Allergy

Question 1

Why is it important to clarify the manifestations of a reported allergy?

Answer 1

• To distinguish true allergy from intolerance
• Avoid mislabeling viral rashes as antibiotic allergy
• Avoid incorrect medication avoidance

Clarifying symptoms helps in accurate diagnosis and management.

Question 2

Name three types of allergies that should routinely be asked about in history.

Answer 2

• Medication allergies
• Food allergies
• Environmental allergies

These are common categories that can lead to significant health issues.

Question 3

Name four medications commonly used to control allergy symptoms.

Answer 3

• Antihistamines
• Bronchodilators
• Corticosteroids
• Epinephrine auto-injector (EpiPen)

These medications help manage various allergic reactions.

Question 4

Who should receive an epinephrine auto-injector prescription?

Answer 4

• Patients with history of anaphylaxis
• Patients at risk for anaphylaxis

EpiPens are critical for those with severe allergic reactions.

Question 5

What key education should be provided to patients prescribed an EpiPen? Name three.

Answer 5

• Recognize symptoms of anaphylaxis
• How to self-administer the EpiPen
• Seek immediate medical care after use

Proper education ensures effective use of the EpiPen in emergencies.

Question 6

Name three symptoms or signs suggestive of anaphylaxis.

Answer 6

• Respiratory distress / wheeze
• Hypotension / dizziness / syncope
• Urticaria or angioedema
• GI symptoms (vomiting, abdominal pain)

Recognizing these symptoms is crucial for timely intervention.

Question 7

What identification should patients with serious drug allergies or major allergic reactions be advised to carry?

Answer 7

• MedicAlert bracelet

This identification can provide critical information in emergencies.

Question 8

Name three key management priorities in anaphylaxis.

Answer 8

• Recognize symptoms quickly
• Treat immediately with IM epinephrine
• Observe for delayed/biphasic reactions

These priorities are essential for effective anaphylaxis management.

Question 9

What medication is first-line for the treatment of anaphylaxis?

Answer 9

• Intramuscular epinephrine

Epinephrine is the most effective treatment for anaphylactic reactions.

Question 10

Why should patients with anaphylaxis be observed after treatment?

Answer 10

• Risk of biphasic (delayed) anaphylactic reaction

Observation is necessary to manage potential recurrence of symptoms.

Question 11

When should a patient with anaphylaxis be referred to an allergist?

Answer 11

• Anaphylaxis of unclear etiology

Referral can help in identifying triggers and managing future risks.

Question 12

In children with food-triggered anaphylaxis, how many epinephrine auto-injectors should be prescribed?

Answer 12

• Multiple devices for different locations
  
  • Home
  • Car
  • School
  • Daycare

Having EpiPens in various locations ensures readiness for emergencies.

Question 13

Name three people who should be educated on EpiPen use in children with severe food allergy.

Answer 13

• Parents
• Teachers
• Caregivers
• The child (when age appropriate)

Education ensures that those around the child can respond effectively in case of an allergic reaction.

Question 14

In a patient with unexplained recurrent respiratory symptoms, what diagnosis should be considered in the differential?

Answer 14

• Allergy (e.g., seasonal allergy, environmental triggers)

Allergies can often present with respiratory symptoms and should be evaluated.

Question 15

What proportion of patients reporting penicillin allergy are truly allergic?

Answer 15

• ~10% report penicillin allergy
• > 90% are not truly allergic

This highlights the prevalence of misdiagnosis in penicillin allergies.

Question 16

Name three reasons why penicillin allergy is commonly misdiagnosed.

Answer 16

• Viral exanthems misattributed to antibiotics
• Medication side effects labeled as allergy
• Childhood reactions that resolved over time

Misdiagnosis can lead to unnecessary avoidance of penicillin.

Question 17

After how many years do most IgE-mediated penicillin allergies resolve?

Answer 17

• ~80% resolve after 10 years

This indicates that many patients may no longer be allergic after a significant period.

Question 18

Name three historical features suggesting a low-risk penicillin allergy.

Answer 18

• Non-urticarial rash
• GI symptoms only (e.g., nausea, diarrhea)
• Remote reaction (>10 years ago)
• Unknown childhood reaction

These features can help assess the risk of true allergy.

Question 19

Name three features suggesting a true IgE-mediated penicillin allergy.

Answer 19

• Urticaria (hives)
• Angioedema
• Respiratory distress
• Anaphylaxis
• Symptoms occurring within minutes to hours of exposure

These symptoms indicate a higher likelihood of a true allergy.

Question 20

Name three severe reactions that should NOT undergo routine penicillin challenge in primary care.

Answer 20

• Stevens–Johnson syndrome (SJS)
• Toxic epidermal necrolysis (TEN)
• Drug reaction with eosinophilia and systemic symptoms (DRESS)
• Serum sickness–like reaction

These conditions pose significant risks and require careful management.

Question 21

What is the preferred approach for delabelling a low-risk penicillin allergy?

Answer 21

• Direct oral amoxicillin challenge

This method allows for safe testing of penicillin tolerance.

Question 22

Name two benefits of penicillin allergy delabelling.

Answer 22

• Allows use of first-line antibiotics
• Reduces broad-spectrum antibiotic use
• Improves antimicrobial stewardship
• Reduces healthcare costs

Delabelling can enhance patient care and reduce unnecessary antibiotic use.

Question 23

Why is incorrect penicillin allergy labeling problematic? Name three consequences.

Answer 23

• Use of broader-spectrum antibiotics
• Higher risk of antimicrobial resistance
• Higher healthcare costs
• Increased adverse drug events

Mislabeling can lead to significant public health issues.

Question 24

True or False: Most patients with penicillin allergy are also allergic to cephalosporins.

Answer 24

FALSE

This misconception can lead to unnecessary avoidance of cephalosporins.

Question 25

What are the **four components** of the **PEN-FAST score** used to risk-stratify reported penicillin allergy?

Answer 25

* PEN – Penicillin allergy reported * F (Five years or less) – Reaction occurred ≤ 5 years ago * A (Anaphylaxis/angioedema) or S (Severe cutaneous reaction) * T (Treatment required) for the reaction (e.g., epinephrine, steroids, hospitalization) ## Footnote The PEN-FAST score helps assess the likelihood of true penicillin allergy.

Question 26

What PEN-FAST score suggests **low risk** of true penicillin allergy and supports direct oral challenge?

Answer 26

* Score < 3 * Low probability of true allergy (~<5%) * Direct oral amoxicillin challenge may be appropriate in low-risk patients ## Footnote A lower score indicates a reduced likelihood of a serious allergic reaction.