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Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology > Food allergy > Flashcards

Food allergy Flashcards

1
Q

Food allergy is an adverse immune response to a food, commonly associated with (?) and (?) reactions, and less frequently associated with respiratory reactions and anaphylaxis

A

Cutaneous

GI

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2
Q

Food allergy is an adverse immune response to a food, commonly associated with cutaneous and GI reactions, and less frequently associated with (?) reactions and (?)

A

Respiratory

Anaphylaxis

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3
Q

What is the difference between a food allergy and food intolerance?

A

Food allergy is an immune response.

Food intolerance is non-immunological

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4
Q

What are the most common food allergens?

A 
Cow's milk
Hen's eggs
Soy
Wheat
Peanuts
Tree nuts
Fish
Shellfish
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5
Q

Why may a person with an allergy to cow’s milk also have an allergy to other mammalian milk?

A

Cross reactivity between similar foods

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6
Q

How do you manage a food allergy?

A

Strict avoidance of the food.

Educating patients about appropriate nutrition, food preparation, and the risks of accidental exposure is recommended, such as food and drinks to avoid, ensuring adequate nutritional intake, and interpreting food labels.

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7
Q

What drug is licensed to be used as an adjunct to dietary avoidance in patients with food allergies?

A

Sodium cromoglicate
- Oral, taken before meals (30-60 mins)

Acts by inhibiting the release of histamine and various membrane derived mediators from the mast cell

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8
Q

What education do patients with food allergies require? (6)

A
  1. Appropriate nutrition
  2. Food preparation
  3. The risks of accidental exposure (such as food and drinks to avoid)
  4. Ensuring adequate nutritional intake
  5. Interpreting food labels
  6. Training to use self-injectable adrenaline/epinephrine (if at risk of anaphylaxis)
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9
Q

Is there high or low quality evidence to support the use of antihistamines to treat acute, non-life threatening symptoms (such as flushing and urticaria) if accidental ingestion of allergenic food?

A

Low

Chlorphenamine maleate is licensed for the symptomatic control of food allergy.

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10
Q

Which drug is licensed for symptomatic control of food allergy?

A

Chlorphenamine maleate

  • an antihistamine
  • Oral: 4 mg every 4-6 hours; maximum 24 mg per day
  • IM or IV: 10 mg, repeated if necessary; max 4 doses per day
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11
Q

What is first-line immediate treatment of food-induced anaphylaxis?

A

IM adrenaline/epinephrine

- ADULT: 500 micrograms, using 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response

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12
Q

Adrenaline/epinephrine acts on both (?) and (?) receptors

A

alpha

beta

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13
Q

What are the effects of adrenaline/epinephrine?

  • Beta1 effects (2)
  • Beta2 effect (1)
  • Alpha effect (1)
A

Beta1 effects:

  • increases heart rate
  • increases contractility

Beta2 effect:
- peripheral vasodilation

Alpha effect:
- peripheral vasoconstriction

Acts on both alpha and beta receptors and increases both heart rate and contractility (beta1 effects); it can cause peripheral vasodilation (a beta2 effect) or vasoconstriction (an alpha effect).

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14
Q

What is the adult dose of IM adrenaline/epinephrine for emergency treatment of acute anaphylaxis?

A

500 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response
(further doses can be given if life-threatening features persist)

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15
Q

What is the child up to 6 months dose of IM adrenaline/epinephrine for emergency treatment of acute anaphylaxis?

A

100-150 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response
(further doses can be given if life-threatening features persist)

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16
Q

What is the child 6 months-5 years dose of IM adrenaline/epinephrine for emergency treatment of acute anaphylaxis?

A

150 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response
(further doses can be given if life-threatening features persist)

17
Q

What is the child 6-11 years dose of IM adrenaline/epinephrine for emergency treatment of acute anaphylaxis?

A

300 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response
(further doses can be given if life-threatening features persist)

18
Q

What is the child 12-17 years dose of IM adrenaline/epinephrine for emergency treatment of acute anaphylaxis?

A

500 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response
(further doses can be given if life-threatening features persist)
SAME AS ADULT

BUT 300 micrograms to be administered if child is small or prepubertal

19
Q

Adrenaline/Epinephrine 1 in (?) injection is used in the emergency treatment of acute anaphylaxis

A

1000

1 in 1000 = 1 mg/mL

20
Q

What is the preferable location to inject IM adrenaline/epinephrine in the emergency treatment of acute anaphylaxis?

A

Anterolateral aspect of the middle third of the thigh

21
Q

What are the risks of using adrenaline/epinephrine (IM or IV) during pregnancy? (2)

A
  1. May reduce placental perfusion and cause tachycardia, cardiac irregularities, and extrasystoles in fetus
  2. Can delay second stage of labour
22
Q

What monitoring is required in patients who have been given adrenaline/epinephrine? (2)

23
Q

If a patient self-injects IM adrenaline due to anaphylaxis and their symptoms improve, should they call for an ambulance?

A

YES

An ambulance should be called after every administration, even if symptoms improve

24
Q

How many self-injectable adrenaline/epinephrine devices should a patient at risk of anaphylaxis carry at all times?

25
Q

If a patient self-injects IM adrenaline/epinephrine due to anaphylaxis, what position should the patient be placed in?

A

Lie down with legs raised

Unless they have breathing difficulties - sit up

Should NOT be left alone

26
Q

What is the contraindication to the use of chlorphenamine maleate?

A

Neonate (due to significant antimuscarinic activity)

27
Q

What are the common side effects of chlorphenamine maleate? (9)

A
  1. Concentration impaired
  2. Coordination abnormal
  3. Dizziness
  4. Dry mouth
  5. Fatigue
  6. Headache
  7. Nausea
  8. Blurred vision
  9. Drowsiness (with oral use)
28
Q

Which patient demographics are more susceptible to the side-effects of chlorphenamine maleate? (2)

A

Children

Elderly

29
Q

What is the risk of using antihistamines in the latter part of the third trimester of pregnancy?

A

Irritability, paradoxical excitability, and tremor in neonates

Most manufacturers advise avoiding antihistamines during pregnancy but there is no evidence of teratogenicity

Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology (27 decks)

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