Allergy/Immunology Flashcards
If a child presents with symptoms of allergic rhinitis younger than what age, you should probably think of another diagnosis?
What are three treatment options for allergic rhinitis?
Younger than three
Intranasal steroids, first line, oral antihistamines, intro, nasal antihistamines
How long should symptoms be present before diagnosing chronic rhinitis?
What are five other differentials to symptoms of chronic rhinitis?
At least four weeks
Hayfever, sinusitis, cystic fibrosis, foreign body, nasal polyp, vasomotor rhinitis
Describe visa motor rhinitis
What are four possible triggers?
And osier to some causes, blood vessel, dilation, and symptoms of rhinitis.
Emotions, cold wind, change in temperature, pollution, typical environmental allergens are not triggers
Describe the NPV and PPV of skin testing/aeroallergen testing
What is the gold standard for diagnosing a food allergy?
NPV is excellent, PPV is good for inhalants, but not for foods
Oral food challenge
What are three contraindications to immunotherapy for allergies?
Poorly controlled asthma
Beta blocker use.
History of repeated episodes of anaphylaxis with allergy shots
Is Rast testing for IGE levels affected by taking antihistamines?
In younger children with allergies to eggs, milk, soy, wheat, they will usually outgrow these by what age? 
No, it is not
By five years old
What is the minimum amount of time that a child should be observed after an exposure to an allergen?
Should foods be restricted only based on positive IGE RAST testing ?
At least two hours since symptoms can continue to evolve for usually up to two hours
No, food allergies are a clinical diagnosis. You must have the history of a reaction to support the diagnosis of a food allergy.
For aeroallergens, what should the next step be if a child is maxed out on antihistamines, montelukast, and nasal steroids
Is there a contraindication to giving contrast in kids with a shellfish allergy?
Refer to an allergist
No, there is not, just give it there is no need to retreat
In a patient with a peanut allergy, you do not need to recommend against all legumes, instead recommend avoidance of what?
If a patient has which two things, it is recommended to test for a peanut allergy prior to introduction of peanuts?
Tree nuts (hazel, macadamia)
Severe eczema or egg allergies
Children without eczema and those with mild to moderate eczema who do not have any food allergies can try peanut products at what age?
Is a food sensitivity the same as a food allergy?
Six months
No
Describe the areas of the body spared in babies with eczema
How is eczema treated?
The diaper folds and flexile surfaces
Emollience, topical steroids, and non-steroids like calcineurin inhibitors like tacrolimus and PDE4 inhibitors like crisaborole
Which type of treatment is preferred for the face in a patient with eczema?
what is the most common cause of acuteurticaria lasting longer than one day?
How long does urticaria caused by food allergies last
Non-steroidal treatment like calciceurin inhib or PDE4 inhibitors
Viruses.
Starts with one hour and only last for a few hours
If urticaria Is noted as an isolated skin manifestation, do you need to give epinephrine?
In what situation would you need to give it?
No, you do not.
If there are other symptoms of anaphylaxis like breathing related symptoms or other systemic symptoms
How long must urticaria be present to be categorized as chronic?
What are five causes of chronic urticaria?
More than six weeks
Idiopathic, auto immune diseases, immune complex, mediated processes, like serum, sickness, chronic viral/bacterial/parasite infections, neoplasm
What enzyme is deficient in hereditary angioedema?
How will this present?
Do these patients have pruritis?
C1esterace deficiency.
Recurrent episodes of swelling/edema and abdominal pain.
No they do not
Anaphylaxis usually requires how many systems to be affected?
What is the only symptom alone that can be defined as anaphylaxis?
What are the four systems that can be affected?
At least two symptoms.
Acute hypotension, presenting hypotonia or syncope.
Skin, respiratory, circulatory, gastrointestinal
Hypertension in anaphylaxis is defined as a drop systolic blood pressure more than what percent?
Which for treatments are given for severe anaphylaxis?
What dilution is epinephrine given in?
More than 30%
Epinephrine, antihistamine, IVF, steroids.
1: 1000 dilution
If you are treating anaphylaxis, and the patient is on beta blockers, what do you give to reverse the beta blocker and then give epinephrine again?
What is an anaphylactoid reaction?
What are four exposures that that is associated with?
Glucagon
It is a mast cell degranulation, not IGE mediated from exposure.
NSAID, opiates, vancomycin, contrast 
To make the diagnosis of a true milk, protein allergy that is IGE mediated, look for which two things?
What type of formula should be prescribed?
Gastrointestinal symptoms, like vomiting, diarrhea, G.I. bleeding and extra intestinal symptoms like eczema or wheezing.
A hydrolyzed formula, not soy
Is food, protein, induced enteropathy IGE mediated?
How does it often present?
Which disease is a part of this group?
No, it is not IGE mediated.
Failure to thrive after months of already being on cows, milk formula.
Celiac disease
What are five symptoms of protein induced enteropathy?
Can this occur in breast fed babies?
Diarrhea with or without vomiting, malabsorption, anemia, failure to thrive while on formula, but not well on clears or non-whole protein containing formulas
Yes, but only if enough whole protein from the mom’s diet enters the breastmilk
How is food, protein induced enteropathy diagnosed?
If you suspect, celiac disease, what test do you need to get and what do you look for?
It is usually a clinical diagnosis.
You get an upper endoscopy and duodenal biopsy looking for villous atrophy
How do you treat food protein induced enteropathy?
If Mom is breast-feeding, ask her to stop drinking milk products, if that does not work change to a hydrolyzed formula or amino acid derived formula
Is Food, protein, induced proctitis or colitis IGE mediated?
What is the main findings/symptom in this?
Which group of babies is this most common in?
No, it is not IGE mediated.
Blood in the stool.
Most common in breast-fed infants due to cows, milk protein in the mothers diet, usually they appear well other than blood in the stool
What is FPIES?
How long after eating the offending food do symptoms present?
What are the three most common triggers?
It is a non-IGE mediated food intolerance in infants, presenting with severe vomiting with or without diarrhea and often leading to lethargy and a shock state
1–3 hours after ingestion
Cows, milk, soy, rice
What is FPIES?
How long after exposure to the offending food do symptoms present
What are the three most common triggers
Is a non-IGE mediated food intolerance in infants, presenting with severe vomiting with or without diarrhea, leading to lethargy and a shock like state
1–3 hours
Cows milk, soy, rice
Lactose intolerance is uncommon in children less than what age?
What test can be done to diagnose lactase efficiency?
How is it treated?
Five years, if they have symptoms of this suspect a different diagnosis
Hydrogen breath, test.
Give soy milk because it does not contain lactose 
