Allergy

Question 1

Definition of anaphylaxis

Answer 1

o Skin changes AND resp or hypotension
o OR At least 2 body systems after known exposure (skin, GI, resp, CNS, circulatory
o OR known exposure and hypotension (low BP for age or > 30% decrease from baseline)

Question 2

5 systems involved in anaphylaxis

Answer 2

Skin, pulmonary, circulatory, GI, CNS

Question 3

Dose and route of epinephrine for anaphylaxis

Answer 3

IM epinephrine 1:1000 in lateral thigh 0.01 mg/

Question 4

What weight to use epipen Jr vs. adult

Answer 4

Epipen Jr 0.15 mg for 10-25 kg

Epipen adult 0.3 mg for > 25 kg

Question 5

Discharge planning for anaphylaxis

Answer 5

leave with an epipen, instructions on when to use it (monitor for biphasic reaction); avoid triggers, refer to peds/allergist, medic-alert bracelet.

Question 6

How to treat patients on beta-blockers with anaphylaxis

Answer 6

May require glucagon if epinephrine is ineffective

Question 7

Management of hereditary angioedema

Answer 7

o Airway management (laryngeal edema)
o IM / inhaled epi can be tried –> often ineffective
o C1-esterase inhibitor
o Plasma kallikrein inhibitor

Question 8

Clinical features of hereditary angioedema

Answer 8

recurrent angioedema (without urticaria), abdo pain/vomiting, laryngeal edema (stridor, dyspnea), positive family hx (AD)

Question 9

Pathophysiology of serum sickness (list 2 events)

Answer 9

1) Antibody-antigen complexes deposit in the tissues

2) Complement activation

Question 10

Clinical features of serum-sickness like reaction (list 6)

Answer 10

fever, malaise, urticarial/vasculitic rash, arthralgias/arthritis, lymphadenopathy, angioedema, nephritis (carditis, neuritis rare but possible)

med exposure 7-14 days prior (common with antibiotics)

Question 11

Management of serum sickness-like reaction

Answer 11

• Remove offending agent. Self-limiting condition
• Supportive for urticaria/pain – NSAIDs, antihistamines (oral steroids for severe/protracted cases)
• Monitor for end-organ damage (renal)
• Labs: usually just need urinalysis to exclude renal involvement.

Question 12

Definition of intermittent vs. persistent allergic rhinitis

Answer 12

Intermittent = < 4 days/week for < 4 weeks/year

Persistent: > 4 days/week for > 4 weeks/ year

Question 13

Management of allergic rhinitis

Answer 13

• Avoid triggers if possible
• Intranasal corticosteroids are first-line treatment (can take 2 weeks for maximal effect)
• Alternative therapy: non-sedating antihistamines, oral montelukast