Allergy/Immunology SAQ Flashcards
You are seeing a child with an immune deficiency of granulocyte function.
A. Name two organs affected
B. Name two bacteria commonly isolated from these sites
A.
- Sinus
- Lungs
- Liver
- LN
- SKin
- GI/GU
B.
- Staph aureus
- Burkholderia cepacia
- Serratia marcens
- Nocardia
- Aspergillus
Mom is worried about giving vaccines to child because immune system has to fight too many antigens.
List 2 things you can explain to mom.
- Vaccines cannot wear out child’s immune system. Our immune system responds to a very large number of antigens (proteins + complex sugars) that are around us every day. Vaccines only add a few antigens to these numbers
- The cahnces of getting sick from a vaccine-preventable disease is far greater than teh very small risk of having a serious side effect from the vaccine itself
- Most vaccines contain inactivated vaccines. They have no living germs in them, so they can’t cause infections. Live vaccines (mumps, rubella, chickenpox, rotavirus, nasal flu) contain weakened form of the germs. These do not cause disease in healthy people, although a few children will have a very mild rash and fever with MMR, MMRV or varicella vaccine. Live vaccines may cause disease in people with conditions that prevent their immune system from working. These people should not be given these vaccines.
An 11 month old baby girl presents with a history of diarrhea and failure to thrive. She also had developed the rashes shown in the figures. The symptoms started shortly after switching from breastmilk to formula.
Please identify the diagnosis to explain these symptoms.
Zinc deficiency
Acrodermatitis enterohepatica
A child has recurrent suppurative adenitis
A. Name TWO other complications associated with this disease.
B. Name TWO common organisms cultured.
C. You suspect chronic granulomatous disease. Name a test to confirm the diagnosis.
A. Complications
- Otitis media, pneumonia, skin abscesses, osteomyelitis
- Granulomas: liver, lung, LN, GI/GU (IBD, gastric outlet obstruction, bladder obstruction)
B. Bugs
- Staph aureus
- Serratia marcens
C. NOBI = nitrogen oxidative burst index
18 months old with CF and egg allergy where they got rash and wheeze mom is asking you about the flu shot.
A. What are THREE steps in your management?
- Explore mother’s concerns/questions about the influenza vaccine + egg allergy
- Explain that influenza vaccine is safe to give in the context of egg allergy
- Both LAIV + IIV are not contraindicated in egg allergy
- Anaphylaxis after vaccination with influenza vaccine is a rare consequence of hypersensitivity to a vaccine component
- Explain the importance of influenza in high risk children (includes childrne with CF)
What are four things you would advise a patient about allergen avoidance in a patient with perennial allergies?
- Nasal corticosteroids
- Non-sedating antihistamine (e.g. Reactine, Aerius)
- Use allergen-proof encasings. Wash bed linen + blankets Qwk in hot water. Remove pet. Stay in controlled environment to avoid pollen + outdoor molds.
- Consider immunotherapy
22 kg child is being discharged post anaphylaxis with an Epinephrine autoinjector.
A. What dose of epi should be in the autoinjector?
B. What two things should parents do if child has anaphylaxis?
C. Where should they administer it?
A. 10-25kg = Epipen Jr 0.15mg IM
B.
- Give epinephrine autoinjector immediately
- Call EMS to bring to hospital for evaluation
C. IM in anterolateral thigh
Child with signs of anaphylaxis after the transition to cow milk formula.
A. Most important medication in the immediate management and route?
B. When can the patient go home (i.e. how long does she need to be observed)?
C. List 4 preventative recommendations for the non acute management.
A. Epinephrine 0.01mg/kg of 1mg/mL (1:1000) IM, Q5-15min PRN
B. At least 4-6H (for biphasic reaction)
C.
- Avoid triggers if known. Read food labels
- Allergy referral for testing of triggers
- Carry epinephrine pen
- MedicAlert
- Anaphylaxis action plan
Baby with recurrent pneumonia. CBC was normal.
A. Name 5 investigations you would do next?
- CXR if not yet done
- Sweat chloride
- OT with bedside + video fluroscopic feeding study or UGI with pullback to assess for evidence of aspiration
- Serum immunoglobulins
- Flow cytometry for lymphocyte assay
- Antibody titre response to vaccines
- NOBI
A 15 y/o immunocompromised male likes to swim in the family hot tub. He presents with a pruritic follicular rash, malaise and lymphadenopathy.
What is the likely etiologic pathogen?
Pseudomonas aeruginosa
Hot tub folliculitis
- P aeru
- Pruritic papules + pustules or deeply red/purple nodules most dense in areas covered by bathing suit
- Develop 8-48H after exposure
- OCcasionally fever, malaise, LND
- Eruption usually resolves spont in 1-2wks, often leaves post inflammatory hyperpigmentation
- Consider ciprofloaxin in adol with systemic Sx
- Counsel immunocompromised pts who are susceptible to Pseudomonas to avoid hot tubs
Child with chronic sinusitis and otitis media. Has normal IgG and IgM but low IgA.
A. What is the diagnosis?
B. What do you caution about (eg. Other diseases other than infections)?
A. Selective IgA deficiency
B.
- Asthma
- Allergies
- Autoimmune disease (SLE, IBD, RA)
Kid with query peanut allergy
A. Name 2 clinical reasons why RAST is better than SPT
B. Name 1 clinical reason why SPT is better than RAST
A.
- Can stay on antihistamine, corticosteroids
- No risk of anaphylaxis
- Not affected by dermatitis or dermatographism
B. SPT
- Immediate results
- Higher sensitivity
- Does not require venipuncture
- Less costly
A. List 4 things on history suggestive of allergic rhinitis
B. List 3 things on physical exam to suggest this diagnosis
A. Sx
- Post nasal drip
- Nasal congestion
- Rhinorrhea (clear + bilateral)
- Sneezing or nasal pruritus
- Ocular pruritis
B. Signs
- Allergic shiners
- Dennis-Morgan lines
- Allergic salute
- Allergic facies (open mouth breathing)
- Pale boggy nasal turbinates
- Cobblestoning of posterior pharyngx
Young boy with chronic draining ears, pneumonia & widespread eczema. Platelets are low.
Diagnosis?
Wiskott Aldrich
Young kid receiving treatment with vancomycin. Thirty minutes into the infusion, he develops an erythematous, diffuse, macular rash over most of his body. No respiratory distress.
A. What’s the NEXT step in management?
B. If you decide to give vancomycin again, what 2 things would you do?
A. Stop the vancomycin and check the pt’s vitals
B.
- Give benadryl + ranitidine
- Restart the infusion at half of the previous rate or 10mg/min, whichever is slower
Redman syndrome
- most common adverse rxn to vanco
- Rate-dependent infusion rxn, not a true allergic rxn
- Flushing, erythema, pruritus
- Upper body (neck, face) more affected than lower body
- May have chest or back pain + m spasms, SOB, hypotension
- For mild-mod rxns (uncomfortable but hemodynamically stable, no CP or m spasm)
- stop
- Give diphenhydramine + ranitidine. Sx typically resolve prompty.
- Restart infusion at half the previous rate or 10mg/min (whichever is slower)
- For severe rxns (CP, m spasm, hypotension)
- As above
- IVF for hypotension
- Once Sx resolve, restart and give over >=4h
- Premedicate with anithistamines in the future + continuous hemodynamic monitoring
