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RACP Written Exam Cram Series > Allergy Cram > Flashcards

Allergy Cram Flashcards

1
Q

When NOT to use allergen specific IgE tests?

A

Tolerating food without IgE reaction
Food “intolerance”
Chronic idiopathic urticaria

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2
Q

Contraindication to oral food challenge?

A

Skin prick test >3mm positive
ssIgE >0.35
Recent hx of reaction

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3
Q

What medications to withhold pre-skin prick testing?

A

Oral antihistamines - 5 days
Some antidepressants (amitriptyline, mirtazepine) - 7 days
Antipsychotics (Quetiapine, olanzepine) - 2 weeks
Anti-emetics (chlorpromazine) - 2 weeks

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4
Q

Factors influencing SPT result?

A

Recent anaphylaxis

Dermatographism

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5
Q

Diagnosis of anaphylaxis?

A

Skin features - rash/erythema/flushing/angioedema
AND
resp/cardio/GI sx OR hypotension

For insect bite/stings GI sx alone is enough for anaphylaxis dx

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6
Q

Risk factors for fatal anaphylaxis?

A

Adolescence
Nut/shellfish allergy
Poorly controlled asthma
Delays to treatment

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7
Q

Do not let children with anaphylaxis _____

A

Stand or walk suddenly - risk of death

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8
Q

Who to prescribe EpiPen to?

A

Any person with food anaphylaxis

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9
Q

Type 1 hypersensitivity?

A

Immediate
IgE mediated
Anaphylaxis, urticaria, atopy

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10
Q

Type 2 hypersensitivity?

A

Sub-acute
Antibody dependant cytotoxic - IgM, IgG, IgA
Haemolytic anaemia, Goodpasture, Myasthenia

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11
Q

Type 3 hypersensitivity?

A

Sub-acute
Immune complex
Serum-sickness like reaction, SLE, GN, HSP

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12
Q

Type 4 hypersensitivity?

A

Delayed
Cell mediated - Lymphocytes
Contact dermatitis, TENS/SJS, transplant rejection, T1DM

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13
Q

Risk factors for allergic rhinitis?

A 
Fix atopy
Elevated IgE by age 6
Maternal heavy smoking
Indoor allergens
LUSCS
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14
Q

Risk of asthma if allergic rhinitis in childhood?

A

3 fold increase in asthma at an older age

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15
Q

Pathophysiology of eczema?

A
  1. Defective epidermal barrier function - allows allergens to penetrate barrier. Keratinocytes induce cutaneous immune reaction.
  2. Immune dysregulation cutaneous lymphocytes increase Th2 cytokine response and IL5
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16
Q

Mutation in patients with severe atopic dermatitis?

A

Filaggrin gene defect in 50%

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17
Q

Severe autosomal recessive eczema with SPINK5 mutation?

A

Netherton Syndrome

18
Q

Pimecrolimus mechanism and SEs?

A

Calcinuerin inhibitor
Irritation, burning, erythema, infections/folliculitis and rarely desquamation
Can result in peri-oral dermatitis

19
Q

Difference between peri-oral dermatitis and eczema?

A

Peri-oral dermatitis has zone of sparing around lips
Rebound effect of steroids/pimecrolimus on face
Treat peri-oral dermatitis with erythromycin/tetracycline

20
Q

Super infections in eczema?

A

Staph aureus - golden crust. Mx bleach baths and PO abx
HSV - vesicles. PO antivirals
Tinea - topical antifungals
Malessezia furfural yeast

21
Q

Treatment of large local reaction to insect bite/sting? Risk of future anaphylaxis follow large local reaction to insect bites/sting?

A

PO pred, antihistamine for pruritus and NSAID for pain.

7%

22
Q

Conjunctivitis of upper tarsal surface. Exacerbations in spring/summer and itching worse with light/sweat. Long eyelashes.

A

Vernal conjunctivitis

23
Q

Conjunctivitis of lower tarsal surface with associated atopic dermatitis

A

Atopic conjunctivitis

24
Q

Conjunctivitis assoc w contact lens wear

A

Giant papillary conjunctivitis

25
Q

Urticaria VS angioedema?

A 
Urticaria = causes swelling of dermis
Angioedema = swelling of dermis, submit tissues, mucus membranes
26
Q

Angioedema without urticaria

A

Drug induced
Hereditary
C1 esterase inhibitor deficiency

27
Q

Recurrent episodes of hand/feet/genital swelling lasting a few days. Sometimes assoc w severe abdominal pain, N+V/diarrhoea. Now presents with feeling of lump in throat

A

Hereditary angioedema
Cutaneous, GI, laryngeal/pharyngeal
50% at some point have laryngeal/pharyngeal involvement

28
Q

Treatment of angioedema attacks?

A

NOT responsive to adrenaline, antihistamines or glucocorticoids
Recombinant/plasma derived C1 concentrate

29
Q

Rash, fever, polyarthralgia 7 days after receiving snake anti-venom/MAB therapy. Bloods show low c3/c4 and low total haemolytic complement

A

Serum Sickness

30
Q

Rash, fever, poly arthritis 2 weeks after cefaclor course.

A

Serum sickness like reaction

31
Q

4 week old baby with blood speckled stool. No FTT, vomiting or frank blood. Mo breastfeeds. Dx and Mx?

A

Allergic proctocolitis
Remove trigger from diet/maternal diet if BF
Usually resolves by 12mths of age - can reintroduce

32
Q

Baby with chronic, non-bloody diarrhoea after introducing cow’s milk/egg/wheat. Abdo distention. Fatty stool. Bloods show anaemia and low albumin. Dx and Mx?

A

Food protein enteropathy
Allergen avoidance
Usually outgrown by 2-3yrs old and can re-introduce then

33
Q

Intestinal biopsy findings of food protein enteropathy?

A

Villous atrophy due to T cell activation

34
Q

Baby with vomiting, diarrhoea and hypotension after introduction of rice. Previously hospitalised for ‘sepsis’.

A

FPIES

35
Q

Severe FPIES blood gas findings

A

Metabolic acidosis and methaglobinaemia

36
Q

Risk of developing atopy if FPIES in infancy?

A

30%

37
Q

When is soy formula not recommended?

A

<6mths old
Higher rate of concurrent soy allergy in younger infants
Nutritionally suboptimal

38
Q

Flu like sx with rash beginning on torso and spreading out. Mucosa is affected. Biopsy shows full thickness epidermal necrosis. Dx?

A

Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis

Consider prednisolone/cyclosporin

39
Q

Nikolsky sign?

A

Blistering where skin is rubbed/pressure point seen in SJS/TENS

40
Q

Likelihood a child will have an topic disease when a first degree relative is affected?

A

75%

RACP Written Exam Cram Series (19 decks)

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