epi for anaphylaxis?

A
  • 3 doses IM
  • persistent low BP despite 20cc/kg NS bolus

Goal: titrate until normal BP

Remember: change concentration (1 in 10K) titrate till normal BP.

49
Q

What do you if patient w/ anaphylaxis on beta blocker and resistant to epi?

A

Glucagon Bolus

50
Q

Antihistamines work on which system in anaphylaxis?

A

Cutaneous

If no vomit= use cetirizine PO
If vomit= diphenhydramine

51
Q

List risk factors for anaphylaxis biphasic response

A

Severe symptom at ppt
Delayed epi
> 1 epi dose

52
Q

Which is true regarding serum specific IGE?

  • more sensitive
  • affected by steroid
  • affected by antihistamine
  • false (+) if elevated total IgE
A

False (+) in pt with elevated total IgE

53
Q

How do you prevent food allergy in high risk infant (1st degree relative w/ atopy)

A
  • No dietary restriction in pregnancy/BF
  • BF exclusive x 6 mo
  • hydrolyzed formula if not BF
  • do not delay intro to specific food (including allergenic) > 6 mo.
  • regular new intro (several time per week) key to keep up maintenance
54
Q

When do you offer allergy testing and possible immunotherapy for stings or bites?

A

Anaphylaxis

OR

> 16 AND high (frequent exposure) AND generalized cutaneous rxn

55
Q

6 y.o. on amox. After 10d- arthritis, rash, fever. Management:

  • NSAID
  • Pred
  • IVIG
  • Plasmaphoresis
A

Serum Sickness Like.

Severe= Pred

56
Q

What is the cross reactivity between pen and cephalosporin?

A

2%

57
Q

Get same red spot in exact same area every time med taken. Dx?

A

Fixed drug eruption.

Tx: D/C med
Topical steroid, antihistamine

58
Q

What is serum sickness?

A

1-3 wk post drug

Rash
Fever
Arthralgia/arthritis

Low complement

D/C med
Steroids if severe

59
Q

What is the diff between serum sickness like and serum sickness?

A

SS- Like:

  • Cefaclor, Pen common
  • NO renal dx
  • NORM complement
60
Q

Patient w/ egg allergy need flu shot.

  • Allergy test
  • Vaccine split dose
  • Full dose
  • No vaccine
A

Full dose

61
Q

What vaccine can people allergic to eggs NOT get?

A

Yellow fever vaccine.

Need skin testing prior to vaccine given.

62
Q

Teenager has tingling/pruritus in mouth w/ apple + peace. Best test for dx?

  • skin prick apple, peach
  • serum specific IgE apple, peach
  • oral food challenge
  • skin test to birch
A

Skin test to birch pollen

** oral allergy syndrome

63
Q

How do you treat oral allergy syndrome?

A
  • pollen testing +/- fresh fruit testing (IgE useless)
  • AVOID raw food; can have cooked
    • Epi pen (esp if high risk peanut allergy or systemic rxn)
64
Q

How do you confirm milk intolerance?

  • D-xylose
  • jejunal bx
  • milk RAST
  • serum IgE
  • milk challenge
A

Milk Challenge

65
Q

Drug non IgE reaction. Likely immune mech:

  • type 1
  • type 2
  • type 3
  • type 4 hypersensitivity
A

type 3

66
Q

T or F: You can give diphenhydramine IV or PO only.

A

False.

IM too.

2019 RC Specialties (31 decks)

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