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Medicine Dermatology > Allergy and the Skin > Flashcards

Allergy and the Skin Flashcards

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Dermatology Board Prep flashcards
1
Q

Skin symptoms in IgE mediated food allergy

A

Pruritus
Erythema
Acute urticaria
Acute angioedema

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2
Q

GI symptoms in IgE mediated food allergy

A 
Angioedema 
Oral pruritis
Nausea
Colicky abdominal pain
Vomiting
Diarrhoea
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3
Q

Respiratory tract symptoms in IgE mediated food allergy

A

URT - nasal itching, sneezing, rhinorrhoea, congestion

LRT - cough, chest tightness, wheezing, SOB

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4
Q

Skin symptoms of non-IgE mediated food allergy

A

Pruritus
Erythema
Atopic eczema

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5
Q

GI symptoms of non-IgE mediated food allergy

A 
GORD
Loose or frequent stools
Blood and/or mucus in stools
Abdominal pain
Infantile colic
Food refusal or aversion
Constipation
Perianal redness
Pallor and tiredness
Faltering growth
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6
Q

Allergy focused clinical history

A

History of atopic disease (personal and family)
Details of food avoided and why
Presenting symptoms and other symptoms that may be associated with food allergy
Cultural and religious factors that can affect an individual’s diet
Who has raised the concern and suspects food allergy?
What caused the allergen to be suspected?
Child feeding history incl. age of weaning and whether breast/formula fed
Details of previous treatment
Any response to elimination and reintroduction of foods

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7
Q

Questions relating to presenting symptoms and other symptoms that may be associated with food allergy

A

Age at first onset
Speed of onset
Duration, severity and frequency
Setting of reaction (school/home)
Reproducibility of symptoms on repeated exposure
What food and how much exposure to it causes a reaction

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8
Q

Urticaria features

A

Erythema with well-defined edge, smooth surface and can be treated with antihistamines

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9
Q

Eczema features

A

Ill-defined erythema with a scaly surface that can be treated with topical steroids and emollients

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10
Q

3 step plan for acute allergic reaction

A 
1 = at first sign of reaction, give chlorophenamine (antihistamine)
2 = if allergic reaction does not resolve or gets worse over the next 30 minutes, seek urgent medical help and give prednisolone 1-2mg/kg
3 = if becomes blue or collapses, give adrenaline IM and dial 999
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11
Q

Diagnosis of food allergy

A

Clinical history very important
Specific IgE
Skin prick testing
Food challenge - gold standard

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12
Q

Specific IgE testing in the diagnosis of food allergy

A

Blood sample is taken and tested in lab. Measures level of IgE in the blood sample that can react to suspected allergen

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13
Q

Why is specific IgE testing not totally reliable?

A

The level of IgE in the blood does not correlate to the severity of food allergy

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14
Q

Skin prick testing in the diagnosis of food allergy

A

Small amount of suspected allergen is put onto skin and a small needle is used to push a small amount into the dermis. If allergy is present then a wheal will be seen
There must be a negative and positive control - negative = water, positive = histamine

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15
Q

Most common food allergens

A 
Cow's milk
Chicken egg
Soya
Tree nuts
Fish
Shellfish
Peanuts
Wheat
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16
Q

Types of food intolerance

A

Intolerance to unknown mechanisms
Pharmacological intolerance
Enzymatic intolerance

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17
Q

What is pharmacologic intolerance?

A

Intolerance to naturally occurring substances in food

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18
Q

Example of an intolerance to unknown mechanisms

A

To food additives

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19
Q

Examples of pharmacological intolerance

A

Histamine, salicylates, caffeine, theobromine

20
Q

Example of enzymatic intolerance

A

Lactose intolerance

21
Q

GI symptoms in mild to moderate non-IgE mediated cow’s milk allergy

A 
Vomiting
Reflux
Unsettled
Loose stools
Constipation
Abdominal discomfort
Blood or mucous in stools
22
Q

Skin symptoms in mild to moderate non-IgE mediated cow’s milk allergy

A

Pruritus
Erythema
Eczema

23
Q

When will a reaction occur in mild to moderate non-IgE mediated cow’s milk allergy?

A

2-72 hours after ingestion of cow’s milk protein. Usually seen in formula fed babies at onset of formula feeding

24
Q

GI symptoms in IgE mediated cow’s milk allergy

A

Vomiting
Diarrhoea
Abdominal pain

25
Q

Skin symptoms in IgE mediated cow’s milk allergy

A

Acute pruritus
Urticaria
Angioedema
Acute flaring of dermatitis

26
Q

Respiratory symptoms in IgE mediated cow’s milk allergy

A

Acute rhinitis
Conjunctivitis
Anaphylaxis if severe

27
Q

When will a reaction occur in IgE mediated cow’s milk allergy?

A

Within minutes of ingestion of cow’s milk protein

28
Q

How long should a cow’s milk free diet be followed for after the diagnosis of cow’s milk allergy?

A

For 9-12 months, at least 6 months

29
Q

Extensively hydrolysed formula

A

Contain cow’s milk proteins that have been broken down into very short pieces and therefore do not trigger an allergic reaction

30
Q

Why are rice milks not recommended for children <5 years

A

Due to increased arsenic content

31
Q

Comfort milks

A

Milks with lower lactose content and are partially hydrolysed, making them easier to digest

32
Q

What are comfort milks marketed for?

A

Management of colic

33
Q

Anti-reflux milks

A

Milks containing a feed thickener with the aim of helping them stay in the stomach

34
Q

Cause of pellagra

A

Vitamin B3 deficiency

35
Q

What foods can you get vitamin B3 from?

A

Meat
Fish
Eggs
Fortified cereal and grains

36
Q

Clinical features of pellagra

A 
3 Ds:
Dermatitis
Diarrhoea
Delirium/Dementia 
(can also lead to Death if untreated)
37
Q

What is pellagra characterised by?

A

Photosensitive dermatitis affecting regions of the skin exposed to sunlight, heat and friction

38
Q

Routes of exposure in type I allergy

A

Skin contact (animal dander, latex)
Inhalation (pollen, house dust mite)
Ingestion (nuts, seafood)
Injection (bee sting, medication)

39
Q

Clinical presentation of type I allergy

A

Urticaria
Angioedema
Wheezing/asthma
Anaphylaxis

40
Q

Angioedema

A

Localised swelling of subcutaneous tissue or mucous membranes
Non-pitting oedema

41
Q

Management of type I allergy

A

Allergen avoidance
Antihistamines as first line
Anti-inflammatory (corticosteroid) as second line
Adrenaline injector (for anaphylaxis) third line or first line if signs of anaphylaxis
Sodium cromoglycate to block mast cell activation
Immunotherapy
Medical alert bracelet
Information and education

42
Q

Dose of adrenaline injector for children and adults

A 
Children = 150 micrograms
Adults = 300 micrograms
43
Q

Describe the process of patch testing

A 
Allergens prepared on Finn chambers
Finn chambers applied on back
Remove after 48 hours
Readings at 48 and 96 hours
Specificity and sensitivity 70-80%
44
Q

What causes irritant contact dermatitis?

A

Contact with agents that abrade, irritate and traumatise the skin directly

45
Q

Examples of irritant contact dermatitis

A

Nappy rash and lip lick dermatitis

46
Q

Conditions associated with endogenous dermatitis

A

Atopic eczema

Psoriasis

47
Q

Management of dermatitis

A 
Allergen/irritant avoidance/minimisation
Emollients
Topical steroids
UV phototherapy
Immunosuppressants

Medicine Dermatology (19 decks)

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