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CHILDHOOD ALLERGIESallergy : hypersensitivity reaction initiated by immunologic mechanisms
,
mostly IGE
atopy : genetic predisposition to become sensitised da produce IGEantibodies on exposure to allergens
Allergic March
Infancy : eczema { Early school : rhinitis G asthma
food allergy conjunctivitis
Food Allergy 4 Intolerance
Food hypersensitivity
Food allergy Non . allergic food
I immunological ) hypersensitivity- toxic
, pharmacologicalIGE - mediated ( bacterial poisoning )
- urticarig - angioedema -
non - toxic,
intolerance- anaphylaxis 1 lactase deficiency )
- oral allergy syndrome- atopic dermatitis g
usually delayed onset
- asthma,
rhinitis
Non - IGE mediated
> Clinical Course - protein induced enterolprocto colitis
- early phase - coeliac disease- within mins - dermatitis herpetiformis- release histamine
- urticariq Causes-
angioedema - genetics-
sneezing- environment ( pollution )
- vomiting - diet G lifestyle- bronchospasm - hygiene hypothesis
- late phase - 1989 Strachan
- 4.6 hrs - environment too clean- nasal congestion → lack of exposure
- cough → immature immune system- bronchospasm → 4'
susceptibility
Food allergy is most commonly primary 4 children react on first
exposure .
Infants : milk, egg , peanuts
80 - 90% outgrow by 5 years
Older : peanut ,tree nut
,
fish,
shellfish
Can also be secondary due to cross - reactivity between proteins found
in fresh fruits 1 vegetable 1 nuts 4 in pollens . Generally leads to
mild allergic reactions eg . itchy mouth.
Diagnosis- History 4 exam
- skin tests assess sensitisation to specific- blood tests allergens .
Doesn't mean clinical
- serum specific 1g :L allergy .
- high sensitivity- challenges
- gold standard
Management- individualised- education
- avoidance of allergen- pharmacological
. antihistamines- adrenaline
- specific immunotherapy- prevention
Eczema: atopic dermatitis
Filaggrin gene mutations are a key genetic risk factor due to
impairment of skin barrier function,
which then leads to
cutaneous sensitisation to inhalant G food allergens ,Onset is
usual'
y in first year of life.
- diagnosis is maid clinically- infants
- face
- extensor surfaces
- older
- flexural areas
- friction surfaces- management
- trigger avoidance
emollients
2 corticosteroids- control infection
urticqria 4 Angioedema- Presents as
hivesor redness
-
Results From local vaso dilation 4 4' permeability of capillaries {
venules
- Classificationusually none
- acute : resolves in 6 weeksallergic
commonly due to infection,
Food G drug allergy /- chronic idiopathic : intermittent For at least 6 weeks
- physical : cold, delayed pressure ,
heat,
solar 4 vibratory- Management
2nd gen antihistamines
Insect Sting ( Hymenoptera venom )
severity- mild : local swelling unlikely to develop severe
- moderate : generalised urticgriq-
severe : systemic with wheeze or shock
epipen+ immunotherapy
Rhino conjunctivitisMay be seasonal or perennial
- 20.1.
of children- presentation
-
coryza- conjunctivitis- cough - variant rhinitis
- due to postnasal drip- chronically blocked nose
- management2nd gen antihistamines
t nasal or eye corticosteroids
+ nasal decongestants
ANAPHYLAXISdef : serious allergic reaction with bronchial
, laryngeal or cardio
involvement that is rapid in onset 4 may cause death .
In children,
851.
is due to Food allergy .
Mechanism
- allergic- IGE : food
,venom
,medications
- non . IGE : medications
- non - immunological direct mast cell activation- opioids
- cold,
heat,
exercise
- ethanol
- idiopathic- donal mast cell disorder
Clinical Features- siin got . urticaria
, angioedema- respiratory 10.1
. acute obstruction, bronchospasm
- 91 45.1. cramping ,
diarrhoea- Cvs 45 't
- CNS 15.1 .
Temporal Pattern
uniphasic : resolves in a few hours
biphasic : symptoms recur up to 8 hours later ( 201.)
protracted : associated with profound hypotension
Diagnostic Criteria WHO Guidelines 2011.
sudden onset with skin,
mucosal tissue or both involvement
t one of
sudden respiratory signs2 sudden reduced BP or end - organ dysfunction
OR 2 two of the following after exposure
sudden onset with skin,
mucosal symptoms2 sudden respiratory signs3 sudden reduced BP or end - organ dysfunction4 sudden 91 symptoms
or 3 I BP after exposure to known allergen
Management under 16 years should be
admitted { monitored.
remove triggerABCDE
, repeat every15 mins
in adrenaline I : 1000as needed
Max 0.3mg in children
place supine G raise legs
- high flow 02
- lv fluids : saline rapidly- Monitor 02
,ECG
,BP
- nebulised salbutamol- antihistamine
- bolus methyl prednisolone
Treatment of Refractory- intubation - antihistamines ( cutaneous symptoms )- lv vasopressors - SABA nebulised ( wheeze )
. adrenaline - adrenaline neblstridor )
. offer epipen- educate trigger avoidance
- referral to allergy service
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