Allergy/Immunology Flashcards
Pneumocystis jirovecii prophylaxis is recommended in which primary immunodeficiency below? [Hamilton] A. Chronic granulomatous disease B. DiGeorge syndrome C. Wiskott-Aldrich syndrome D. Common variable immunodeficiency E. Complement deficiency
WAS
PCP for T cell/combined
- Digeorge: immunodeficiency rare, so unlikely opportunistic
- CVID - limited to B cells
- Complement: encapsulated bacteria, not opportunistic
In what situation is immunotherapy beneficial?
a) Food allergy
b) Bee sting allergy
c) Penicillin allergy
d) Atopic dermatitis
Bee sting allergy
A 6mos male has several abscesses (S. aureus) now and in the past. He has also had recurrent respiratory infections and Serratia UTI. Now has butt abscess. Which diagnosis is most likely?
a) SCID
b) LAD 1 def
c) CGD
d) Bruton’s agammaglobulinemia
Abscesses
Staph + serratia = catalase+
CGD
SCID = combined, bacterial, viral, fungal. Chronic diarrhea -> FTT. No LN/tonsil/thymus. Low T #+fxn, low B fxn. Medical emergency, needs HSCT
LAD = phagocytic. >4wk for umibilical cord. No pus. High ANC (think leukocyte). No CD11/18.
XLA = BTK. no B cell -> no LN/tonsils, no Ab.
A 2 year old male has a history of cervical adenitis at 18 months of age that required drainage and IV antimicrobials. Pus was obtained and the culture was positive for S. aureus. He has diarrhea that started 2 months ago and poor weight gain. His labs reveal: Normal CBC, differential, IgG, IgA, IgM Normal CD4+ T cell and CD8+ T cell numbers What is the most likely diagnosis? A. Common variable immunodeficiency B. Complement deficiency C. Leukocyte adhesion defect D. Chronic granulomatous disease
CGD
LAD - no pus
CVID - would expect probs with B cell function
Which condition can be treated with immunotherapy? [Hamilton]
a) Food allergy
b) Venom allergy
c) Penicillin allergy
d) Urticaria
Venom allergy
Aeroallergen allergy for allergic rhinitis, allergic asthma, atopic dermatitis
Child got IVIg recently. How long do you have to wait before giving the DTaP vaccine? a) Give now b) Wait 4 weeks c) Wait 8 weeks d) Wait 11 months ----------- When can you give DTap-IPV vaccine after ivig? a) Now b) 4wks after the ivig c) 8wks after the ivig d) 11 months
Give now
If MMR+/V, would depend on dose (0.2-2mg/kg), 3-11mo, but wait 11mo to be safe
Ideally give vaccine 14d prior to IVIG or until Ab in the Ig preparation or blood product have been degraded. If not during this time, repeat as per schedule
A 15-year old boy with recurrent pneumonias, RMLx3, RLL, LLL in the past. What would you do to investigate?
a) Quantitative immunoglobulins
b) Pulmonary function tests
c) Lung scan
?Quantitative immunoglobulins
Would be more concerning if >=2 pneumonias in past 1y
Maybe lung CT for bronchiectasis?
Multiple lobes doesn’t suggest anatomic abN
Child is brought to the ER with anaphylaxis. Epinephrine should be administered by which route? [Hamilton]
a) Subcutaneous in the abdomen
b) Intramuscular
c) Subcutaneous in the thigh
d) Intravenous
IM
Child with symptoms of rash with egg ingestion, here for 1 year MMR vaccinations
a) Refer to allergist
b) Give him entire dose of MMR vaccine in your office and observe
c) Break up the doses of MMR and administer in office with observation
Give him entire dose of MMR vaccine in your office and observe
A teenager has a tingling feeling in her mouth when she eats apples and peaches. What is the best test to confirm the diagnosis?
a) IgE (RAST)
b) Oral food challenge
c) Skin prick testing to pollen
SPT to pollen
A 7 year old girl is newly diagnosed with ovarian Burkitt lymphoma. She has no prior history of significant infections, but her parents note that she has always been a clumsy child and has difficulty climbing stairs, writing and doing up buttons. As you are taking the history, you notice that she sways from side to side while sitting and has oculomotor apraxia.
An MRI of her brain demonstrates diffuse cerebellar volume loss.
What is the most appropriate screening test for the suspected immunodeficiency? [Hamilton]
A. ADA level
B. Vitamin B12 levels
C. Alpha fetoprotein level
D. Blood smear
AFP level to screen for ataxia-telangiectasia
- Ataxia in child with lymphoma = think AT!
ADA level = SCID
Vit B12 is leevated in ALPS (enlarged LN)
Blood smears not helpful from PID perspective
Patient with egg allergy requires influenza vaccine. Most appropriate management? [Hamilton]
a) Allergy referral for skin testing
b) Give vaccine in split dose (10% of dose followed by 90% if there is no reaction)
c) Give full dose
d) Do not recommend the vaccination
Give full dose
A 6 month old boy was brought to the emergency department with a second episode of pneumonia. He has had intermittent thrush and diarrhea for the past 2 months.
On examination, he is in respiratory distress and hypoxic. His weight was < 3rd %ile and height was at 25%ile.
His differential shows: Neutrophils 10.8x109/L
Basophils 0.02x 109/L
Eosinophils 0.03x 109/L
Lymphocytes 0.8 x 109/L What is the most likely diagnosis? [Hamilton]
A. X-linked agammaglobulinemia
B. Common variable immunodeficiency
C. Severe combined immunodeficiency
D. Complement deficienc
2 pneumonia, thrush, FTT = RF for PID
SCID
X-linked agammaglobulinemia = male, no B cell, no Ig, no lymphoid tissue
CVID = 1) recurrent infection (sinopulm, GI), 2) autoimmunity, 3) malignancy. No vaccine titres, low IgG
Complement deficiency = Neisseria, encapsulated. Problem with complement
A young girl has hives and swelling the day after eating Chinese food. She was also sick with a URTI at the time. The hives have remained for a few weeks. What do you recommend? a) Antihistamines b) Steroids c) Epi pen d) Allergy testing ------------- 14y girl ate Chinese food 2 weeks ago and has had an urticarial rash since then. What is the best treatment? a) Oral antihistamine b) Administer an epipen c) IV antihistamine d) Oral steroids ------------- Kid ate Chinese food at birthday party. Since then has had 2 weeks of angioedema, urticaria. Rx? a) Steroids b) Antihistamine c) Auto epi injector -------------- Young girl has had 2 week history of urticarial rash and facial swelling, onset after having birthday party at Chinese restaurant. She is well otherwise. Examination – urticaria and angioedema. She also had a cold 3 weeks ago. Treatment: a) Benadryl prn b) Epi autoinjection d) Oral prednisone
PO antihistamine
Child has asthma and anaphylactic reaction to peanuts and you refer to allergist for testing. Mother is apprehensive regarding the serum test that the allergist will perform. She wants to know why the bloodwork? Best answer is:
a) RAST has a higher sensitivity than skin test
b) Child can stay on montelukast for the blood test
c) RAST decreases child’s risk for a severe systemic reaction with the skin test
d) RAST better predicts future anaphylactic rxn’s.
——————-
Child with peanut allergy. You order RAST. Mom asks you why you’re doing it. You tell her that the advantage of RAST is:
a) Avoids anaphylaxis that may happen with skin test
b) Does not have to go off daily meds
c) High sensitivity
——————-
5 year old had a severe reaction to peanut at 1 year of age. He also has asthma. Now, allergist has ordered an IgE level for peanut. Mom is wondering why. What do you tell them?
a) The RAST is more sensitive than skin prick
b) The child does not need to stop taking his montelukast for this test
c) RAST is a good predictor of the chances of a future reaction
d) It prevents systemic reactions that could result from the skin test
——————-
5 yr child with asthma and severe allergic reaction at 1 year of age to peanuts. Allergist wants RAST. Mom unsure about test. How do you counsel her?
a) Rast more specific than skin testing
b) Don’t need to stop his daily monteleukast
c) Rast prevents risk of severe allergic reaction with skin testing
——————-
A child has a history of severe peanut allergies when she was 18 months old. Her allergist now want her to have a specific IgE test for peanuts. Of the following what would you tell her mother?
a) The IgE level will determine how allergic to peanuts she is
b) She will not have to go off of her daily montelukast
c) This test negates the risk of possible anaphylaxis
d) This test is more sensitive than skin testing
—————
RAST.
a) More sensitive
b) No need to go off montelukast
c) Risk of anaphylaxis
d) More indicative of predictive severity
RAST decreases child’s risk for a severe systemic reaction with the skin test
Can also stay on montelukast (can do that with SPT too but would need to be off antihistamines + corticosteroids)
6mos. old baby with bloody diarrhea, eczema, FTT, hepatosplenomegaly, Recurrent Otitis and pneumonia and bloodwork shows Plts 12, and remaining CBC normal with eosinophilia, and lymphopenia. What lab abnormality would you expect:
a) Increased IgE and IgA
b) Decreased CD4 count
c) Neutropenia
d) Abnormal NBT
Increase IgE + IgA
WAS
Other PIDs don’t have plt probs
Which is true regarding serum specific IgE? [Hamilton]
a) More sensitive than skin testing
b) Affected by corticosteroids
c) Affected by antihistamines
d) False positive in patients with elevated total IgE
False positive in pts with elevated total IgE
Skin is more sensitive
Not affected by corticosteroids or antihistamines
What is the treatment for chronic urticaria in a patient who failed H1 antihistamines?
a) H2 – antihistamine
b) Steroids
Would increase dose first
Urticaria Mmgt
1st line: standard dose of 2nd gen antihistamine
If Sx persists after 2wks
2nd line: increase dose by 4X
If Sx persists after 1-4wks
3rd line: Add on montelukast or cyclosporin or (if >12yo) omalizumab
Short course (max 10d) of corticosteroids
An 11 month old presents with a scaly rash all over, especially in the diaper area. He also has exopthalmos and HSM. Xrays show bony lucencies on the scalp. What is the likely diagnosis?
a) Neuroblastoma
b) Langerhans cell histiocytosis
c) ALL
Langerhans cell histiocytosis
18 mo boy with meningococcal meningitis and sepsis. Which is most likely to be abnormal?
a) C3, C4 and CH50
b) Immune globulin levels
c) Lymphocyte count
C3, C4, CH50
A 3 year old boy presents with the following history:
• Pneumonia at 10 months and 27 months of age
• 6 episodes of acute otitis media
• Cord separated at 2 weeks, no abscesses, thrush or fungal infections
• Maternal uncle died from pneumonia at 2 years of age
His physical exam reveals no tonsils or palpable lymph nodes
Which of the following is the most helpful investigation to establish the diagnosis in this patient? [Hamilton]
A. Flow cytometry for T cell numbers
B. Immunoglobulin levels
C. Alpha fetoprotein level
D. Neutrophil oxidative burst index
E. Complement levels
Immunoglobulin levels
sinopulmonary
NO TONSILS OR LN
SCID vs XLA
Baby presenting with eczema, thrombocytopenia and infections. What is the likely diagnosis?
Wiscott-Aldrich
—————
4 month old baby with eczema, petechiae, infection, failure to thrive. What is the diagnosis?
a) Wiskott Aldrich
b) SCID
WAS
Thrombocytopenia
Immunodeficiency: sinopulm
Eczema
Description of a child with multiple abscesses, including lymph nodes and hepatic with serratia. which immunodeficiency?
a) CGD
b) SCID
c) CVID
CGD
Abscesses + serratia
Infant with recurrent staph aureus abscess and klebsiella UTI and now presenting with gluteal abscess. You suspect which immunodeficiency:
a) Leukocyte adhesion defects
b) Chronic granulomatous disease
c) HIV
Abcesses
Staph is catalase pos
CGD
LAD can have staph skin + lung infections, but very rare
Healthy kid w recurrent otitis media, IgA low, IgG and IgM are normal, what is this associated with?
a) Autoimmune conditions
Selective IgA deficiency
90% ASx, asthma, allergies, autoimmunity (SLE, IBD,
Sinopulm + GI
12 year old with recurrent episodes of facial swelling. No associated urticaria. Father also has angioedema. What is the most likely condition? [Hamilton]
a) Chronic urticaria
b) Hereditary angioedema
c) Cow’s milk protein allergy
d) Latex allergy
Hereditary angioedema
AD, C1 esterase inhibitor deficiency/dysfunction
Kid with what sounds like serum sickness. How to treat? a) Benadryl and NSAIDs b) Methylpred c) IVIG ------------------------ Child on penicillin, now day 10 and develops rash, joint swelling (describes serum sickness features). What is your management? a) IV pulse methylpred b) IVIG
NSAIDs + benadryl if mild
If severe: pred or methylpred
RAST test, which is true?
a) Best test for food allergies
b) More sensitive than skin testing
c) False positives can be associated with children with high IgE
d) Results may be affected by use of corticosteroids
——————-
Which is true regarding RAST testing?
a) more sensitive than skin testing
b) Affected by corticosteroids
c) False positive in children with hyper-IgE states
d) Preferred test for testing food allergies
False positive in children with hyper-IgE states
Eczema like rash with scaling on the periphery, sinusitis symptoms, hilar lymphadenopathy on CXR. Ca 2.8, cbc with increased eosinophils.
a) Blastomycoses
b) Cryptococcus
c) Miliary TB
d) Sarcoidosis
Sarcoidosis
- multisystem granulomatous disease
Rash - eczema like
Bilateral hilar LND
Eosinophilia
Child with eczema like rash with scale. Cough, looks unwell. Leukopenia, increased eosinophils, increased alk phos. Hilar adenopathy and Ca normal. Dx? a) Miliary TB b) Sarcoidosis c) Cryptococcosis d) Blastomycosis -------------------- Teen with anorexia, shortness of breath, wheeze, and cough. Found to have elevated Ca, ALP and eosinophils. CXR shows hilar adenopathy. Diagnosis: a) Miliary TB b) Sarcoidosis c) Blastomycosis d) Coccidiomycosis
Sarcoidosis
Eczema
Lung + bilater hilar LND
Eosinphilia
What is the most common use for immunotherapy
a) Peanut allergy
b) Bee sting allergy
c) Penicillin allergy
d) Atopic dermatitis
Bee sting allergy
What is cross reactivity between penicillin and cephalosporins? [Hamilton]
a) 2%
b) 5%
c) 7%
d) 10%
2%
old literature said 10% when old generations of cephalosporin had penicillins inside them
Kid with thrombocytopenia and platelets of 6. Normal H2. Bad eczema, chronic fingernail infection with S. aureus. What finding would confirm your diagnosis? a) Absent radius b) No LNs/tonsils c) Draining ears d) Hypoplastic patellae ------------------- Child with severe eczema, recurrent staphylococcus infections at nail bed. Failure to thrive. CBC – platelets 5. What findings would support your diagnosis? a) Hypoplastic patellae b) Absent radius c) Draining ears d) Neutropenia
Draining ears
WAS
T
I
E
Absent radius = Fanconi anemia
No LN/tonsils = XLA
Hypoplastic patellae + poorly developed nails = nail patella syndrome
14 year old with urticaria for 8 weeks. What is the best treatment for chronic urticaria? [Hamilton]
a) Oral second generation antihistamine
b) Epinephrine
c) Oral steroids
d) IV antihistamines
Oral second generation antihistamine
Child with eczema and chronic sinopulmonary infections with petechiae. Likely to find:
a) High IgA and IgE
b) Low CD4
High IgA and IgE
WAS!
Variable IgG
N/low IgM
No B cell # problem
The following may be associated with IgA deficiency except: [Hamilton] A. Wiskott-Aldrich syndrome B. X-linked hypogammaglobulinemia C. No clinical symptoms D. Severe combined immunodeficiency E. Ataxia telangiectasia
Wiskott-Aldrich
b/c IgA is ELEVATED!!!
An 8 month old boy presents with petechiae. On the examining table he has a bloody stool. He also has a history of eczema, pneumonia and an otitis media. His lab work shows an elevated IgE, and IgA. He has a platelet count of 80 and a coombs positive anemia. What is his diagnosis?
a) Hemophilia
b) HSP
c) Wiskott Aldrich
WAS
A 6 year old boy presents to the family doctor with an eczematous rash. On exam he looks unwell and is tachypneic. He has a large rash with scaling at the edges. On eye exam he has miliary conjunctivitis. His mother says that he has joint pain in the morning and he has a knee effusion on exam. His bloodwork reveals eosinophilia, with leucopenia with normal calcium. He also has hilar nodes on his chest X-ray. What is the cause of his symptoms. a) Miliary TB b) Cryptococcosis c) Blastomycosis d) Sarcoidosis ------------------- Child with pulmonary findings, eosinophilia, slightly elevated calcium (2.8) a) Miliary TB b) Sarcoidosis c) Cryptococcus d) Blastomycosis
Sarcoidosis
Eczema Eye involvement Lung + bilateral LND Arthritis Eosinophilia
A 14 month old child has had two previous pneumonias, and 3 otitis media infections. His mom says he had varicella a month ago, but it was pretty mild. On exam he has an anterior cervical lymph node 1.5 x 1.0 cm. How would you investigate this child?
a) Drainage
b) NBT test
c) Quantitative immunoglobulins
d) T cell proliferation assay
——————–
Recurrent infections. Okay with varicella. Best test?
sinopulm but did okay with varicella
CGD
NBT = CGD
B cell quantitative = XLA (NO LN/tonsils); (CVID is B cell fxn prob more than #)
T cell prolif assay = SCID (no LN/tonsils or thymus)
Reasoning is that sinopulmonary can be both phagocytic and B cell. However, had lymphadenopathy so r/o XLA. Also, is okay with varicella, so it means that B cell function is relatively intact. Therefore unlikely CVID. Thus, CGD
18mo boy has had 3 staph aureus abscesses and a serratia UTI. What is the most likely diagnosis?
a) CGD
b) SCID
c) Agammaglobulinemia
CGD
Kid w egg allergy – only skin symptoms; what do you do if wants influenza vaccine
a) Split dose given in hospital
b) Allergy referral for vaccine skin testing
c) Give full dose now
Give full dose now
A 4 month old baby presents with eczema, recurrent pneumonias and absent thymus shadow on CXR. What is the most likely diagnosis?
a) SCID
SCID
Absent thymus
SCID
or diGeorge - most often have mild T cell deficinecies and thus not recurrent pneumonias, also not eczema
14 mo old kid with multiple pneumonia (x2), ear infections (x4), and has buttocks abscesses (serratia). Has lymphadenitis. Which test would determine the diagnosis?
a) NBT
b) Immunoglobulins
c) T cell subsets
Abscesses
Sinopulm
Serratia
=> CGD
Do NBT/NOBI
Boy with wheezing and respiratory distress and urticaria after lunch. What should you treat with?
a) Oral Dexamethasone
b) Inhaled Ventolin
c) IM Epi
d) IV Diphenhydramine
IM epi
Urticaria = skin Sx
Needs 1 of resp distress or hypotension
= anaphylaxis
Child with eczema and recurrent pneumonia. Hepatomegaly, petichiae, otitis media and low platelets. What do you expect?
a) Elevated IgA and IgE
b) Immune response to polysaccharide vaccine
c) Oral Candida
d) Abnormal mitogen proliferation
Elevated IgA + IgE
A 10 year old female presents with abdominal pain and has an ultrasound revealing edema of the sigmoid colon and a moderate amount of free fluid in her lower quadrants. On further history, she has had intermittent facial and left arm swelling over the last 5 years. Which test would reveal the diagnosis?
a) C1 esterase inhibitor level
C1 esterase inhibitor levels
Hereditary angioedema
- AD
- angioedema (painless, not itchy) skin, GI, resp tract
You are asked to see a 5 year old girl who has had 2 pneumonias in the past year. She has normal growth and development.
Physical exam demonstrates normal sized tonsils and lymph nodes.
Laboratory evaluations show:
IgG 1.5 g/L (normal range 5-14.6 g/L) IgM 0.2 g/L (normal range 0.2-2.5 g/L)
What is the most likely diagnosis? [Hamilton]
A. Common variable immunodeficiency
B. Agammaglobulinemia
C. DiGeorge syndrome
D. Chronic granulomatous disease
- has 1 RF for PID
- sinopulmonary
- low IgG, LLN IgM
CVID - B cell defect, no vaccine titres, low IgG
X linked agamma - expect male, no B cells, no Ig, no lymphoid tissue
Digeorge - absent thymus, T cell issues
CGD - phagocytic issue, normal IgG
Which of the following statements about anaphylaxis is correct? [Hamilton]
a) IV epinephrine would be the preferred medication
b) Diphenhydramine can be given IV, IM or PO
c) Salbutamol and budesonide should be administered
d) Hydrocortisone does not prevent the late onset effects
Diphenhydramine can be given IV/IM/PO
A 7 month old female has recurrent viral infections following cardiac surgery. She has a history of seizures and a cleft palate.
Her labs reveal:
Lymphocytes 3.0 x 109/L (normal range 4.00-10.50 x 109/L) IgG 2.2 g/L (normal range 2.3-8 g/L)
What would be the most appropriate immunological recommendation? [Hamilton]
A. Delay live vaccines until T cells are evaluated
B. Start immunoglobulin replacement therapy
C. Start prophylactic antibiotics
D. Refer for hematopoietic stem cell transplantation
Delay live vaccines until T cells are cleared
DiGeorge: cleft, cardiac, sz (hypocalcemia)
Low lymphocytes
Low IgG
B+T cell
A 3 year old has a history of recurrent fevers for the past year. They occur every 4-12 weeks for 1-4 days each. He has been treated for numerous otitis media and pharyngitis. She is growing well. The likely underlying cause is:
a) Multiple viral infections
b) Familial med fever
c) CVID
d) Ig deficiency
Multiple viral infections
- normal for kids in daycare to have 6-12 viral infections/yr
Growing well
Q1-3mo, only lasting 1-4d
AOM + pharyngitis are common
FMF
- fever 1-3d, no true periodicity
- clinical hallmark: serositis (peritonitis, pleuritis, synovitis)
- erysipelas-like rash on shin + dorsum of feet
- Amyloidosis!! (therefoere on colchicine)
Which of the following statements is TRUE regarding intravenous immunoglobulin (IVIG)? [Hamilton]
A. Adverse reactions to IVIG are so common that patients should routinely be pre-medicated with antihistamines and acetaminophen prior to receiving IVIG
B. IVIG replacement therapy is given at a dose of 400-600 mg/kg every 3-4 weeks
C. Patients with XLA should continue to receive their routine vaccinations to give them extra protection
D. IgG levels no longer need to be measured once patients with XLA have started IVIG replacement therapy
IVIG replacement 0.4-0.6mg/kg Q3-4wks
- Higher reaction rates with higher dose IVIG (for inflammatory dz)
- Doesn’t have Ig so can’t mount immune response for vaccinations
- Need trough levels to ensure getting enough IgG replacement
Teenager has tingling / pruritus in her mouth when she eats apples and peaches. What is the best test to confirm the diagnosis? [Hamilton]
a) Skin prick to apples and peaches using commercial extract
b) Serum specific IgE to apples and peaches
c) Oral food challenge
d) Skin test to birch pollen
Skin test to birch pollen
- Must prove sensitized to birch pollen
- A & B often negative. May be positive SPT if fresh apples & peaches
What is the best therapy for allergic rhinitis? [Hamilton]
a) Avoidance of allergen
b) Intranasal corticosteroid
c) Oral antihistamines
d) Oral corticosteroids
Intranasal corticosteroids
Anaphylaxis kid. Where to give Epi? IM SQ ------------- Child with periorbital edema with allergic reaction. How should epinephrine be administered? SQ in arm IM in thigh SQ in abdomen IV -------------------- Infant with acute angioedema of face, anaphylaxis; how would you administer epinephrine? IM in thigh IV SC arm SC abd ------------------- Child with anaphylaxis reaction. How should epinephrine be administered? SQ in arm IM in thigh SQ in abdomen IV
IM
IVIG replacement therapy is indicated in the following primary immunodeficiencies, except: [Hamilton] A. X-linked agammaglobulinemia B. Chronic granulomatous disease C. Common variable immunodeficiency D. Severe combined immunodeficiency E. Hyper IgM syndrome
CGD b/c phagocytic
Young child presents with abdominal pain. He has had a history of 2 pneumonias in the past. On ultrasound he is found to have a hepatic abscess. A culture of the abscess aspirate grew staphylococcus species. Which of the following investigations would be MOST helpful to reach a diagnosis?
a) Immunoglobulins
b) Complement levels
c) T cell proliferation
d) NBT assay
Sinopulm
Abscesses
Staph = catalase+
CGD
NBT
A 6 yo M was started on penicillin for an AOM and is on the 10th day of treatment when he develops hives and abdominal pain. He also develops joint swelling and pain. What is the appropriate treatment?
a) PO steroids
b) Hydroxyzine + ibuprofen
c) IVIg
Hydroxyzine + ibuprofen
for serum-sickness like
Urticaria
abdo pain => angioedema
Joint swelling + pain = arthritis
