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Paediatric food allergy Flashcards

1
Q

pathophysiology of IgE mediated allergy?

A

allergen on class II MHC - T helper- IL - B cells

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2
Q

T2 helper cells affect ?

A

B cells - Production of IgE

  • mast cells - sensitisation to allergen
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3
Q

Release of soluble mediators of mast cells? (4)

A
  • histamine
  • cysteine leukotrienes
  • prostaglandins
  • cytokines
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4
Q

what cells do mediators affect (4)

A
  • epithelial cells
    blood vessels
  • smooth muscle
  • fibroblasts
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5
Q

mast cell degranulation? rapid secretions

A

histamine, tryptase, hydrolase

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6
Q

what is secrete in the biphasic reaction

A
  • prostaglandins
  • cytokines
  • leukotrienes
  • PAF
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7
Q

what does histamine do?

  • what signs does it clinically show?
A

Smooth muscle contraction - wheezing

  • vasodilation - flushing, hypotension - white pallor patches
  • separation of endothelial cells - hives , oedema
  • pain and itching
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8
Q

genetic influence to allergy ?

what are the percentages?

A
  • maternal atopy
  • twins

neither parent = 14%, one part = 30%
both parents = 60%

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9
Q

how to decide if it is allergy or not?

A

rapid onset

histamine mediated reactions

  • improvement with antihistamines
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10
Q

clinical signs of allergy (5)

A

angioedema, urticaria (raised skin lesions), erythema, pallor/sweating, wheeze

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11
Q

what caused the reaction?

A

food

environmental

drug

sting/bite

idiopathic

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12
Q

most common food allergens you get?

A

milk

hen’s egg

peanut

tree nuts

soya

wheat

fish

sesame

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13
Q

how to work out hoe severe the reaction is - mild/moderate?

A

Angioedema - not involving airway ,

  • urticaria and rash
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14
Q

how to work out hoe severe the reaction is- severe

A

angioedema of airway - stridor

  • bronchospasm
  • hypotension
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15
Q

what investigations are available? (3)

A

skin pick testing
specific IgE - blood test
oral food challenge

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16
Q

first line investigation for allergy

A

skin prick testing

  • non-invasive
  • immediate results
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17
Q

negative skin prick tests are a good predictor for?

A

negative IgE mediated food reaction in patients with anaphylaxis

18
Q

pitfalls of skin pick testing

A

stop antihistamines 48 ours prior

  • broken skin
  • risk of reactions
  • dermatographism
  • over interpretation
  • avoid random tests
19
Q

positive test is?

A

3ml over the negative control

20
Q

Specific IgE testing

A
  • no need to stop antihistamines
  • expensive and invasive
  • delay in obtaining results
  • less sensitive and specific than SPT
  • high unreliable with children who have eczema
21
Q

children with eczema have high levels of?

A

basal levels of IgE

22
Q

IgE egg, milk and peanut allergy kUA/L score at age 5

23
Q

specific IgE testing can cause interference from ?

A

high total IgE

24
Q

oral food challenge is the ?

A

gols standard test

- day case procedure

25
urticaria and angioedema - chronic? - what is more common to have on its own?
> 6 weeks urticaria
26
without urticaria - may be due to
C1 inhibitor deficiency
27
investigation for urticaria on its own?
None
28
possible food or Environmental trigger / investigations
skin testing | specific IgE
29
Angioedema only - | Investigations?
hereditary - teengers C4 and C1 esterase inhibitor
30
Rarely you may do what investigations?
FBC, urinalysis, ESR, LFT, coeliac screen, TFT, antithyroid
31
Treatment of allergy
- triggers | H1 - antihistamine - 2nd/3rd generation
32
Treatment of allergy - acute episode? - what can you add in?
high dose antihistamines - leukotriene antagonist (montelukast) corticosteroids (3-5 days) Anti IgE monoclonal antibody (Omalizumab) > 7 years
33
Angioedema - what can you use to treat
Tranexamic acid
34
anaphylaxis involves
laryngeal - oedema - stridor hypotension/collapse - - pallor - bronchospasm - feeling impeding doom
35
clinical features of anaphylaxis
-20 % have biphasic reaction up to 8 hours later
36
risk factors for anaphylaxis
ASTHMA - poorly controlled - stress - exercise - viral infection - alcohol
37
Adrenaline pens - what is the adult and junior dose
0. 3 mg | 0. 15mg
38
First line treatment of anaphylaxis
adrenaline pen
39
adrenaline pen can interact with?
bet blockers and tricyclics
40
what does adrenaline do (6)
- reverses peripheral vasodilation - inc peripheral vascular resistance - improves BP and coronary perfusion - decreases angioodema and inflammatory mediators - causes bronchodialtion
41
next 300 vs 150 - patient weight
300 > 30kg 150 - 15-30kg
42
who needs an adrenaline pen?
those who have had severe reaction - when allergy can't be avoided - high risk allergens , asthma risk factors

Paediatrics (49 decks)

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