Allergy and Immunology Flashcards
(39 cards)
You review the immunisation history of a seven-year-old girl who has recently joined your practice from China.
Which ONE of the following vaccines is NOT ROUTINELY administered as part of the current UK immunisation schedule? Select ONE option only.
A. Bacille Calmette–Guérin (BCG)
B. Meningitis C
C. Human papillomavirus (HPV)
D. Tetanus
E. Pneumococcal conjugate vaccine (PCV)
Correct answer: A. Bacille Calmette–Guérin (BCG)
Answer justification and feedback: The BCG vaccine is not routinely given to all children in the UK. It is targeted to those at increased risk of tuberculosis (e.g., from high prevalence areas).
Resource: UK Health Security Agency. Complete routine immunisation schedule. 2025.
You are called to the treatment room to see a 17-year-old boy who has become unwell after receiving the influenza vaccination. You note he has erythema and swelling at the site of injection, and he is wheezing. You suspect anaphylaxis. His observations have been noted by the nurse:
Temperature 37.4°C
Blood pressure 90/60 mmHg
Pulse 128 beats/min
Respiratory rate 28 breaths per minute
Oxygen saturations 93% in room air
What is the SINGLE MOST appropriate initial treatment for this patient? Select ONE option only.
A. Adrenaline 0.5 ml 1:1000 intramuscularly
B. Chlorphenamine 10 mg intramuscularly
C. Hydrocortisone 200 mg intramuscularly
D. Chlorphenamine 10 mg orally
E. Adrenaline 1 ml 1:1000 intramuscularly
Correct answer: A. Adrenaline 0.5 ml 1:1000 intramuscularly Adrenaline 0.5 ml 1:1000 intramuscularly
Answer justification and feedback: The UK Resuscitation Council advises that intramuscular adrenaline should be administered as soon as possible in patients with suspected anaphylaxis with signs of shock, airway swelling or breathing difficulty. The dose of adrenaline for adults and children over the age of 12 years is 0.5 ml (500 micrograms) 1:1000. Hydrocortisone and chlorphenamine are second-line agents.
You are called to the treatment room to see a 17-year-old boy who has become unwell after receiving the influenza vaccination. He has erythema and swelling at the site of injection, and he is wheezing.
What is the SINGLE MOST appropriate initial treatment? Select ONE option only.
A. Adrenaline 0.5 ml 1:1000 intramuscularly
B. Adrenaline 1 ml 1:1000 intramuscularly
C. Chlorphenamine 10 mg intramuscularly
D. Chlorphenamine 10 mg orally
E. Hydrocortisone 200 mg intramuscularly
Correct answer: A. Adrenaline 0.5 ml 1:1000 intramuscularly
Answer justification and feedback: The UK Resuscitation Council advises that intramuscular adrenaline should be administered as soon as possible in patients with suspected anaphylaxis with signs of shock, airway swelling or breathing difficulty.
Resource: Resuscitation Council UK. Emergency treatment of anaphylaxis. 2021.
Which SINGLE ONE of the following tests is validated for food allergy diagnosis in children?
A. Applied kinesiology
B. Biofield resonance scanning
C. Hair analysis
D. Vega testing
E. No validated commercial test
Correct answer: E. No validated commercial test
Answer justification and feedback: None of the listed commercial tests are validated.
Resource: NICE CG116.
Which ONE of the following vaccines is NOT routinely administered in the UK schedule?
A. Human papillomavirus (HPV)
B. Tetanus
C. Nasal flu spray
D. Pneumococcal conjugate vaccine
E. Hepatitis A
Correct answer: E. Hepatitis A
Answer justification and feedback: Hepatitis A is only given to high-risk individuals in the UK.
Resource: Gov.uk immunisation schedule.
Which ONE of the following vaccines is LIVE?
A. Measles, mumps, rubella (MMR)
B. Tetanus
C. Hepatitis B
D. Human papillomavirus (HPV)
E. Diphtheria
Correct answer: A. Measles, mumps, rubella (MMR)
Answer justification and feedback: MMR is a live attenuated vaccine.
Which ONE of the following should be referred to a specialist allergy service? Select ONE option only.
A. A man who developed an extensive urticarial rash on his face after a dental local anaesthetic last year. He now requires excision of a skin cancer
B. A child who vomits on several occasions after taking erythromycin for extensive impetigo
C. A woman with asthma who notices that she occasionally requires salbutamol when she takes ibuprofen
D. A teenager who develops an extensive rash while taking amoxicillin for tonsillitis. She is subsequently diagnosed with glandular fever
E. A man who develops cholestasis after taking flucloxacillin for cellulitis
Correct answer: A. A man who developed an extensive urticarial rash on his face after a dental local anaesthetic last year. He now requires excision of a skin cancer A man who developed an extensive urticarial rash on his face after a dental local anaesthetic last year. He now requires excision of a skin cancer
Answer justification and feedback: Refer people to a specialist drug allergy service if they have a suspected allergy to local anaesthetics and they need a procedure involving a local anaesthetic. Only severe non-steroidal anti-inflammatory drugs (NSAIDs) allergies require referral, while the cholestasis and glandular fever rash are well-recognised adverse reactions not requiring further investigation.
Resource: NICE. Drug Allergy: diagnosis and management. CG183. 2014.
Which ONE of the following should be referred to a specialist allergy service?
A. Amoxicillin rash in glandular fever
B. Vomiting after erythromycin
C. Asthma symptoms with ibuprofen
D. Rash with local anaesthetic and further procedure needed
E. Cholestasis with flucloxacillin
Correct answer: D. Rash with local anaesthetic and further procedure needed
Answer justification and feedback: Referral is appropriate to evaluate if the procedure can safely go ahead.
Resource: NICE CG183.
Which of the following possible symptoms of food allergy in children is MOST UNLIKELY to be immunoglobulin E (IgE)-mediated? Select ONE option only.
A. Rhinorrhoea
B. Wheezing
C. Angioedema
D. Gastro-oesophageal reflux disease
E. Urticaria
Correct answer: D. Gastro-oesophageal reflux disease
Answer justification and feedback: Food allergy is an adverse immune response to food allergens and can be IgE-mediated, non-IgE-mediated or a mixed allergic reaction. IgE-mediated reactions are acute and frequently have rapid onset. Gastro-oesophageal reflux disease is usually a non-IgE mediated symptom.
Which of the following possible symptoms of food allergy in children is MOST UNLIKELY to be immunoglobulin E (IgE)-mediated? Select ONE option only.
A. Wheezing
B. Angioedema
C. Rhinorrhoea
D. Urticaria
E. Gastro-oesophageal reflux disease
Correct answer: E. Gastro-oesophageal reflux disease Gastro-oesophageal reflux disease
Answer justification and feedback: Food allergy is an adverse immune response to food allergens and can be IgE-mediated, non-IgE-mediated or a mixed allergic reaction. IgE-mediated reactions are acute and frequently have rapid onset. Gastro-oesophageal reflux disease is usually a non-IgE mediated symptom.
What is the gold standard test for diagnosing food allergies?
Which SINGLE option is MOST appropriate? Select ONE option only.
A. Serum specific IgE blood tests
B. Skin prick tests
C. Oral food challenge
D. Patch testing
E. Diagnostic elimination of food items
Correct answer: C. Oral food challenge Oral food challenge
Answer justification and feedback: An oral food challenge is the gold standard test for confirming food allergies. It should be undertaken in an adequately resourced clinic or hospital setting, under close observation by appropriately trained staff with facilities for emergency treatment of anaphylaxis and resuscitation.
Resource: Akinwande I, Salako K. Food allergies and atopic dermatitis. InnovAiT 2020; 13(11): 655–659.
What is the gold standard diagnostic test for allergic contact dermatitis? Select ONE option only.
A. Autoantibody screen
B. Patch testing
C. Serum IgE levels
D. Radio-allergosorbent testing (RAST)
E. Skin prick testing
Correct answer: B. Patch testing Patch testing
Answer justification and feedback: Patch testing is the gold standard diagnostic test for allergic contact dermatitis. It is recommended for any patient with persistent dermatitis or atopic dermatitis that was formerly well controlled with topical therapy but becomes difficult or impossible to control with the same treatment.
Resource: Not provided
What is the correct adrenaline dose and route for a 25-year-old man with anaphylaxis?
A. Adrenaline 0.5 ml 1:10,000 IM
B. Adrenaline 0.5 ml 1:10,000 IV
C. Adrenaline 0.5 ml 1:1000 IM
D. Adrenaline 0.5 ml 1:1000 IV
E. Adrenaline 0.5 ml 1:10,000 SC
Correct answer: C. Adrenaline 0.5 ml 1:1000 IM
Answer justification and feedback: Intramuscular is the recommended route unless specialist care is available.
Resource: Resuscitation Council UK.
The mother of a four-year-old child has brought him to the surgery on repeated occasions as she is convinced that he has multiple food allergies. She describes a variety of symptoms such as headaches, abdominal pains and transient skin rashes. Although he is small for his age, his growth velocity has followed the 10th centile from birth.
Which is the SINGLE MOST appropriate NEXT management option? Select ONE option only.
A. Blood radioallergosorbent test (RAST) for standard battery of allergens
B. Skin patch testing for standard battery of allergens
C. Skin prick testing for standard battery of allergens
D. Referral to dietician for exclusion and challenge dietary advice
E. Referral to paediatrician
Correct answer: E. Referral to paediatrician Referral to paediatrician
Answer justification and feedback: Many symptoms of food allergy are common to both IgE-and non-IgE-mediated reactions, but it is important to attempt to identify children with IgE-mediated allergy due to their risk of anaphylactic reactions in the future. IgE-mediated allergic reactions tend to have a rapid onset and present acutely however there can be overlap with non-IgE mediated reactions. Referral should be considered when there is persisting parental suspicion despite lack of supporting history.
Resource: Not provided
In allergy testing, which test is an indirect measure of cutaneous mast cell reactivity due to the presence of specific IgE?
A. Oral food challenge
B. Diagnostic elimination of food items
C. Skin prick tests
D. Patch testing
E. Serum specific IgE blood tests
Correct answer: C. Skin prick tests Skin prick tests
Answer justification and feedback: Skin prick tests indirectly assess the reactivity of mast cells on the skin to the presence of specific IgE. They involve pricking the skin with a droplet of the allergenic extract. Allergen-specific IgE bind to the mast cells and cross linking by allergens leads to degranulation of the mast cells, producing mediators such as histamine. This results in wheals. A positive test is a wheal equal to or larger than the histamine control.
Resource: Akinwande I, Salako K. Food allergies and atopic dermatitis. InnovAiT 2020; 13(11): 655–659. https://journals.sagepub.com/doi/full/10.1177/1755738020949897
For each of the patients with a history suggestive of extrinsic allergic alveolitis (EAA), choose the SINGLE MOST likely causative organism/substance. Each answer can be used once, more than once or not at all.
- A 42-year-old man presents with fever, dry cough, and dyspnoea after working with damp hay during harvest (Farmer).
- A 60-year-old man presents with progressive dyspnoea and has bred pigeons for 25 years.
- A 40-year-old man presents with respiratory symptoms after working in a mushroom farm (Mushroom grower).
Correct answer:
- Farmer: Thermophilic actinomycetes
- Pigeon breeder: Avian bloom
- Mushroom grower: Thermophilic actinomycetes
Answer justification and feedback: EAA or hypersensitivity pneumonitis is a diffuse inflammatory condition of the alveoli caused by inhaled organic dusts (e.g., bacteria, fungal spores, animal proteins). Farmer’s lung and mushroom worker’s lung are commonly caused by thermophilic actinomycetes; pigeon fancier’s lung is caused by avian proteins.
Resource: BMJ Best Practice. Extrinsic allergic alveolitis.
Current guidance recommends that children and adults with impaired immune response should not receive live vaccines.
Which ONE of the following vaccines is LIVE? Select ONE option only.
A. Hepatitis B
B. Tetanus
C. Human papillomavirus (HPV)
D. Measles, mumps, rubella (MMR)
E. Diphtheria
Correct answer: D. Measles, mumps, rubella (MMR) Measles, mumps, rubella (MMR)
Answer justification and feedback: The measles, mumps, rubella (MMR) vaccine is a live attenuated vaccine.
An eight-year-old boy is brought to the out-of-hours centre by his mother. He has eaten peanuts approximately 15 minutes ago and has developed an allergic reaction. On examination he has facial oedema, wheeze and respiratory distress. You suspect anaphylaxis.
What is the SINGLE MOST appropriate treatment? Select ONE option only.
A. 500 micrograms intramuscular adrenaline 1:1000 (0.5 ml)
B. 400 micrograms intramuscular adrenaline 1:1000 (0.4 ml)
C. 200 micrograms intramuscular adrenaline 1:1000 (0.2 ml)
D. 300 micrograms intramuscular adrenaline 1:1000 (0.3 ml)
E. 150 micrograms intramuscular adrenaline 1:1000 (0.15 ml)
Correct answer: D. 300 micrograms intramuscular adrenaline 1:1000 (0.3 ml) 300 micrograms intramuscular adrenaline 1:1000 (0.3 ml)
Answer justification and feedback: Adrenaline (1:1000) is administered intramuscularly in anaphylaxis. For children aged between 6–12 years, the required dose is 300 micrograms (0.3 ml). For children aged less than six years, the required dose is 150 micrograms (0.15 ml). For adults and children older than 12 years, the required dose is 500 micrograms (0.5 ml).
Resource: Resuscitation Council UK. Anaphylaxis.
A patient with suspected coeliac disease has low IgA and a negative tissue transglutaminase.
What is the next investigation?
A. Capsule endoscopy
B. No further tests – coeliac confirmed
C. Endomysial IgG antibody
D. Oesophagogastroduodenoscopy
E. No further tests – coeliac excluded
Correct answer: C. Endomysial IgG antibody
Answer justification and feedback: In IgA deficiency, IgG-based tests should be used for coeliac disease.
A mother reattends with her nine-month-old girl who has a history of atopic eczema that is not settling despite treatment. She wonders if the condition is related to a food allergy.
What is the most appropriate assessment according to current NICE guidelines? Select ONE option only.
A. Focused history
B. Two-week trial of lactose-free milk
C. Skin prick testing
D. Two-week trial of cow’s milk exclusion
E. Oral antihistamine
Correct answer: A. Focused history
Answer justification and feedback: Current guidelines state that food allergy should be suspected in any child with eczema, gastro-oesophageal reflux or constipation, which has failed to respond as expected. An allergy-focused clinical history is recommended prior to undertaking any allergy testing and will guide the suitability of trials of exclusion diets.
Resource: NICE. Food Allergy. QS118. 2016.
A four-year-old boy develops an urticarial rash around his mouth whenever he eats strawberries.
Which is the SINGLE MOST appropriate diagnostic test for this child? Select ONE option only.
A. Tissue transglutaminase
B. Serum specific immunoglobulin E (IgE) antibody blood test
C. Endomysial antibodies
D. Serum specific immunoglobulin G (IgG) antibody blood test
E. Serum specific immunoglobulin A (IgA) antibody blood test
Correct answer: B. Serum specific immunoglobulin E (IgE) antibody blood test Serum specific immunoglobulin E (IgE) antibody blood test
Answer justification and feedback: An urticarial reaction suggests an IgE-mediated food allergy and specific IgE antibody testing is appropriate. IgG antibody testing should not be used.
Resource: Not provided
A four-month-old baby boy has had severe, difficult to control atopic eczema since being a neonate. He has been exclusively breast-fed and his mother thinks that her own diet affects her baby’s eczema. She asks about food elimination diets.
Which is the SINGLE MOST likely food allergen in the mother’s diet that could be implicated in her baby’s eczema? Select ONE option only.
A. Cow’s milk
B. Eggs
C. Monosodium glutamate
D. Tartrazine
E. Wheat
Correct answer: A. Cow’s milk Cow’s milk
Answer justification and feedback: Cow’s milk may be a possible food allergen in severe atopic eczema in babies. It is not known for certain whether moderating the mother’s diet is effective, but a 2–6 week trial is recommended.
A concerned parent presents with their baby who has developed an upset stomach. The child was recently started on formula milk and a few days after starting this, developed symptoms. The child is irritable, has suffered a flare in pre-existing eczema and has developed loose stools. As a result of this the child has developed a nasty nappy rash.
Which of the following is the MOST likely diagnosis? Choose ONE option only.
A. Gastroenteritis
B. Coeliac disease
C. IgE mediated cow’s milk allergy
D. Non-IgE mediated cow’s milk allergy
E. Inflammatory bowel disease (IBD)
Correct answer: D. Non-IgE mediated cow’s milk allergy Non-IgE mediated cow’s milk allergy
Answer justification and feedback: This child is suffering from Non-IgE mediated cow’s milk allergy. With this allergy children often develop loose stools, abdominal discomfort, eczema and general irritability/colic. In IgE mediated cow’s milk allergy the reaction is much sooner after ingestion, more severe and can include angioedema or even anaphylaxis. There are no infective symptoms here to suggest gastroenteritis, and coeliac disease and IBD are not as likely as cow’s milk allergy.
A concerned parent presents with their baby who has developed an upset stomach. The infant was recently started on formula milk and a few days after starting this, developed symptoms. The child is irritable, has suffered a flare in pre-existing eczema and has developed loose stools. As a result of this the child has developed a nasty nappy rash.
Which of the following is the MOST likely diagnosis? Choose ONE option only.
A. IgE mediated cow’s milk allergy
B. Gastroenteritis
C. IBD
D. Coeliac disease
E. Non-IgE mediated cow’s milk allergy
Correct answer: E. Non-IgE mediated cow’s milk allergy
Answer justification and feedback: This child is suffering from Non-IgE mediated cow’s milk allergy. With this allergy children often develop loose stools, abdominal discomfort, eczema and general irritability/colic. In IgE mediated cow’s milk allergy the reaction is much sooner after ingestion, more severe and can include angioedema or even anaphylaxis. There are no infective symptoms here to suggest gastroenteritis, and coeliac disease and IBD are not as likely.
