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Allergy & immunology > Allergy > Flashcards

Allergy Flashcards

1
Q

what are physical findings suggestive of allergies

A
  1. transverse nasal bridge from allegic salute
  2. white dermatographism
  3. hyperlinearity on palms and soles
  4. Keratosis pilaris
  5. Dennis - morgan line under the eyes
  6. allergic shiners
  7. pityriasis alba
  8. cobble stoning of post pharynx
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2
Q

when would you do a RAST or cap-RAST

A 
RAST - Radioallergosorbent test
Do RAST if can't do skin testing:
- pt with dermatographism or extensive dermatistis
- risk of anaphylaxis
- can't stop antihistamine
- uncooperative
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3
Q

what disorders have high Ig E

A 
allergic disease
atopic dermatitis
eosinophilic esophagitis
Hyper Ig E syndrome
allergic bronchpulmonary aspergillosis
Helminthic infection
IgE leukemia
bone marrow transplant
Wishkott Aldrich syndrome
nephrotic syndrome
bullous pemphigoid
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4
Q

what is allergic bronchopulmonary aspergillosis?

A

hypersensitivity type reaction to Ag from Aspergillous mold

mainly in pt with CF or steroid dependent asthma

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5
Q

what is Atrovent?

A

anticholinergic bronchodilator
decreases mucus
decreases cough
has additive effect with b2 agonist

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6
Q

what can help you know if child needs daily inhaled steroid

A

rule of 2s:

  • more than 2 daytime symptoms per week
  • more than 2 nightime awakenings per month
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7
Q

what are SE of 1st generation antihistamines?

A 
Blind as a bat (blurred vision)
Dry as a bone (dry mouth)
Red as a beet (flushing)
Mad as a hatter (confusion)
Hot as a hare (hyperthermia)
Can’t see(vision changes)
Can’t pee(urinary retention)
Can’t climb a tree
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8
Q

when do we use topical tacrolimus?

A 
as second line
if older than 2 yrs
for short and intermediate 
especially if poor responders to steroid
if mainly face and neck eczema and steroids may not be appropriate
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9
Q

what is caused by a deficiency in C1 esterase inhibitor

A

hereditary angioedema , AD

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10
Q

what is a screening bld test for hereditary angioedema

A

low C4

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11
Q

what is serum sickness

A

systemic, type III immune complex–mediated hypersensitivity vasculitis classically attributed to the therapeutic administration of foreign serum proteins.

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12
Q

what are clinical features of serum sickness

A 
Fever
malaise
rashes - Urticaria and morbilliform 
angioedema, EM
myalgia and arthralgia
lymphadenopathy
GI-pain, nausea, diarrhea, and melena
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13
Q

what bld test will help Dx serum sickness

A

LOW C3, C4
circulating immune complexes
high ESR

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14
Q

what are possible complications of serum sickness

A 
carditis
GBS
nephritis
encephalomyelitis
peripheral neuritis
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15
Q

who requires immunotherapy for allergies

A

life threatening event post insect

+ venom skin test or RAST

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16
Q

child presents with swelling > 2 inches at site of insect bite. The swellin has gotten bigger over 24-48 hours. Dx

A

large local reaction can be mistaken for cellulitis

can give PO steroids for 4-5 days

17
Q

what percent of children with a peanut allergy will outgrow itif the manifested it before 2 yrs

A

20%

BUT most likely lifelong allergy especially is severe allergy

18
Q

what are the types of epipen and doses

A

if 15 - 30 kg - EpiPen Jr -0.15 mg

if > 30 kg - EpiPen - 0.30 mg

19
Q

what food allergies tend to get outgrown

A

milk
eggs
wheat
soy

20
Q

What food allergies tend to not get outgrown!

A

peanut
fish and shellfish
tree nuts

21
Q

what are the 3 types of drug reactions

A

1) Immediate (within 1h): anaphylaxis, hypotension,
wheezing, angioedema and laryngeal edema.

2) Accelerated (1-72h): urticarial/angioedema and/or wheezing. - derm or serum sickness
3) Late (>72h): macular/popular rashes, desquamation, SJS, TEN, hemolytic anemia and serum sickness.

22
Q

baby has recurrent urticaria when rubbed. Dx?

A

urticaria pigmentosa

usually < 2 yrs

23
Q

how do we manage urticaria?

A

H2 receptor antihistamine - non sedating
oral steroids - rarely needed
if chronic - need immune suppression

24
Q

what % of children with allergic rhinitis also have asthma/eczema?

A

13-38 %

25
Q

what are complications of allergic rhinitis?

A 
nasal polyps
sinusitis
? dental malocclusion from mouth breathing
sleep apnea
serous otitis media
26
Q

how do we manage AR

A 
avoid triggers
oral antihistamine
intranasal steroids
leukotriene receptor antagolnist - singulair
allergen immunotherapy
27
Q

what is the most common cause of erythema multiforme?

A

HSV

most often infectious

28
Q

What are CF of erythema multiforme

A

target lesions
dorsal hands/plams and arms
fixed
painless or mild burning

29
Q

how do you manage EM

A

anti histamine if itchy

supportive

30
Q

what are the most common cause of SJS?

A

drugs

Mycoplamsa pneumonia

31
Q

what is the main complication of SJS

A

ocular damage

32
Q

what are the most common causes of TEN

A 
NSAIDS
sulphonamide
AED
penicillin
infection
33
Q

who should get an epinephrine pen?

A
  1. previous anaphylaxis
  2. if had Rx with just trace allergen
  3. if likely to have repeated exposure
  4. if get generalized urticaria to insect venom
  5. if unclear Hx
  6. if live in remote areas
34
Q

when can a baby get introduced to allergenic foods?

A

after 6 mo

35
Q

what is the risk of anaphylaxis from a vaccine

A

0.6-1.5 per million doses

36
Q

if pt has egg allergy, what vaccine can they not get before skin testing?

A

yellow fever

37
Q

what should you do if you have a pt with an egg allergy that needs their influenza vaccine

A

no need for skin test
observe for 30 min
use same brand for booster

38
Q

what is a large local reaction from stinging insect

A 
late phase IgE
develops 12-48 hr later
same place as sting
often > 15 cm
resolves 5-10 days
39
Q

when does serum sickness occur

A
  1. 7-14 days post contact or

2. if previous sensitization - 1-4 days

Allergy & immunology (2 decks)

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