Allergy in Children

Question 1

What are the most common antigens causing allergy in children?

Answer 1

• Antigens of peanuts, soy, eggs, milk, fish, wheat, shellfish, tree nuts

Question 2

Describe the presentation of an anaphylactic child

Answer 2

• Immediate onset after ingesting allergen (minutes to hours)
• Cutaneous - erythema, urticaria, pruritis, angioedema
• GI - nausea, vomiting, abdominal pain, diarrhoea
• Resp - coryzal symptoms, wheeze, hoarseness, cough, dyspnoea
• Cardio - tachy/brady, hypotension, dizziness, LOC

Question 3

If you suspect a child has a hypersensitivity to a substance, what are the important points to elicit on history?

Answer 3

• What was it? Remember the common antigens
• How was it cooked?
• How much did you have?
• Timing of reaction?
• Previous reactions?

Question 4

When can you perform a skin-prick test? What considerations in its use should you have?

Answer 4

• 3-4 days after last H1 antagonist
• 6 weeks after last anaphylactic event
• Size of wheal predicts reaction likelihood but not severity
• More people have a positive SPT than are actually allergic

Question 5

What are some tests that can be done to confirm a food allergy?

Answer 5

• Skin prick test (not very specific - correlate with history)
• Serum specific IgE (expensive, slow turn-around)
• Food challenges (if low positive SPT or non-IgE reaction suspected)

Question 6

What is the difference between food-induced proctocolitis/enteropathy/enterocolitis?

Answer 6

• Proctocolitis - mild diarrhoea, small amounts of bloody stools
• Enteropathy - chronic diarrhoea/GI upset
• Enterocolitis - acutely unwell child with severe GI symptoms and bloody diarrhoea
• All are caused by milk protein (cow or soy normally)

Question 7

List some allergens that can contribute to allergic rhinitis

Answer 7

• Tree pollens (winter/spring), grass pollens (spring/summer), weed pollens (winter through spring)
• Dust mite, pet dander, moulds, cockroaches

Question 8

Describe the management of someone with allergic rhinosinusitis

Answer 8

• Allergen avoidance
• Antihistamines/IN corticosteroids
• LT antagonists
• Allergen immunotherapy

Question 9

What are food intolerances?

Answer 9

Non-immune-mediated phenomena e.g. CHO malabsorption/lactose intolerance, food poisoning, caffeine overdose

Question 10

Describe the acute management of a person with anaphylaxis

Answer 10

• Adrenaline (0.01 mg/kg) repeating after 5 minutes if no improvement
• ABCDE
  
  • Nebulised adrenaline and early intubation
  • High flow oxygen
  • 2 x large-bore cannulae, supine positioning, leg elevation
• Other treatments - steroids (bronchospasm) and anti-histamines (pruritus). No role for these acutely