Allergy

Question 1

What is an allergy?

Answer 1

Geneti susceptibility resulting in an abnoral reaction to an environmental allergen

Question 2

What is the commonest chronic disease in children?

Answer 2

Allergy

Question 3

What percentage of children in the UK suffer fro allergy?

Answer 3

40%

Question 4

What is specific allergen immunotherapy?

Answer 4

Solutions of allergen are injected SC or sublingually on reg basis for 3-5 years with the aim of developing immune tolerance

Question 5

Are most allergies in children primary or secondary?

Answer 5

Primary - failed to ever build tolerance

Question 6

Hypersensitivity

Answer 6

Reproducible signs/symptoms following exposure to a defined stimulus at a dose tolerated by normal people

Question 7

Allergy

Answer 7

Hypersensitivity reaction IgE or non-IgE

Question 8

Given an example of a non-IgE mediated allergy

Answer 8

Coeliac

Question 9

Atopy

Answer 9

Personal/familial tendency to produce IgE antibodies to normal stimuli

Question 10

Categories of allergic rhinitis

Answer 10

Atopic vs Non-atopic
Intermitten vs persistent
Mild vs severe
Seasonal vs perennial

Question 11

What percentage of children suffer from allergic rhinitis?

Answer 11

20%

Question 12

Signs/symptoms allergic rhinitis

Answer 12

Conjunctivitis
Coryza
Coughing (+/- post nasal drip)
Mouth breathing, halitosis (chronic nasal congestion)

Sleep disturbance
Impaired behaviour
Reduced concentration
–> Affecting school performance

Question 13

Sepcifics to look out for allergic rhinitis

Answer 13

Monitor closely for asthma/other atopy
Check for nasal polyps/narrowing/deviated nasal septum
Identify most likely causative agent(s)

Question 14

Mouth breathing

Answer 14

Dry mouth

Halitosis

Question 15

Allergic rhinitis management (intermittent mild)

Answer 15

Allergen avoidance
Oral/intranasal antihistamine

LTRA

Question 16

Allergic rhinitis management (persistent mild)

Answer 16

Allergen avoidance
Oral/intranasal antihistamine
Intranasal corticosteroids
SL/SC immunotherapy

+Intranasal decongestant
+Nasal saline irrigation

Question 17

Allergic rhinitis management (persistent moderate to severe)

Answer 17

Allergen avoidance
Intranasal corticosteroids
Intranasal antihistamine

+Intranasal decongestant
+Nasal saline irrigation
+ INTRANASAL IPRATROPRIUM

Question 18

What percentage of infants may have cow’s milk protein allergy?

Answer 18

15%

Question 19

Signs/symptoms cow’s milk protein allergy

Answer 19

Resp - wheeze, coryza, cough, dribble
Gastro - vom, diarrhoea, constipation, wind
Skin - eczema, hives, angiodema, dermatitis

(Starting when using starting formula with cow’s milk protein, or in infants exclusively breastfed by mothers drinking cow’s milk)

Question 20

Management for CMPA in breastfed infants

Answer 20

Mother should avoid drinking cow’s milk
(Consider calcium and vitD)

Paediatric dietician
Monitor for growth
Regular ax for allergy (many children grow out)

MILK LADDER beginning at 1 year

Question 21

Management for CMPA in formula fed infants

Answer 21

Change formula to hypoallergenic:

• Hydrolysed - Aptamil pepti 1
• Amino acid if severe

Paediatric dietician
Monitor for growth
Regular ax for allergy (many children grow out)

MILK LADDER beginning at 1 year

Question 22

Management of CMPA in children

Answer 22

Remove cow’s milk from diet
Dietician input for nutritional counselling

Paediatric dietician
Monitor for growth
Regular ax for allergy (many children grow out)

MILK LADDER beginning at 1 year

Question 23

What is a milk ladder?

Answer 23

If tolerance to CMP is established, gradual exposure of less processed milk

Question 24

What is the most common pathophysiology of food allergy?

Answer 24

(Usually) IgE mediated reaction to environmental allergen. Most are primary, meaning the individual failed to ever develop tolerance to allergen

Question 25

Wht is food intolerance?

Answer 25

Non-immunological hypersensitivity to allergen

Question 26

Commonest food allergens in infants?

Answer 26

CMP, egg, peanut

Question 27

Commonest food allergens in children?

Answer 27

Peanut, tree nut, (Shell)fish

Question 28

Symptoms of IgE mediated food allergy

Answer 28

Acute onset (10-15 mins) - Resp symptoms: wheeze, stridor Angiodema Urticaria --> SHOCK

Question 29

Symptoms of non-IgE mediated food allergy

Answer 29

``` Insidous onset (over hours) - GI symptoms: abdo pain, DNV, FTT ```

Question 30

Which food allergies have a positive skin prick test? Which have negative?

Answer 30

+ve: IgE | -ve: non-IgE

Question 31

How are IgE mediated food allergies diagnosed?

Answer 31

Skin prick testing or specific IgE Abs in blood Food challenge

Question 32

How ae non-IgE mediated food allergies diagnosed?

Answer 32

Endoscopy and intestinal biopsy (eosinophilic infiltrates) | Food challenge

Question 33

Management of mild food allergies (no cardioresp symptoms)

Answer 33

Educate child and parents. Allergy action pain ``` AVOID TRIGGERS Anti histamines (non sedating) ```

Question 34

Management of severe food allergies (cardioresp symptoms)

Answer 34

Educate child and parents Allergy action plan ``` IM ADRENALINE (epipen) - <30kg = 0.15mg, >30kg = 0.3mg Salbutamol if bronchospasm ```

Question 35

Dosages for epipens

Answer 35

``` <30kg = 0.15mg >30kg = 0.30mg ```

Question 36

How is severity of urticaria assessed?

Answer 36

Urticaria activity score

Question 37

Management for symptomatic urticaria

Answer 37

Non-sedating antihistamine (e.g. cetirizine) Oral pred Daily antihistamines if persistent Refractory: LTRA, or anti-IgE antibody

Question 38

Name a non-sedating antihistamine

Answer 38

Cetirizine

Question 39

What is omalizumab?

Answer 39

Anti-IgE antibody