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3a Child Health > Immunology > Flashcards

Immunology Flashcards

1
Q

What is anaphylaxis?

A

Anaphylaxis is a life-threatening medical emergency caused by a severe type 1 hypersensitivity reaction.

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2
Q

What triggers anaphylaxis at the immunological level?

A

Anaphylaxis is triggered when Immunoglobulin E (IgE) stimulates mast cells to rapidly release histamine and other pro-inflammatory chemicals, a process known as mast cell degranulation

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3
Q

Describe the presentation of anaphylaxis

A

sudden onset and rapid progression of symptoms
* airway: swelling of the throat and tongue →hoarse voice and stridor
* breathing: dyspnoea and wheeze
* circulation: hypotension, tachycardia

additional symptoms:
* widespread erythematous or urticarial rash
* generalised Itching
* Angioedema (swelling around lips and eyes)

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4
Q

What is the initial step in managing anaphylaxis?

A

IM adrenaline (repeated after 5 minutes if required)

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5
Q

How can anaphylaxis be confirmed?

A
  • measuring serum mast cell tryptase within 12 hours of the event
  • Tryptase is released during mast cell degranulation and levels rise following an acute episode
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6
Q

How should an adrenaline auto-injector be used in anaphylaxis?

A
  • Firmly jab the device into the anterolateral aspect of the middle of the thigh until it clicks (can be done through clothing)
  • A second dose may be given (with a new pen) after 5 minutes if required
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7
Q

How is anaphylaxis managed following stabilisation

A
  • non-sedating oral antihistamines
  • all patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic
  • adrenaline injector: patients should be prescribed 2 adrenaline auto-injectors, training should be provided on how to use it
  • a risk-stratified approach to discharge
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8
Q

Why should a risk-stratified approach to discharge be taken in anaphylaxis patients

A

biphasic reactions can occur in up to 20% of patients

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9
Q

What is refractory anaphylaxis

A

defined as respiratory and/or cardiovascular problems that persist despite 2 doses of IM adrenaline

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10
Q

How is refractory anaphylaxis managed

A
  • IV fluids should be given for shock
  • expert help should be sought for consideration of an IV adrenaline infusion
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11
Q

What is allergic rhinitis?

A

a condition caused by an IgE-mediated type 1 hypersensitivity reaction, resulting in an allergic inflammatory response in the nasal mucosa

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12
Q

What are the types of allergic rhinitis?

A
  • Seasonal: For example, hay fever.
  • Perennial: Year-round, such as house dust mite allergy.
  • Occupational: Associated with allergens in the school or work environment.
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13
Q

What are the typical symptoms of allergic rhinitis?

A
  • Runny, blocked, and itchy nose
  • Sneezing
  • Itchy, red, and swollen eyes
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14
Q

What personal history is often associated with allergic rhinitis?

A

commonly associated with a personal or family history of other allergic conditions (atopy).

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15
Q

What is the first step in managing allergic rhinitis?

A

Avoid the trigger. Actions include:
* Hoovering and changing pillows regularly.
* Ensuring good ventilation of the home.
* Staying indoors during high pollen counts.
* Minimizing contact with known allergy-triggering pets.

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16
Q

What oral antihistamines are used for allergic rhinitis?

A
  • Non-sedating antihistamines: Cetirizine, loratadine, fexofenadine.
  • Sedating antihistamines: Chlorphenamine (Piriton), promethazine.
17
Q

What nasal medications can help manage allergic rhinitis?

A
  • Nasal corticosteroid sprays (e.g., fluticasone, mometasone) to suppress local allergic symptoms.
  • Nasal antihistamines for rapid onset symptoms in response to triggers.
18
Q

What is cow’s milk protein allergy?

A

a condition typically affecting infants and young children under 3 years, involving hypersensitivity to the protein in cow’s milk

19
Q

What are the two types of reactions associated with cow’s milk protein allergy?

A
  • IgE-mediated: Rapid reactions occur within 2 hours of ingestion (allergy)
  • Non-IgE mediated: Reactions occur slowly over several days (intolerance)
20
Q

What type of feeding increases the risk of cow’s milk protein allergy in infants?

A

more common in formula-fed babies

21
Q

What are the features of cow’s milk protein allergy?

A
  • GI: regurgitation, vomiting, diarrhoea
  • Skin: urticaria, atopic eczema
  • Behavioural: irritability, “colic” symptoms
  • Respiratory: wheezing, chronic cough
  • Rare reactions: angioedema, anaphylaxis
22
Q

How is cow’s milk allergy managed

A
  • extensive hydrolysed formula (eHF) milk for infants with mild-moderate symptoms
  • amino acid-based formula (AAF) in infants with severe CMPA
  • continue breastfeeding but eliminate cow’s milk protein from maternal diet
  • Consider prescribing calcium supplements for breastfeeding mothers
  • Every 6 months or so, infants can be tried on the first step of the milk ladder
23
Q

What is the typical prognosis for children with cow’s milk protein allergy

A
  • usually resolves in most children.
  • IgE-mediated: Most will be milk tolerant by age 5.
  • Non-IgE mediated: Most will be milk tolerant by age 3.
24
Q

Give 3 contraindications to immunisation

A
  • confirmed anaphylactic reaction to a previous dose of a vaccine containing the same antigens
  • confirmed anaphylactic reaction to another component contained in the relevant vaccine (e.g. egg protein)
  • Live vaccines: pregnancy and immunosuppression
25
Q

What vaccines are given to babies under 1 year old in the UK?

A
  • 8 weeks: 6-in-1 vaccine, Rotavirus vaccine, MenB vaccine
  • 12 weeks: 6-in-1 (2nd dose), Pneumococcal vaccine, Rotavirus (2nd dose)
  • 16 weeks: 6-in-1 (3rd dose), MenB (2nd dose)
26
Q

What 6 illnesses does the 6-in-1 vaccine protect babies against?

A
  • Diphtheria
  • Hepatitis B
  • Hib (Haemophilus influenzae type b)
  • Polio
  • Tetanus
  • Whooping cough
27
Q

What vaccines are given to children aged 1 in the UK

A
  • Hib/MenC (1st dose)
  • MMR (1st dose)
  • Pneumococcal (2nd dose)
  • Meningococcal B (3rd dose)
28
Q

What vaccines are given at 3 years and 4 months, and at 12-13 and 14 years in the UK?

A
  • 3 years and 4 months: MMR (2nd dose), 4-in-1 preschool booster (diphtheria, tetanus, whooping cough and polio)
  • 12-13 years: HPV vaccine
  • 14 years: Tetanus, diphtheria and polio (3-in-1 teenage booster), MenACWY vaccine

3a Child Health (19 decks)

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