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Flashcards in Allergies Deck (66):
1

What types of reactions are allergic reactions?

IgE mediated
Non-IgE mediated

2

IgE Mediated Reactions

Rapid in onset
Skin
GI Tract
Respiratory tract
Anaphylaxis

3

What are the top 8 sources of IgE mediated responses?

Cow's milk
Eggs
Soybeans
Wheat
Peanuts
Tree nuts
Fish
Shellfish

4

Which of the top 8 sources of IgE mediated responses resolve by age 5?

Cow's milk
Eggs
Soybeans
Wheat

5

Which of the top 8 sources of IgE mediated responses are lifelong?

Peanuts
Tree nuts
Fish
Shellfish

6

Non-IgE Mediated Reactions

Hours to days after exposure
Presents in infants
Present as chronic skin conditions or GI symptoms

7

Common GI Symptoms for Non-IgE Mediated Reactions

Proctitis/Proctocolitis
Enteropathy
Enterocolitis

8

Cutaneous Symptoms of Food Induced Allergic Reactions

Erythema
Pruritus
Urticaria
Angioedema

9

Ocular Symptoms of Food Induced Allergic Reactions

Pruritis
Conjunctival erythema
Tearing
Periorbital edema

10

Upper Respiratory Symptoms of Food Induced Allergic Reactions

Nasal congestion
Pruritis
Rhinorrhea
Sneezing
Laryngeal edema
Hoarseness
Dry cough

11

Lower Respiratory Symptoms of Food Induced Allergic Reactions

Cough
Chest tightness
Dyspnea
Wheezing
Intercostal retractions

12

GI Oral Symptoms of Food Induced Allergic Reactions

Angioedema of the lips
Tongue or palate
Oral pruritis
Tongue swelling

13

Lower GI Symptoms of Food Induced Allergic Reactions

Nausea
Colicky abdominal pain
Reflux
Vomiting
Diarrhea

14

CV Symptoms of Food Induced Allergic Reactions

Tachycardia
Hypotension
Dizziness
Fainting
LOC

15

Diagnostic Tests for Food Induced Allergic Reactions

Skin prick test (SPT)
Allergen specific serum IgE
Oral food challenge

16

Treatment of Food Induced Allergic Reactions

Avoidance
Eli-Pen for anaphylacis

17

Is/are atopic dermatitis, chronic nasal congestion, or acute urticaria associated with food allergies?

Atopic dermatitis
Acute urticaria

18

What happens to atopic dermatitis after the elimination of the allergen?

Often improves

19

When do you want to consider evaluation of atopic dermatitis in infants & children?

When there is moderate to severe atopic dermatitis
History of exacerbation with eating specific foods

20

Causes of Acute Urticaria

Infection
Drug reaction
Food allergy

21

Is acute or chronic urticaria present with a food allergy?

Acute

22

Nasopharyngeal Symptoms with Food Allergies

Acute rhinitis
Pruritis of the throat
Angioedema

23

What must be continued in order to do skin prick testing?

Antihistamines

24

Which serum specific IgE tests need to be correlated with the patient's clinical history?

Positive tests
Negative tests

25

What is the gold standard for a diagnosis of food allergies?

Oral food challenge

26

How does the oral food challenge work?

Patient given gradually increasing amounts of the suspected food allergen over a time period of hours to a day
Close medical supervision

27

What are atopy patch tests used for?

Diagnose delayed hypersensitivity T-cell mediated reactions such as contact dermatitis

28

Diagnostics of Food Allergies

Clinical history
Oral challenge
Skin tests
Serum specific IgE

29

Established Cutoff Values for Serum Specific IgE for Eggs

3-17 years: 7 kU/L

30

Established Cutoff Values for Serum Specific IgE for Cow's Milk

3-17 years: 15 kU/L

31

Established Cutoff Value for Serum Specific IgE for Peanuts

14 kU/L

32

Established Cutoff Value for Serum Specific IgE for Fish

20 kU/L

33

Treatment of Food Allergies

Avoidance of food
Notify adult when they eat something that may contain the food
Epi-pen auto injector

34

Where should Epi-pens be available for the child?

Home
Daycare
School

35

Define pollen-food allergy syndrome (PFAS)

Occur from cross-reactivity between proteins present in pollens and those expressed by fruits & veggies

36

Another Name for Pollen-Food Allergy Syndrome

Oral Allergy Syndrome (OAS)

37

Symptoms of PFAS and OAS

Tingling & itching of the lips, tongue, and palate when eating certain raw fruits & veggies

38

Do symptoms of PFAS/OAS occur when the fruit or vegetable is cooked?

No

39

Birch Pollen Cross Reactivity is Associated with Which Fruits/Veggies

Apples
Plums
Peaches
Nectarines
Cherries
Almonds

40

Ragweed Pollen Cross Reactivity is Associated with Which Fruits/Veggies

Melons
Bananas
Tomatoes

41

Grass Pollen Cross Reactivity is Associated with Which Fruits/Veggies

Melons
Kiwi fruit

42

Diagnosis of PFAS/OSA

Confirmed through skin prick testing to the fresh foods and pollen
Also with oral food challenges

43

Treatment of PFAS/OSA

Controlled with antihistamines
Avoid consumption of raw food product
Strictly avoid food in all forms if systemic symptoms
Epi-pen

44

What advice would you give a peanut/tree nut allergy regarding their risk of fatal anaphylaxis?

Foods may unknowingly contaminated with peanuts/tree nuts and therefore having an Epi-pen is critical at all times

45

Who is at a higher risk for fatal food-induced anaphylaxis?

Teenagers

46

Why are teenagers at a higher risk for fatal food-induced anaphylaxis than younger children?

Decreased dose with increasing age
Poor understanding when reactions are severe and when Epi-pen use is needed

47

Are shellfish, eggs, or peanuts more common in adults than children?

Shellfish

48

What are the most common food allergies in children?

Milk
Eggs
Peanuts

49

What are the most common food allergies in adults?

Shellfish
Peanuts
Tree nuts

50

Symptoms of Allergic Rhinitis

Sneezing
Rhinorrhea
Nasal congestion
Itching of the eyes, nose, palate, ear canals
Postnasal drip, cough
Irritability
Fatigue

51

Allergic Rhinitis Significant Impact on QOL & Cognitive function

Sleep disordered breathing
Fatigue
General malaise
Cognitive & psychiatric issues in children

52

What types of cognitive and psychiatric issues are there in children?

ADHD
Lower exam scores in peak pollen season
Poor concentration
Impaired athletic performance
Low self esteem

53

Diseases Associated with Allergic Rhinitis

OM
Eustachian tube dysfunction
Sinunsitis
Asthma
Sleep-related breathing disorders

54

Physical Findings of Allergic Rhinitis

Allergic salute
Allergic shiner
Dennie Morgan lines
Conjunctival chemosis
Cobbelstoning

55

Diagnosis of Allergic Rhinitis

Suggestive history
Supportive exam
Identify specific-IgE

56

Define Sensitization

Presence of specific IgE to an allergen

57

Define Allergy

Allergy symptoms
Evidence of sensitization

58

Treatment of Allergic Rhinitis

Environmental control
Pharmacotherapy
Immunotherapy

59

Pharmacotherapy Options for Allergic Rhinitis

Antihistamines
Decongestants
Nasal steroids
Anticholinergics
Mast cell stabilizers
Ocular meds
Leukotriene modifiers

60

Treatment in Children

Avoidance therapy
Cromolyn nasal spray
Ceterizine
Fexofenadine
Intranasal glucocorticoids (severe)

61

Treatment for Allergic Rhinitis with Mild or Episodic Symptoms

Cetirizine, loratidine, or fexofenidine
Azelastine (>5 years)
Olopatidine (>12 years)
Intranasal glucocorticoid
Intranasal cromolyn

62

Treatment for Allergic Rhinitis with Persistent or Severe Symptoms

Intranasal glucocorticoid
Topical nasal antihistamines
Oral antihistamine
Decongestant
Start with 1st and work down

63

Intranasal Glucocorticoids for Children

Memetasone (Nasonex) >2 years
Fluticasone furoate (Veramyst) >2 years
Fluticasone propionate (Flonase) >4 years

64

Topical Nasal Antihistamines for Children

Azelastine (Asteline) >5 years
Olopatidine (Patanase) >12 years
Combo azelastine & fluticasone (Dymista) >12 years

65

Treatment of Allergic Rhinitis with Allergic Conjunctivitis

Intranasal glucocorticoid
Topical Ophthalmic antihistamine drops

66

Treatment of Allergic Rhinitis with Asthma

Monteleukast (Singulair) >6 months