Allergy

Question 1

Eosinophilic esophagitis symptoms, dx, tx

Answer 1

Sx:
Dysphagia
Odynophagia
Wt loss
Food impaction
Emersis
Abd pain

Dx: elim diets with food introductions with EGDs

Tx: elim diet, steroids, high dose PPI

Question 2

Food protein-induced enterocolitos sx, dx, tx

Answer 2

Sx:
Acute exposure after restriction: emesis, diarrhea, hypotension with 2-6 hrs after exposure
Chronic: emesis, diarrhea, poor growth, lethargy

Labs: anemia, hypoalbuminemia, leukocytosis, acidosis, methemoglobinemia

Dx: clinical
Tx: acute with iv fluids and iv zofran

Question 3

Follow up for patients with anaphylaxis

Answer 3

4-6 weeks after intial episode need skin testing done by specialist

1-2 weeks after initial episode need tryptase level checked. If persistently elevated need referral to A/I or hematology due to assoc with underlying mastocytosis or clonal mast cell disorder

Question 4

Treatment for known radiocontrast media allergy

Answer 4

Prophylactic corticosteroids 12 hours prior

IV Benadryl immediately before contrast injection

Question 5

Pthophys of anaphylaxis

Answer 5

Mediator release from mast cells and basophils

Question 6

Anaphylaxis first line therapy and second line therapy

Answer 6

1st line:
0.01 mg/kg epinephrine (1:1000) given intramuscular you every 5-15 min as needed

Home autoinjector
<30 kg : 0.15 mg
>/= 30 kg : 0.30 mg

2nd line:
1-2 mg/kg diphenhydramine IV/IM
1-2 mg ranitidine IV/IM
Inhaled beta agonist for bronchospasm/wheeze
Corticosteroids for long term therapy

Question 7

Acura urticaria causes

Answer 7

Infectious diseases( viruses most common cause in children)
Aeroallergens, foods, meds, insects
Physical triggers: cold, pressure , heat light

Question 8

Chronic urticaria causes

Answer 8

Thyroid disease
Rheumatologist disease
Malignancy

Question 9

Tx urticaria

Answer 9

• 2nd gen antihistamines = 1st line (ceterizine, fexofenadine, loratidine)
• First generation antihistamines for breakthrough
• short course corticosteroids with high burden or poor response

Question 10

Type I hypersensitivity
Name
Mechanism
Examples

Answer 10

• Immediate
• IgE mediated activation of mast cells and basophils
• ex: ige mediated food allergy, anaphylaxis and anaphylactoid rxns, allergic rhinitis, asthma

Question 11

Type II hypersensitivity
Name
Mechanism
Examples

Answer 11

Antibody mediated
IgG or IgM
- hemolytic anemia, graves dz, myasthenia gravis

Question 12

Type III hypersensitivity
Name
Mechanism
Examples

Answer 12

Immune complex mediated
IgG and complement deposition
- SLE, glomeruloneohritis, serum sickness, Arthus reaction, vasculitis

Question 13

Type IV hypersensitivity reaction
Name
Mechanism
Examples

Answer 13

Delayed
T cell activation
Contact dermatitis, PPD testing

Question 14

Pathophys and inheritance of hereditary angioedema

Answer 14

Autosomal dominant disease due to deficiency in C1 esterase inhibitor -> dysregulation of complement pathway and intermittent episodes of swelling of various body parts

Question 15

Hereditary Angioedema Presentation, dx, Tex

Answer 15

Sx

• swelling of any body part without urticaria ( laryngeal swelling=v bad)
• episodes may be preceded by trauma
• no pruritus and rarely urticaria
• can last several days

Dx

• C4 level low when asymptomatic
• C4 lead absent during acute attacks
• C1 esterase inhibitor activity low (send as confirmatory test if C4 auspicious)

Tx
- replacement of C1 esterase inhibitor