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34 Cards in this Set

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What percentage of infants who have moderate-to-severe atopic dermatitis have an underlying immunoglobulin (Ig) E-mediated food allergy?
Approximately 30% to 40%
What foods are most commonly implicated in AD?
milk, eggs, soy, wheat, and peanuts
In what range are the positive and negative predictive values of food allergy testing?
low positive predictive value (50%), high negative predictive value (90-95%)
What is the gold standard for food allergy diagnosis?
double-blind, placebo-controlled food challenges
Are perioral rashes after fruit juice atopic?
No, typically nonpruritic, limited to the area of contact, resolve within a few hours
How do you treat perioral fruit juice rash?
Child outgrows it by age 4
What does skin testing identify?
allergen-specific immunoglobulin E (IgE)
What causes a late phase reaction?
influx of inflammatory cells due to mast cell mediator release
What are the two types of skin testing techniques?
percutaneous and intradermal tests
When does a late phase reaction to skin testing occur?
4 or more hours after skin testing
Which kind of test correlates better with clinical history?
Percutaneous
Are percutaneous tests more sensitive or more specific than intra dermal?
More specific; intradermal are more sensitive
When are intradermal skin tests used?
when a significant allergic history is obtained and results of the percutaneous tests are negative or equivocal
Can a patient with a history of dermatographism be skin tested?
Should have controls placed first to see if valid results are possible.
Which medications interfere with skin tests?
Older first generation antihistamines, newer anti-histamines, tricyclics, H2 antagonists
For how long do first generation anti-histamines interfere with skin testing?
Up to 24 hrs
For how long do newer antihistamines interfere with skin testing?
for 3-10 days
For how long does astemizole (Hismanal, withdrawn from market) interfere with skin testing?
30-60 days
For how long H2 antagonists interfere with skin testing?
Same day
For how long do asthma medications interefere with skin testing?
They do not
What is a RAST test?
Radioallergosorbent test
When are RAST or ELISA tests used?
1-severe cutaneous disease, 2-cannot discontinue medications that interfere with skin testing, or 3-pt has experienced severe anaphylaxis
Drawbacks of in vitro tests
not as sensitive, not specific in highly atopic patients with elevated total IgE, costs more, depends on laboratory, test results difficult to interpret
What time of year do trees pollinate?
Early spring
What are the most common food allergies in children?
milk, wheat, soy, egg, peanut, tree nuts, and fish
What is more accurate, aeroallergen or food allergen skin testing?
Aeroallergen testing
What time of year do weeds pollinate?
Summer through fall
What time of year do grasses pollinate?
late spring to early summer
Do IgE mediated allergies cause crying, poor sleeping, hyperactivity?
No, behavioral issues are called “food intolerances” and aren’t IgE mediated
what is a Type I reaction?
immediate hypersensitivity
what is a Type II reaction?
cytotoxic antibody response
what is a Type III reaction?
immune complex reaction
what is a Type IV reaction?
delayed hypersensitivity
Is serum IgE testing for penicillin allergy useful?
No, poor positive predictive value