Allergy

Question 1

Allergy general Mx

Answer 1

GP/Paediatric management
Paeds help with specific trigger avoidance
Specific allergen immunotherapy:
- allergic rhinitis + conjunctivitis
- insect sting
-anaphylaxis
- asthma

Question 2

Immunotherapy for allergy

Answer 2

solution of allergen injected sc or sublingual for 3-5y

must be done under specialist supervision (risk anaphylaxsis)

Question 3

Food allergy Mx

Answer 3

Avoidance
Education and allergy action plan
mild - non sedating antihistamine
severe - IM adrenaline
Milk and egg allergy often resolves early
nuts and seafood usually persist

Question 4

mild food allergy

Answer 4

no cardio/resp Sx

Question 5

severe food allergy

Answer 5

CVS/laryngeal/bronchial involvement

Question 6

PACES counselling of food allergy

Answer 6

Immune system reacts to substances not harmful to others 
Avoidance
discuss allergy action plan
some children grow out
non-sedating histamines and adrenaline`

Question 7

Cows milk protein allergy Ix

Answer 7

Clinical dx
consider skin prick and or specific IgE
Refer all confirmed cases to paed. dietician
monitor growth regularly
re-evaluate 6-12monthly w/Milk ladder

Question 8

Cows milk protein allergy Mx breastfed

Answer 8

Strict cows milk elimination for 6m or until child is 9-12m
If bf mother should avoid too
(consider daily 1000mg calcium and 10mcg vitD)
When weaning use extensively hydrolysed formula until 12 months of age or for at least 6m

Question 9

Cows milk protein allergy Mx formula fed

Answer 9

Strict cows milk elimination

replace w/hypoallergenic infant formula (extensively hydrolysed/AA if severe)

Question 10

Cows milk protein allergy Mx weaned

Answer 10

exclude cows milk from diet

Question 11

PACES counselling of cows milk allergy

Answer 11

Allergic reaction to proteins in milk
5-15% of infants
Mx: avoidance (inc mother if bf) (vitamin D/Ca supplements)
many will grow out, 6-12m testing
Monitor growth regularly
Support: british dietetic association

Question 12

Allergic rhinitis Ix

Answer 12

Assess for sx of asthma
Identify causal allergen
Look for signs of chronic nasal congestion
Examine for nasal polyp, deviated septum

Question 13

Allergic rhinitis if prefer as required Mx

Answer 13

age 2-5 or preference for oral Mx = oral antihistamine (certizine)
others: intranasal azelastine (anti-hisatmine)

Question 14

Allergic rhinitis if prefer preventative Mx for frequent Sx

Answer 14

avoid cause
if main issue blockage or polyp then intranasal corticosteroid (beclometasone)
if main issue sneezing or discharge: oral antihistamine or instranasal corticosteroid

Question 15

Allergic rhinitis Mx for pts wanting rapid relief while waiting for preventative Mx to take effect

Answer 15

IN corticosteroids for up to 7d
consider oral antihistamine
if Sx severe try 5d pred

Question 16

Urticaria and angiooedema

Answer 16

Identify and manage underlying triggers
Symptom diary
likely to be self limiting
If Sx:
antihistamine up to 6w
if severe: short course PO corticosteroid
Refractory cases: LTR antagonists, anti-IgE antibodt

Question 17

Urticaria monitoring

Answer 17

severity tool = urticaria activity score