> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/02-step-2/pediatrics/14-allergies.md).

# 14 Allergies

## Acute

* path: IgE mediated, exposure to trigger causes mast cell cross linking/degranulation. Histamine releases that mediates reaction

3 types for acute:

* anaphylaxis
* urticaria
* Angioedema

### Anaphylaxis

* symptoms: urticaria (rash) all over body + **hypotension**, wheezing, loss of airway
* diagnosis: clinical
* treatment
  * epinephrine 1:1000 IM ASAP
  * H1/H2 blockers for histamine relief
  * Steroids: lessen immune reaction

### Urticaria

* symptoms: wheal, whelt, erythema, **no hypotension**
* diagnosis: clinical
* treatment
  * usually self limiting: observe, topical antihistamines
  * rule out anaphylaxis
* Case: someone with bee sting. Treat anaphylaxis if present. Otherwise treat urticaria

### Angioedema

* symptoms: **Swelling airway** and wheezing. **No hypotension or rash**
* Always with ACE I use
* diagnosis: clinical
* treatment
  * secure airway
  * H1/H2 blockers
  * Steroids
  * rule out C1 esterase deficiencies: give FFP

## Chronic

* allergic rhinitis
* allergic conjunctivitis

### Allergic Rhinitis

* Triggers: seasonal (weed, pollon) or perinneal (around all the time, smoking, dusts, pets)
* symptoms
  * allergic shiners and salute
  * pale, boggy mucosa; polyps in nose
  * cobblestoning from postnasal drip
* diagnosis
  * **clinical only**
  * RAST and skin testing only when refractory or for desensitization
* treatment
  * avoiding triggers
  * **intranasal steroids**
  * H2 > H1
* Allergic Rhinitis

pale, boggy mucosa, and polyps:

![\_](https://i.imgur.com/1wxWHzP.png)

cobblestoning:

![\_](https://i.imgur.com/xIMupkp.png)

* Allergic rhinitis

**Allergic shiners** are dark circles under the eyes caused by congestion of the nose and sinuses. They're usually described as dark, shadowy pigments that resemble bruises:

![\_](https://i.imgur.com/nUziW8Y.png)

The **allergic salute** is the characteristic and sometimes habitual gesture of wiping and/or rubbing the nose in an upwards

![\_](https://i.imgur.com/K51bVHB.png)

### Allergic Conjunctivitis

* same path, diagnosis, treatment as rhinitis
* symptoms: shiners, injection, chemises (swelling)

![\_](https://i.imgur.com/qt3eFxS.png)

## Food allergies

* Usually outgrow: wheat, soy, milk, eggs
* May carry throughout life and cause anaphylaxis: shellfish, nuts
* symptoms: NVD, look for other allergy signs (asthma, atopic dermatitis). Can cause **anaphylaxis**
* diagnosis: food trial: withdraw all agents, introduce one at a time
* treatment: avoid triggers, epi

## Milk Protein Allergy

* path allergy to soy
* symptoms: NVD, bloody bowel movement. Failure to thrive despite feeding adequate amounts
* diagnosis: clinical
* treatment: change formula to cow's milk, breastfeed, hydrolyzed formula