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Paediatrics > ALLERGY AND ANAPHYLAXIS > Flashcards

ALLERGY AND ANAPHYLAXIS Flashcards

1
Q

What percentage of children have some form of allergy in the UK?

A

Up to 40%

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2
Q

What are the most common allergens?

A

Inhaled:

House-dust mite, plant pollens, pet dander, moulds

Ingested:

Nuts, seeds, legumes, cow’s milk, eggs, seafood and some fruits

Insect stings/bites

Drugs

Latex

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3
Q

What types of allergic reaction occur?

A

Eczema

Allergic rhinitis and conjunctivitis

Urticaria

Anaphylaxis

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4
Q

How do we classify allergic immune responses?

A

IgE related - occurs within minutes

Non-IgE related - occurs after 4-6 hours

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5
Q

What are the clinical features of allergy?

A

Mouth breathing

Allergic salute - from rubbing an itchy nose

Pale and swollen inferior nasal turbinates

Hyperinflated chest or Harrison sulci from chronic undertreated asthma

Atopic eczema in limb flexures

Allergic conjunctivitis

Failure to thrive

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6
Q

What is the difference between allergy and intolerance?

A

Allergy is immune modulated whereas intolerance is not

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7
Q

What are the most common food allergies in infants?

A

Milk

Eggs

Peanuts

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8
Q

What are the most common food allergies in older children?

A

Peanut

Tree nut

Fish

Shellfish

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9
Q

What is a secondary food allergy?

A

Where children initially tolerate a food and then become allergic to it. This is usually due to cross reactivity between proteins present in fruits and pollens. Eg apples and birch tree pollen.

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10
Q

What are the clinical features of IgE mediated food allergy?

A

Urticaria

Facial swelling

Anaphylaxis

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11
Q

What are the clinical features of non-IgE mediated food allergy?

A

Diarrhoea

Vomiting

Abdominal pain

Failure to thrive

Blood in stools in neonates (due to proctitis)

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12
Q

How is the diagnosis of food allergy made?

A
  1. Skin prick test and measurement of specific IgE antibodies in blood (RAST test)

Gold standard – Exclusion of relevant food under a dietician’s supervision, followed by double blind placebo controlled challenge. Must be performed in hospital.

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13
Q

What are the three drugs used in the emergency treatment of anaphylaxis?

A

Adrenaline

Hydrocortisone

Chlorphenamine

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14
Q

What dose of adrenaline would be given to an infant of less than 6 months in anaphylaxis?

A

150 micrograms (15ml of 1 in 1000)

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15
Q

What dose of hydrocortisone would be given to an infant of less than 6 months in anaphylaxis?

A

25 mg

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16
Q

What dose of chlorphenamine would be given to an infant of less than 6 months in anaphylaxis?

A

250 micrograms/kg

17
Q

What dose of adrenaline would be given to a child of less than 6 years old in anaphylaxis?

A

150 micrograms (15ml of 1 in 1000)

18
Q

What dose of hydrocortisone would be given to a child of less than 6 years but older than 6 months in anaphylaxis?

A

50 mg

19
Q

What dose of chlorphenamine would be given to a child of less than 6 years but older than 6 months in anaphylaxis?

A

2.5 mg

20
Q

What dose of adrenaline would be given to a child of 6-12 years of age in anaphylaxis?

A

300 micrograms (30ml of 1 in 1000)

21
Q

What dose of hydrocortisone would be given to a child of 6-12 years of age in anaphylaxis?

A

100 mg

22
Q

What dose of chlorphenamine would be given to a child of 6-12 years of age in anaphylaxis?

A

5 mg

23
Q

What dose of adrenaline would be given to a child older than 12 years of age in anaphylaxis?

A

500 micrograms (50ml of 1 in 1000)

24
Q

What dose of hydrocortisone would be given to a child older than 12 years of age in anaphylaxis?

A

200 mg

25
Q

What dose of chlorphenamine would be given to a child older than 12 years of age in anaphylaxis?

A

10 mg

26
Q

A 12-year-old girl is admitted to the Emergency Department following a suspected peanut allergy. On examination she has gross facial and tongue oedema. Her oxygen saturations are 97% on room air, pulse is 110 / min and blood pressure is 90/62 mmHg. The paramedics have already gained intravenous access. What is the most appropriate way to give adrenaline in this situation?

A

The Resuscitation Council guidelines only recommend giving adrenaline intramuscularly, regardless of whether the patient has intravenous access or not.

27
Q

What is the best site for an IM adrenaline injection to treat anaphylaxis?

A

Anterolateral aspect of middle third of the thigh

28
Q

How often can IM adrenaline injection be repeated in anaphylaxis?

A

Every 5 minutes

Paediatrics (56 decks)

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