Allergy in children

Question 1

Features of anaphylaxis in children

Answer 1

Very fast onset
A -swelling, constriction-> stridor, hoarsness
B- high RR, Wheeze, SpO2<92, cyanosis
C-pallor, clammy, drowsy, low BP
Skin -urticariea

Comes very fast after allergen exposure -recognise and treat immediately

Question 2

Acute Management of anaphylaxis in children

Answer 2

Follow BLS + ABCDE approach if not breathing/unresponsive

Start with - 1:1000 IM adrenaline (per weight approach/ 3mg)
Assess if need repeat after 5mins
Airway help -gedelle, Rebreather mask

Question 3

Follow up management of anaphylaxis in children

Answer 3

After BLS+ABCDE+ Adrenaline approach =>

Establish airway and give O2
Give crystalloid fluids
IV chloramphenamine, IV Hydrocortisone,
Salbutamol

monitor BP, sats, HR

Question 4

Epidiemology and pathophys of Cows milk protein allergy

Answer 4

occurs in 3-6% of children
Presents usually before 3 years old
Allergy is not to milk/maternal milk -its to cow proteins that are passed through mothers diet

Both IgE (immediate) and non-IgE (delayed) reactions are seen, create a wide scope of presentation

Question 5

Signs and Sx of Cows Milk Protein allergy

Answer 5

Features:

regurgitation and vomiting
diarrhoea
urticaria, atopic eczema
'colic' symptoms: irritability, crying
wheeze, chronic cough
rarely angioedema and anaphylaxis may occur

55% of IgE mediated dissapears by 5 years old -
Most non IgE dissapears by 3

Question 6

Ix and Mx of Cows Milk protein allergy

Answer 6

Ix -clinical but can do skin prick and/or RAAST testing

Mx - if on bottle, switch formula
Hydrolysed milk in mild-moderate CMPA
AminoAcid based formula if severe CMPA or not responding

If breastfed - mother cuts out Cow protein from diet
use special formula when switch