pediatric allergy Flashcards
what is the most common chronic respiratory disorder in childhood?
asthma
define asthma3
it is a heterogeneous disease, usually characterized by chronic airway inflammation. history of respiratory symptoms: wheezes, shortness of breath , chest tightness, cough that vary over time and in intensity with expitatory airflow limitation
what is the ratio of asthma between boys and girls before and after puberty
2:1 before and equal after
what is the age of onset of asthma
at any age mostly before 5 years
what is the pathophysiology?
when the child is subjected to a precipitating risk factor , the mast cells release cytokines that leads to: constriction, ++mucus, mucosal edema, cellular inflilitartion and desquamination
normall the airways are narrower in expiration
airway obstruction may lead to:4
area of hyperinflation
area of segmental atelectasis
alveolar hypoventilation: hypoxia, acidosis
ventilation perfusion mismatch
what are the asthma triggers6
- allergens: house dust………
- viral infection:respiratiory syncytial virus RSV
- cold air and exercise induced asthma
4, emotional and psychological - drugs as asprin and nsads
- pollutants, smoke
items in diagnosis of asthma6
history1
2. physical examination: normal in free intervals, prolonged expiration - or + exp rhonchi in symptomatic periods accouding to the severity
3. objective measurment of air flow: PEFM and spirometry
4 . assessment of atopy
5. others: chest x ray, blood eosinophilia
6. DD
what is the most common cause of wheezing in children
asthma
what do you call the level of treatment required to control symptoms and exacerbations?
assessing severity of asthma as a chronic disease
items in assessing acute attacks of asthma 10
talk,look, rate , rate, wheeze,conscious , O2, CO2, pEFM
what is the difference in the assessment of asthma control between 5y and 6-11y?2
in older : day time symptoms,
need reliever medications more than twice a week
what are the objectives in management asthma?4
1.Treat: of the acute attacks
2.Prevent: by controllers
3. Avoid the triggers
4. educate:patient and family
see page 111
what are the goals and primary therapies for asthma excacerbations?4
- Oxygen:maintenance of adequate o saturation
- Relief: the obstruction by rapid acting beta agonist
- inflammation: reduction with early systemic corticosteroides
- monitor: response to treatment with clinical assessment of lung functions
mild and moderate managing of acute exacerbations : lines 3+consider
- short acting beta2 agonist
consider ipratropium bromide - controlled o to maintain saturation 93-95 children :94-95
3.oral corticosteroides
while asthma acute in severe
if drowsy and confused =ICU or
good mentality: same as mild and moderate but1. i will use ipratropium
2. consider IV magniesium
3.consider high dose of ICS
both cases of acute finaally iw
Assessment :1. clinical progress 2.lung function after one hour of initial treatment
management of acute severe asthma: life threatening condition5
- Hospitalization in ICU 2. Oxygen: to correct hypoxemia
- IV fluid therapy: maintenance therapy 4. drug therapy : separete question
- mechanical ventilation: WHen?? withA. marked CO2 retention above 55mmhg
B.severe hypoxemia, C.severe acidosis orD. disturbed consciousness
what is the drug therapy in life threatening asthma5
- Nebulized salbutamol: 0.25-0.5 ml added to 2-3 ml saline every 1-2 hours
- IV salbutamol: by infusion under continuous monitor
- IV methyl prednisolone 2mg\kg first dose followed by 2mg\kg\24 divided \6h
or IV hydrocortisone:5-10mg\kg every 6hours - IV magnesium sulphate:25-75 mg\kg once slowly by infusion over 60min
- IVaminophylline: 5mg\kg slow every 6 hours or 1mg\kg\hour
when the asthma controllers are indicated
in persistent asthma
what are the long term control medications for asthma 8
leukotriene receptor antagonist : montelukast
anti-IgE , anti interleukin-5
anti-cholenergic
cromones
immunotherapy:NOT more than THREE allergen…NOT under FIVE years
stepwise for long term sthma in 5 y:
infrequent viral wheezing or few interval symptoms??
NOthing
5y:symptoms not well controlled or exacerbations in 3y and up
which step
step 2:preferred : daily low dose ICS
other: LTRA or intermittent ICS
symptoms not well controlled on low dose ICS
step??
step 3:preferred: Double low dose ICS
other: low dose+ LTRA
symptoms not well controlled on double dose of ics
step??
4
preferred:continue and refer to specialist
other; add ltra or increase ics frequency or intermittent ics
symptoms less twice \onth for 6-11
step
1
pr:no
oth:daily low Ics or low ics with saba
symptoms twice or more \month but not daily step?
2
p:daily low ics
other:daily ltra or low ics with saba
symptoms most days or waking from as once or more \week
step
3
pref:low ics - laba or medium ics
oth:low ics+ltra
low lung function
4
prf:medium ics-laba and refer for advice
oth: high dose ics-laba or add on tiotropium or add on ltra
short course of ocs
5
p: refer for phenotypic +- anti IgE
oth: add on anti-IL5 or add on low ocs
what should you consider in stepping up?4
- uncontrolled symptoms
- exacerbations or risks
- check: diagnosis, inhaler technique , adherence first
what should you do when stepping down2
- symptoms controlled for 3 months + low risk for exacerbations
- stopping ics is not advised
etiology of allergic rih and conjunctivitis
seasonal allergic: pollens
perennial: house mite pets
what is CP of allergic rhi
coryza
conjunctivitis
sneezing
itching of nose……assoctioation : eczem.asth. sinust
whaat si th e trtt of allergic rhi
- 2nd antihistamicns:topical or systemic
.2. leukoterine antagonis , topicl corticosterid
3, immunotherapy
food allergy is rare 6-8% may be igE or non igE
what the cp of food allergy:5
1.skin ; itching , eczema , swelling of lips , face , tongue , throat
2. respiratory: wheezing , nasal congestion , bad breathing
3. abdomen: distension , diarrhea, nausea vomiting
4, cns:dizziness
5,cvs: anaphylaxis
what is the onset of food allergy symptoms?
few minutes to 2 hours
even after 1st time of ingestion
symptoms of food allergy 5 : skin, res. cvs, cns, abo
itching swelling lip……throt
wheezing bad breath, nasal
pain. diarrhea, nause vomiting
dizzines
anaphylaxis
how to diagnosis the food allergy4
- typical history of exposure
- gold stander: double blind placebo controlled food challenge
3.skin prick test - measurment of specific IgE
ttt of food allergy:2
avoide
epinephrine IM in severe
incidence of atopic eczema or atopic dermatitis is very common
cp of atop derma:
onset of it:?
almost always before 5 years
all ages can be affected by atopic derma
treatment of derma atop:general , medications
1.avoid hot baths medications:1.corticosteriod cream
2. oral antihistaminces
3. some case oral cortesione
2.soft cotton clothes
3. moisturizing ointments
.4.cool compresses of areas
urticaria may be acute or chronic more than 6 weeks which usually non allergic in orgin
what is the etiology of urticaria?5
q1idiopathic
2. infection
3. igE mediatied: food, blood , drugs:pencillin
4. pharmacological: foods containing histamine releasing sub:strawbe,egg,white cheese
asprin non ster
5.physical: heat , cold , pressure
acute urticaria is self limited , adrenalin insevere, short course oral cotrt for sever
insect bite:mild local, mod:generlized swelling or severt. :systemic
child with only mild mod are UNlikely to severe
who had severe carry adrenalin
