Allergy

Question 1

How do you confirm penicillin allergy?

Answer 1

Penicillin skin testing + oral challenge (if skin test positive, avoid penicillins).

Question 2

How do you differentiate angioedema from triggers vs hereditary/ACEi angioedema?

Answer 2

Hereditary/ACEi angioedema not associated with pruritis or urticaria.

Question 3

What are symptoms and lab findings of combined variable immunodeficiency? How do you treat?

Answer 3

Recurrent sinopulmonary infections
Low IgG, IgA or IgM AND poor response to vaccinations

Treat with IVIG or subcutaneous immunoglobulin

Question 4

What are symptoms of urticaria?

Answer 4

Triggered by common antigens
Last typically < 48hrs (if >6 weeks without clear trigger, may be chronic spontaneous urticaria)
Heal without skin changes
Pruritis

If not consistent, need to look for autoimmune diagnoses

Question 5

What is the diagnostic criteria for anaphylaxis?

Answer 5

Possible allergen + 
Skin/mucosa + ONE of
Resp
HoTN
End organ dysfunction

Known allergen + HoTN

Question 6

What is the IM and IV dose of epinephrine to treat anaphylaxis?

Answer 6

IM 0.01mg/kg (1:1000 dose, 1mg/ml) max 0.5mg

IV: 0.05-0.1mg IV bolus over 5 minutes then infusion (1:10000 dose, 0.1mg/mL)

Question 7

What is Leser-Trelat sign?

Answer 7

Acute appearance of multiple seborrheic keratoses along with skin tags and acanthosis nigricans. Associated with GI and lung malignancy.