Pediatric Allergy

Question 1

What does mast cell de-granulation cause?

Answer 1

Rapid release of Histamine, Tryptase and Hydrolase and onset of symptoms.

Later release with subsequent effects - secreted inflammatory mediators such as Prostaglandins, Leukotrienes and Cytokines.

Question 2

What does Histamine do ?

Answer 2

Bronchial and smooth muscle contraction.

Vasodilation.

Separation of endothelial cells (responsible for hives)

Pain and itching

Question 3

How do you know if what is happening is an allergic reaction ?

Answer 3

Rapid onset.
Histamine mediated reactions.
Urticaria, itching, angioedema, pallor, sweating and wheeze.
Improves with antihistamines.
Relatively quick resumption of symptoms.

Question 4

What are some common food allergies ?

Answer 4

Milk 
eggs
Peanuts
Tree nuts
Soya
Wheat
Fish
Sesame

Question 5

What are the common signs and symptoms in a mild/moderate allergic reaction ?

Answer 5

Angioedema (not involving airway)

Urticaria and rash

Question 6

What are the common signs and symptoms in a severe allergic reaction ?

Answer 6

Angioedema involving airway - Stridor.

Bronchospasm

Hypotension

Question 7

What are some of the investigations used to test for allergies ?

Answer 7

Skin prick testing.

Specific IgE.

Oral food challenge.

Question 8

A negative skin prick test is an excellent predictor for what ?

Answer 8

A negative IgE mediated food reaction in patients with anaphylaxis

Question 9

What do you need to stop before attempting a SPT ?

Answer 9

Antihistamines

Question 10

What are the benefits of the specific IgE test ?

Answer 10

No need to stop antihistamines prior.

No risk of reactions.

Question 11

What are the cons of specific IgE ?

Answer 11

Expensive.
Delay in obtaining results.
Less sensitive and specific than SPT.
Highly unreliable results in eczema.

Question 12

What is the gold standard for allergy testing ?

Answer 12

Oral food challenge

Question 13

What are the sins and symptoms of anaphylaxis ?

Answer 13

Laryngeal edema
Hypotension
Bronchospasm
Feeling of impending doom
Onset usually in minutes

Question 14

Name some risk factors in anaphylaxis ?

Answer 14

Poorly controlled asthma.
Stress.
Exercise.
Viral infection.
Alcohol.

Question 15

How does adrenaline act to counteract an allergic reaction ?

Answer 15

Reverses peripheral vasodilation
Increases peripheral vascular resistance
Improves BP and coronary perfusion.
Decreases angioedema.
Causes bronchiodilation.
Decreases the release of inflammatory mediators.

Question 16

What is the management for an allergic reaction ?

Answer 16

Allergen avoidance.
Anti-histamine.
Adrenaline injectors (Asthma/Anaphylaxis).
Dietary advice.
Optimise Asthma control.

Question 17

What kinds of foods cause oral allergy syndrome ?

Answer 17

Celery, fennel and carrots.

Melon, tomato and orange.

Question 18

What is the symptoms of oral allergy syndrome ?

Answer 18

Itching

Mouth swelling and tongue discomfort

Question 19

What is the treatment for oral allergy syndrome ?

Answer 19

Antihistamine and avoidance

Question 20

What is the management of an egg allergy ?

Answer 20

Avoidance
Re-introduction
Egg ladder

Question 21

What are the symptoms of IgE mediated cow’s milk allergy ?

Answer 21

Rapid onset
Histmine based reaction.
Vomiting and occasionally diarrhea.

Question 22

How do you identify IgE mediated cow’s milk allergy ?

Answer 22

SPT or specific IgE

Question 23

How do you identify a non-IgE mediated cow’s milk allergy ?

Answer 23

Not histamine based.

Varying in presentation (bloating, Bleeding PR and irritability)

Question 24

What is the diagnostic test and management of non IgE mediated cow’s milk allergy ?

Answer 24

No diagnostic test other than dietary management - improves with withdrawal of milk protein

Question 25

How does a lactose intolerance present ?

Answer 25

Similar to a non-IgE mediated response.

Question 26

How do you diagnose and manage a lactose intolerance ?

Answer 26

Skin prick test.
Specific IgE

Therapeutic trial of exclusion under dietetic review.

Question 27

What is the management for IgE - cows milk allergy and non-IgE ?

Answer 27

Maternal avoidance of cows milk - need to supplement Calcium and Vit. D.

EHF Formula.

AA formula if not tolerated.

soya milk >1 years of age or not tolerated the above

Question 28

What would you include in an allergy focused history and diagnosis ?

Answer 28

Timing of events.
When did it begin, what caused it and how long did the symptoms last ?
What made it better ?
Any atopy in the family ?

Question 29

What signs would you consider to be indicative of IgE mediated reaction ?

Answer 29

Acute Pruritis.
Urticaria.
Angioedema.
Acute flaring of eczema.
Wheeze.
Pallor and Sweating.

Question 30

Which symptoms would you consider to be severe in an allergic reaction ?

Answer 30

Blood/mucous in stool.
Failure to thrive.
Wheeze.
Pallor and sweating.