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Year 4 Paediatrics > Paediatric Allergies > Flashcards

Paediatric Allergies Flashcards

1
Q

Definition of an allergy

A

Allergen specific reproducible immune mediated hypersensitivity reaction

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2
Q

Definition of sensitisation

A

Production of IgE antibodies after repeated exposure to an allergen

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3
Q

Definition of atopy

A

A tendency to produce IgE antibodies in response to ordinary exposure to potential allergens

Associated with asthma, rhinitis, eczema and food allergy

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4
Q

Anaphylaxis

A

Rapid, life threatening hypersensitivity response to an allergen

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5
Q

Investigations for suspected allergy

A

Screening:

  • Skin prick test - low sensitivity therfore used to rule out allergy
  • Blood specific IgE - useful to confirm diagnosis
  • Elimation from diet

Diagnosis verification:
- controlled oral food challenge

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6
Q

Allergy history (EATERS)

A

Exposure - eaten, smells, handling
Allergen - common food allergens
Timing - IgE mediated - immediate, non IgE mediated - delayed
Environment - weaning, eating away e.g. holiday or nursery
Reproducibilty - no reaction if avoiding the food
Symptoms - rash, nausea and vomiting, breathlessness, angioedema

FHx

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7
Q

Skin symptoms

A

Pruritis
Erythema
Urticaria
Angioedema - lips, face and around eyes

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8
Q

GI symptoms

A

Nausea and vomiting
Diarrhoea
Colickly abdominal pain

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9
Q

Respiratory symptoms

A 
Blocked or runny nose 
Sneezing 
Itch 
Wheeze 
Cough 
Breathlessness
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10
Q

Cardiovascular symptoms

A

Pallor
Drowsy
Hypotension

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11
Q

Non IgE mediated specific symptoms

A

Atopic aczema
Food refusal
GORD - not responding to treatment
Constipation

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12
Q

Cross reactive food allergens

A

If allergic to on allergen, more likely to be allergic to another similar allergen e.g. cow’s milk and goats milk

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13
Q

Which type of sensitivity reaction is a food allergy

A

Type 1

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14
Q

Pathophysiology of allergy

A
  1. Sensitisation - allergen presented to T cell
  2. TH2 cells commit B cells to produce IgE
  3. Allergen specific IgE bind to mast cells and basophils
  4. Subsequent allergen exposure in sensitised patient
  5. Allergens cross link receptor bound IgE which activates mast cells and bosphils
  6. Mast cells release mediators - cytokines and leukotrienes
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15
Q

Immunoassay of serum IgE method

A
  1. Allergen absorbed onto a solid phase
  2. Patients serum is added
  3. Allergen bound IgE detected using a IgE monoclonal antibody - detects IgE circulating in the blood
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16
Q

How does a skin prick test work?

A

Skin prick test exposes the patient to the allergen

Detects IgE bound to skin mast cells

17
Q

Wheal size

A

More than 8mm has a 95% positive predictive value

18
Q

Do levels or allergy testing correlate with severity

A

No

- determines presence of sensitivity

19
Q

Cows milk protein allergy presentation

A

General:

  • irritable, crying and poor sleep
  • atopy

Feeding:

  • difficult to feed
  • vomiting and pulls legs up
  • back arching or abdo pain

Bowels:

  • constipated or loose stools
  • straining
  • mucus/ blood in stool
  • vomiting
  • bloating

Skin:

  • erythema
  • Pruritis
  • urticaria
  • angioedema
20
Q

Differentials for CMPA

A

GORD
Pyloric stenosis
Hirschprung disease
Malrotation

21
Q

Features of CMPA

A

All present before 12 months old
Delayed response - weeks
Most become tolerant by the age of 5 yo

22
Q

FPIES - food protein enterocolitis syndrome features

A
  • Non IgE mediated food hypersensitivity
  • Presents in infancy
  • Delayed presentation 1 - 3 hours after exposure
23
Q

FPIES presentation

A

Rectal bleeding
Profuse repetitive vomiting leading to shock
Pallor
CRP NORMAL, WCC elevated

24
Q

Management of CMPA

A

Breastfeeding:

  • mother to avoid milk in diet if exclusively breastfeeding
  • give mother calcium and vitamin D

Not breastfeeding:

  • trial of extensively hydrolysed formula
  • if not tolerated, amino acid formula
  • soya infant formula if > 6 months
25
Q

Administration of adrenaline

A
  1. Lie child flat with legs raised or sit up
  2. Inject adrenaline in lateral thigh
  3. Time, if symptoms not resolved after 5 mins, inject again
26
Q

Rhinitis

A

Inflammatory disorder of the nasal mucosa initiatedd by an allergic immune reaction to inhales allergens

27
Q

Rhinitis presentation

A 
Nasal congestion 
Rhinorrhoea 
Sneezing 
Itching 
Mouth breathing 
Halitosis - bad breath 
Allergic facies
Swollen nasal turbinates
28
Q

Allergic facies

A 
Lick eczema - due to dry lips 
Swollen midface 
Mouth breather 
Allergic crease (nose) 
Allergic shiners - eye bags
29
Q

Management of rhinits

A

Intranasal corticosteroids - beclomethasone
Oral antihistamine - cetirizine (non sedating)
Intranasal decongestants

30
Q

Anaphylaxis management

A
  1. IM 1:1000 Adrenaline - repeat after 5 mins if still symptomatic
    - 12+ yo - 500 micrograms
    - 6 - 12yo - 300 micrograms
    - 6 months - 6 years - 150 micrograms
31
Q

Top 3 common allergens in children

A

Cow’s milk
Tree nuts
Eggs

32
Q

Types of hypersensitivity reactions and examples

A

Type 1 - IgE mediated - allergies

Type 2 - IgG and IgG - haemolytic anaemia and transfusion reactions

Type 3 - immune complexes - Henoch Schonlein purpura, SLE, RA

Type 4 - T lymphocytes - contact dermatitis

33
Q

What needs to be stopped before a skin prick test is done

A

Antihistamines

34
Q

Management of anaphylaxis after the reaction

A
  • Period of observation due to biphasic reactions
  • serum mast cell tryptase within 6 hours of reaction
  • education and follow up
35
Q

Triggers for allergic rhinitis

A

Pollen
House dust mites
Pets
Mould

36
Q

Nasal spray technique

A

Close one nostril and spray in other
Spray upwards and then sniff (not at same time)
Should not be able to taste medication

Year 4 Paediatrics (19 decks)

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