Allergy and Immunology

Question 1

Adrenaline dose for anaphylaxis in children under the age of 6?

Answer 1

150 micrograms IM of 1:1000 adrenaline (0.15ml)

Question 2

Adrenaline dose for anaphylaxis in children aged 6-12 years?

Answer 2

300 micrograms IM of 1:1000 adrenaline (0.3ml)

Question 3

Adrenaline dose for anaphylaxis in children aged over 12 years?

Answer 3

500 micrograms IM of 1:1000 adrenaline (0.5ml)

Question 4

When should a patient with a food allergy be given an epipen?

Answer 4

• previous severe systemic reaction
• allergy to high risk allergen e.g. nuts/sesame, with other RFs e.g. asthma, even if relatively mild reaction
• reaction to trace amounts of allergen/trigger
• those who cannot easily avoid the allergen
• idiopathic anaphylaxis
• those with continuing risk of anaphylaxis e.g. food-dependent exercise induced
• significant co-factors e.g. asthma in food allergen, raised serum tryptase in venom allergy

Question 5

When to refer to allergy clinic in suspected reaction to an insect bite or sting?

Answer 5

if they have had, or suspected of having a systemic reaction to the insect bite/sting e.g. widespread erythema/itching, urticaria and/or angioedema.

Question 6

When should venom allergy be tested for?

Answer 6

In any patient with hx of systemic reaction causing airway compromise or haemodynamic instability after an insect bite/sting

Question 7

When might skin prick tests not be suitable for a patient?

Answer 7

• already taking antihistamines
• extensive eczema
• hx of anaphylaxis to allergen

Question 8

Medications commonly responsible for causing angioedema?

Answer 8

ACE inhibitors
Angiotensin II receptor blockers
NSAIDs

Question 9

RFs for cows milk protein allergy?

Answer 9

male sex
other food allergy
PH of atopy
FH of food allergy
FH of atopy

Question 10

If suspected IgE mediated cows milk protein allergy, whilst awaiting specialist assessment what could be trialed if infant is formula fed or mixed feeding and Mum can’t return to exclusive breastfeeding?

Answer 10

extensively hydrolysed formula (EHF)-1st line hypoallergenic infant formula

Question 11

Gold standard test for diagnosis of food allergy?

Answer 11

oral food challenge

Question 12

Initial management of suspected non IgE mediated cows milk protein allergy if referral to specialist allergy clinic not needed?

Answer 12

• 2-4 week trial elimination of all cows milk from mothers/infants diet.
• if formula fed or mixed fed then replace with hypoallergenic infant formula-EHF if mild non-IgE allergy, AAF if severe non-IgE allergy suspected e.g. failure to thrive.
• if clear improvement in sx after trial then arrange home reintroduction of cows milk to confirm the diagnosis.

Question 13

How is confirmed non-IgE mediated cows milk protein allergy managed?

Answer 13

• referral to specialist allergy clinic if severe allergy
• ensure referral to dietician
• strict adherence to cows milk protein free diet for mother/infant until child is 9-12 months old and for at least 6 months.
• following this then planned home reintroduction of cows milk to see if tolerance has developed (NOT if child has signs of current atopic eczema or hx at any time of immediate onset sx). Use milk ladder-baked milk products reintroduced first. If sx return on reintroduction should go back to cows milk protein free diet and should re evaluate after 6-12 months.