Pediatric Allergies

Question 1

IgE Mediated reactions

Answer 1

Typically rapid in onset
Skin
GI tract
Respiratory tract
Anaphylaxis

Question 2

90% of IgE mediated reactions in children are from these 8 sources

Answer 2

Cow’s milk, Eggs, Soybean, Wheat (will resolve)

Peanuts, Tree nuts, Fish, Shellfish (lifelong)

Question 3

Non-IgE mediated reactions

Answer 3

Occur hours to days after exposure
Typically presents in infants 
Can present as chronic skin conditions or most commonly manifests as GI symptoms
Proctitis/Proctocolitis
Enteropathy
Enterocolitis

Question 4

A positive reaction to skin prick testing

Answer 4

a wheal at least 3mm greater than the negative control (saline) or greater than positive control (histamine)

Question 5

Pollen-food allergy syndrome (PFAS), also known as oral allergy syndrome (OAS)

Answer 5

IgE-mediated reaction that affects the oropharynx
It is thought to occur from the cross-reactivity between proteins present in pollens and those expressed by fruits and vegetables.
Patients develop tingling and itching of the lips, tongue and palate when eating certain RAW fruits and vegetables.
Symptoms do not occur when the fruit or vegetable is cooked

Question 6

Meds for children < 2 years old

Answer 6

NO first generation antihistamines (H-1 blockers)
Cromolyn nasal spray
2nd generation antihistamine: Ceterizine, fexofenadine (for kids ≥ 6 months)
Intranasal glucocortocoids if severe symptoms and no response to above therapies

Question 7

Meds for Kids > 2 yrs old with persistent or severe symptoms

Answer 7

Intranasal glucocorticoid
Topical nasal antihistamines
Oral antihistamine
Decongestant

Start with first med and add on in this order if needed for persistent symptoms

Question 8

Intranasal glucorticoids for kids

Answer 8

Mometasone (Nasonex) ≥ 2 years
Fluticasone furoate (Veramyst) ≥ 2 years
Fluticasone propionate (Flonase) ≥ 4 years