Immunology

Question 1

After an anaphylaxis. What key consideration is needed when deciding if it is safe for this patient to be discharged from the hospital?

Answer 1

The patient’s remaining symptoms and his response to adrenaline

A risk-stratified approach should be taken when discharging patients who have presented with anaphylaxis

The patient’s symptoms and his response to adrenaline, is the correct answer, with UK Resuscitation Council guidelines listing the following as criteria, all of which need to be met, for consideration of fast-track discharge after anaphylaxis:
Good response (within 5-10 mins) to a single dose of adrenaline given within 30 minutes of the onset of the reaction
Complete resolution of symptoms
The patient already has unused adrenaline auto-injectors and has been trained on how to use them
There is adequate supervision following discharge

Question 2

What is the most useful test to establish whether this episode was due to anaphylaxis?

Answer 2

Anaphylaxis - serum tryptase levels rise following an acute episode

Serum tryptase levels may remain elevated for up to 12 hours following an acute episode of anaphylaxis.

Question 3

wasp sting. Which one of the following is the most appropriate first-line test to investigate the cause of the reaction?

Answer 3

Radioallergosorbent test (RAST)

Question 4

intramuscular adrenaline injection.

What is the most appropriate site for injection?

Answer 4

IM adrenaline should be injected in the anterolateral aspect of the
middle third of the thigh

Question 5

testing can be read

Answer 5

Skin prick testing can be read after 15-20 minutes. Skin patch testing is read 48 hours after patch removal.

Question 6

After 2 doses of IM adrenaline what is the next best step in the management of this patient?

Answer 6

Refractory anaphylaxis is defined as respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline

Question 7

nickel. Which one of the following is the best test to investigate this possibility?

Answer 7

Skin patch test. This is because it is the gold standard for diagnosing contact dermatitis, such as nickel allergy. The test involves applying a small amount of various potential allergens, including nickel, to patches which are then placed on the skin. After 48 hours, the patches are removed and any skin reactions are assessed. A positive reaction typically presents as redness and swelling at the site where the allergen was applied.

Question 8

What is the most suitable test to investigate possible food allergy?

Answer 8

Skin prick testing would be first-line here as it is inexpensive and a large number of allergens can be investigated. Whilst there is a role for IgE testing in food allergy it is in the form of specific IgE antibodies rather than total IgE levels.

Question 9

How soon after the first-dose of adrenaline can he be given a further dose?

Answer 9

In the treatment of anaphylaxis, you can repeat adrenaline every 5 minutes

Question 10

Adrenaline dose < 6 months

Answer 10

100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

Question 11

Adrenaline dose 6 months - 6 years

Answer 11

150 micrograms (0.15 ml 1 in 1,000)

Question 12

Adrenaline dose 6-12 years

Answer 12

300 micrograms (0.3ml 1 in 1,000)

Question 13

Adrenaline dose Adult and child > 12 years

Answer 13

500 micrograms (0.5ml 1 in 1,000)