Allergy

Question 1

What is the order of the allergic march

Answer 1

Dermatitis (eczema)
Food
Asthma
Rhinitis

Question 2

What are examination findings of a child with allergy?

Answer 2

mouth breathing (rhinitis)
allergic salute (rubbing nose upwards - due to nose being itchy)
hyper inflated chest, Harrison sulci (chronic underrated asthma)
atopic eczema on limb flexures9
allergic conjunctivitis

Question 3

How di you investigate food allergy?

Answer 3

Skin prick test
Patch testing (delayed contact hypersensitivity)
Specific IgE antibodies

Question 4

How do you manage food allergies

Answer 4

avoid relevant food
allergy action plan - to manage allergic attack
mild reactions - antihistamine
severe reactions - IM adrenaline (EpiPen)

Question 5

Cows milk protein allergy presenttion

Answer 5

Immediate (IgE - T1)
Delayed (T4)

Gi sx: vomiting, abdo pain, blood in stool, diarrhoea
Skin: hives, eczema
babies: wheezing, irritability, poor growth, facial swelling

Question 6

What is management for cow milk protein allergy

Answer 6

refer for skin prick or IgE antibody

Implement strict cows milk elimination diet:

• if breastfed: mum must eliminate
• Formula fed: replacement of cows milk based formal with hypoallergenic infant formula
• weaned infants: replace cows milk with alternatives

Question 7

What are 2 possible timing patterns of rhinitis?

Answer 7

seasonal

perennial

Question 8

how do you manage allergic rhinitis

Answer 8

AS REQUIRED:

• oral antihistamine e.g. cetirizine if preference for oral
• OR intranasal azelastine

PREVENTATIVE TX:

• avoid causative agent
• intranasal corticosteroid (beclomethasone) if nasal block
• oral antihistamine or IN corticosteroid if sneezing / nasal discharge

Question 9

What is management of urticaria

Answer 9

identify triggers
non-sedating antihistamine (cetirizine)
OR oral corticosteroid
consider germ referral

Question 10

What tool can you use to grade urticaria

Answer 10

Urticaria activity score UAS7