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Year 4 - Paeds > Paeds Immunology > Flashcards

Paeds Immunology Flashcards

1
Q

Allergy
- ‘Sensitisation’ physiology

A

Sensitisation
- IgE response without clinical picture

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2
Q

Allergy
- Screening tests

A

Allergy screening

  1. IgE Mediated
    - Skin prick
    - Serum IgE
  2. Non-IgE
    - Elimination diet
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3
Q

EATERS History

A

EATERS History

E - xposure
A - llergen
T - iming
E - nvironment
R - eproducibility
S - ymptoms

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4
Q

Non-IgE reaction
- Symptoms

A

Non-IgE Sx

  • GI
    1. Food refusal
    2. Infantile colic/abdo pain
    3. GOR
    4. Loose/frequent stools
  1. Skin
    - Pruritus
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5
Q

Food allergy march

  1. Infancy
  2. Early childhood
  3. Adolescence
A

Food allergy march

  • Infancy
    1. Milk
    2. Egg
    3. Peanut

Early childhood
1. Soy
2. Wheat
3. Nut
4. Fish

Adolescence
1. PFS (pollen food syndrome)

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6
Q

Food re-introduction

  1. Milk
  2. Egg
A

Food reintroduction

  • Milk
    1. Baked with wheat
  • 70% tolerated
  • Egg
    1. Baked with wheat
  • 70% tolerated
    2. Well cooked
  • Improved tolerance
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7
Q

Food allergy
- Diagnosis verification

A

Food allergy verification

  • Food Challenge
    1. Increased over time
    2. Establish diagnosis/tolerance
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8
Q

Skin prick test

  1. Sensitivity
  2. Interpretation
A

Skin prick test

  1. Good negative predictive value
    - Poor positive predictive value
    [ 8mm wheal could still have no clinical picture (food challenge)]
  2. IgE determines Sensitivity
    - Not Severity
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9
Q

CMPA

  1. Presentation
  2. Symptoms
A

Cow’s Milk Protein Allergy

Presentation
1. 1-2% of infants
2. Before 12 months
3. Several week delay in Dx

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10
Q

FPIES

  1. Pathophysiology
  2. Foods
  3. Complications
A

FPIES

  • Syndrome
    1. Non-IgE
    2. Induced Enterocolitis Syndrome
  • Infant Foods
    1. Milk
    2. Soy
    3. Eggs
    4. Rice
  • Complication
  1. Severe N+V
  2. Shock
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11
Q

CMPA

  • Management
A

CMPA Mx

<6mo
1. Mother’s milk
2. Fortified EHF
- Extensively hydrolysed formula
3. Hypoallergenic formula
- Fully hydrolysed
- Amino Acids

> 6mo
1. Can tolerate soya
- Fortified

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12
Q

Lactase persistence
- Epidemiology
- Symptoms of intolerance

A

Lactase persistence

  1. Epidemiology
    - Only 35% of adults can digest milk
    - 10% in China and SE Asia
  2. Symptoms
    - 250ml tolerated
    - Bloating
    - Diarrhoea
    - Pain
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13
Q

Antihistamine Drugs

  1. Best drugs
  2. Not so good drugs
A

Antihistamines

  • Recommended
  1. Fexofenadine (Allegra)
    - Gold Standard
    - No BBB
  2. Loratadine (Claritin)
    - Second gen
    - No BBB
  • Avoid
  1. Piriton (Chlorphenamine)
    - 1st gen
    - BBB involvement
  2. Zyrtec ( Cetirizine)
    - BBB
    - Don’t drive
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14
Q

Allergy Steroids

  1. Recommended
  2. Adverse
A

Allergy steroids

  • Recommended (non-systemic)
  1. Fluticasone furoate
  2. Mometasone furoate
  3. Fluticasone propionate
  • Avoid
    1. Beclomethasone dipropionate
  • Reduced growth
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15
Q

Desensitisation

  • Available immunotherapies
A

Desensitisation immunotherapies
- SC & SL

  1. Wasp/bee
  2. Grass/tree
  3. HDM
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16
Q

PID
- Red Flag Infections

A

Primary Immune Deficiency Flags

S - erious
P - ersistent
U - nusual
R - ecurrent

17
Q

PID
- Family History

A

PID FHx

  1. Infections
  2. Autoimmunity
  3. Consanguinity
  4. Neonatal deaths
18
Q

PID
- Categories

A

PID Categories

  1. Antibody deficiencies
    - XLA (x-linked agammaglobulinemia)
  2. Combined Immune Deficiencies
    - SCID/DiGeorge
  3. Complement disorders
    - eg C2 deficiency
  4. Phagocyte disorders
    - CGD (chronic granulomatous disease)
19
Q

Antibody deficiency

  • Disorders
A

Antibody deficiency disorders

  1. XLA
    - X-linked agammaglobulinemia
    2.CVID
    - Common Variable ID
  2. IgG Subclass deficiency
  3. Transient hypogammaglobulinemia of infancy
20
Q

Antibody deficiency

  • Infections
  • Management
A

Antibody deficiency

  • Infections
    1. Sinus-pulmonary infections
    2. Giardia
  • Management
    1. IgG (SC or IV)
    2. ABx
21
Q

Combined immune deficiencies

  • Disorders
A

Combined immune deficiencies

  • Disorders (CD4, CD8, TReg)
  1. SCID
    - Severe Combined
  2. Hyper - IgM Syndrome
    - Low IgG
  3. Complete DiGeorge
    - Thymus
    - CHD and Facial
22
Q

Combined immune deficiencies

  • Infections
  • Management
A

Combined immune deficiencies

  • Infections
    1. Any
  • Management
    1. Igs
    2. ABx
    3. Marrow Transplant
    4. Thymus transplant
  • to Quads
23
Q

Complement deficiency

  • Disorders
A

Complement deficiencies

  1. C2 Deficiency
  2. Hereditary Angioedema
    - C1-Inh
24
Q

Complement deficiency

  • Infections
  • Mx
A

Complement deficiency

  • Infections
    1. Reduced opsonization
    2. Reduced phagocytosis
  • Mx
    1. Penicillin prophylaxis
    2. Additional Imms
  • Men ACWY, Men B, Pneumo
25
Q

Phagocyte disorders

Examples

A

Phagocyte disorders

  1. Chronic granulomatous disease
    - Associated IBD
26
Q

Phagocyte disorders

  1. Infections
  2. Mx
A

Phagocyte disorders

  • Infections
    1. Abscesses
    2. Granulomas
    3. IBD
  • Mx
    1. BMT
  • Bone marrow transplant
    2. Prophylaxis
    3. Contact avoidance
  • Compost
27
Q

ToRCH Infections

To
R
C
H
J

A

ToRCH Infections

T oxoplasmosis

R ubella

C MV

H SV

28
Q

Febrile Seizure

  1. Epidemiology
  2. Mx
    - Simple
    - Complex
    - Status
A

Febrile Seizure

  • Epidemiology
    1. 6mo - 5yo
    2. First occurrence before 3yo
  • Status
    1. Neurology/intensivist mx
  • Simple and complex
    1. Anti-pyretic
    + Midazolam
    +phenytoin

Year 4 - Paeds (11 decks)

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