Paediatrics: Respiratory, Allergy Flashcards
(41 cards)
What are urticaria/hives?
Raised, itchy red rashes
What causes urticaria?
Allergies or idiopathic
How do you manage urticaria?
1) Antihistamines ± steroids
2) But rash often self-limiting within hours
When can urticaria be an emergency?
When it presents as part of anaphylaxis - where there is acute, multi-systems compromise as a result of exposure to an allergen
How does asthma present in children?
1) Cough
2) Breathlessness
3) Wheeze
4) Chest tightness
- History of recurrent episodes of symptoms and symptom variability which may be triggered by dust, smoke, exercise or animal hair
What are example triggers of asthma?
Dust, smoke, exercise or animal hair
What are other differential diagnoses in asthma?
1) Respiratory tract infections
2) Viral wheeze
3) Foreign body inhalation
4) Bronchiolitis
5) Allergic reactions
6) Anaphylaxis
What do you note on examination in an acute asthma exacerbation?
Widespread wheeze on auscultation of the chest
What % of children in the UK have asthma?
Almost 10%
What are risk factors for asthma?
1) FH of asthma
2) History of atopy (allergy/eczema)
How do you diagnose asthma?
1) Detailed history - to establish episodic nature of wheeze, breathlessness, cough and chest tightness
2) Serial expiratory peak flow readings - when symptomatic and asymptomatic as the airflow obstruction is reversible
3) If suspected high probability of asthma can start on a trial of SABA inhaler
4) Spirometry
5) Where cases are unclear - FeNO testing
What are the non-medication parts of chronic asthma management in children?
1) Personalised written asthma plan - regularly checked and updated
2) Use of a spacer is the preferred method of delivery for inhaled treatments > inhaler
What is the stepwise management of chronic asthma in children?
1) Inhaled SABA PRN ± monitored initiation of very low to low dose ICS
2) Add very low dose ICS OR LTRA if < 5 years
3) Add very low dose ICS AND LTRA if < 5 years OR LTRA/LABA if > 5 years
4) If no response to LABA - consider stopping LABA and increase ICS to low dose
5) If some benefit from LABA but inadequate - increase ICS to low dose
6) If benefit from LABA + low dose ICS but inadequate - consider trial of LTRA
7) Consider increase ICS to medium dose ICS
8) Addition of fourth drug e.g. theophylline
9) Refer patient for specialist care
10) Daily steroid tablet + maintain medium- dose ICS (consider other Tx to minimise use of steroid tablets)
Is a rescue pack including abx and oral steroids indicated in astham?
No - COPD
Which vaccine is recommended to all patients with asthma who are taken regular corticosteroid therapy incl. inhaled?
Influenza vaccine - IM/nasal spray (nasal spray CI in children with severe asthma who are taking regular steroids as it is a live attenuated vaccine)
Which vaccine is recommended to all patients with asthma who are taken regular corticosteroid therapy incl. inhaled?
Influenza vaccine - IM/nasal spray (nasal spray CI in children with severe asthma who are taking regular steroids as it is a live attenuated vaccine)
What type of hypersensitivity reaction causes anaphylaxis?
Type 1 - acute allergic reaction resulting in multi-systems compromise
What are causes of anaphylaxis?
1) Animals - insect stings, animal dander
2) Food - nut, peanuts, shellfish, fish, eggs, milk
3) Medication - abx, IV contrast, NSAIDs
What are the clinical features of anaphylaxis?
1) Airway - swollen lips/tongue, sneezing
2) Breathing - wheezing, SOB (low sats, high RR), stridor, sudden onset resp distress
3) Circulatory - tachycardia, hypotension/shock, angioedema (pale and clammy)
4) GI - abdo pain, D&V
5) Skin - urticaria, pruritis, flushed skin
What investigation can be done to confirm a diagnosis of anaphylaxis?
Serum levels of mast cell tryptase
What is the critical treatment of anaphylaxis?
IM adrenaline 1:1000
What is the general management of anaphylaxis?
1) Remove trigger if possible
2) Call for help early
3) Lie patient flat and raise legs
4) Administer adrenaline
When skills + equipment is available:
5) Manage airway and administer high flow oxygen
6) IV fluids if shocked
7) Administer 100mg slow IV hydrocortisone (not urgent)
8) Attach pt to monitoring
How long should patients with anaphylaxis be monitored for after initial presentation in case of a rebound episode?
6-12 hours
What should be given to newly diagnosed patients with anaphylaxis and their carers before being discharged?
1) Counselling on how to use adrenaline auto-injectors
2) Supply of 2 auto-injectors
3) Written advice
4) A referral to the local allergy service for follow-up
