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Manual of Pediatric Allergy
Major K Nagaraju
1:
Approach to Allergic Patient
INTRODUCTION
HISTORY
CHIEF COMPLAINTS
TRIGGERS
ENVIRONMENT
DRUG HISTORY
Past Medical History
Family History
Social history
Housing
Smoking
Pitfalls in History
PHYSICAL EXAMINATION
Face
Eye
Ears
Nose
Throat
Neck
Respiratory System Examination
Skin
POINTS TO REMEMBER
2:
Pathophysiology of Sensitization and Allergy
INTRODUCTION
PATHOPHYSIOLOGY OF ALLERGIC INFLAMMATION
FACTORS ASSOCIATED WITH SENSITIZATION
DIAGNOSIS OF SENSITIZATION
POINTS TO REMEMBER
3:
Diagnosis of Allergic Diseases
ALLERGY SKIN TESTING
HISTORY OF ALLERGY TESTING
CONTRAINDICATIONS
The Phadiatop Test
Epicutaneous Skin Tests
Skin Prick Test
Prick to Prick test
Intradermal Skin Test
In Vitro tests
Patch Skin Tests
Clinical Indications for Patch test
Procedure of Patch Skin Testing
Grading
Total Serum IgE
Other Tests
Provocation tests
FUTURE DIAGNOSTIC TESTS FOR ALLERGIC DISEASES
POINTS TO REMEMBER
4:
Atopic Dermatitis
DEFINITION
EPIDEMIOLOGY
DISEASE COURSE
Genetics of Atopic dermatitis
Immunopathogenesis of Atopic Dermatitis (Figure 1)
Aeroallergens role
Food Allergy and Atopic Dermatitis (Table 1)
Microorganisms and Atopic Dermatitis (Table 1)
Climate and Atopic Dermatitis
Psychological Factors and Atopic Dermatitis
Irritants and Atopic Dermatitis
Mechanism of Pruritus
Mechanism of Atopic dermatitis
CLINICAL FEATURES (FIGURE 2)
SKIN BIOPSY
Complications
Treatment
Non-pharmacological measures
Pharmaceutical Measures
Topical Steroids
Systemic steroids
Topical Calcineurin Inhibitors
Indications for TCIs
Antipruritics
Antibiotics
Phototherapy
Immunomodulator drugs
Allergen Specific Immunotherapy
Treatment Algorithm
Prognosis
POINTS TO REMEMBER
5:
Urticaria and Angioedema
INTRODUCTION
DEFINITION
CLASSIFICATION
PATHOPHYSIOLOGY
ETIOPATHOGENESIS
Papular Urticaria
Giant urticaria
Urticarial Rashes
Differential Diagnosis of Urticaria
Diagnosis
Allergy Skin Prick Test – Reaction
Indications for Skin Biopsy in Urticaria
Autologous Serum Skin Test
Approach to Urticaria
TREATMENT
Acute Urticaria
Chronic Urticaria
Second Line of Therapy
Third Line Therapy
POINTS TO REMEMBER
6:
Cow's Milk Allergy
INTRODUCTION
DEFINITIONS
EPIDEMIOLOGY
MECHANISM OF COW'S MILK PROTEIN ALLERGY (CMPA)
Cross-reactivity
Clinical Features
IMMEDIATE COW'S MILK PROTEIN ALLERGY
Late onset Cow's Milk Allergy
Upper GI
Lower GI
Others
Diagnosis
ALLERGEN ELIMINATION TEST
Atopic Patch Test
Challenge Tests
Indications for Challenge Tests
Indications for DBPCFC
Treatment
Other therapies
Prognosis
Factors responsible for persistence of disease
POINTS TO REMEMBER
7:
Food Allergy
INTRODUCTION
PREVALENCE
DEFINITIONS
CLASSIFICATION
PATHOPHYSIOLOGY (TABLE 1)
Comorbidities with Food Allergies
Foods Commonly Implicated in Allergy
CLINICAL FEATURES
Food Induced Anaphylaxis
Exercise Induced Food Allergy
DIAGNOSIS
History
Physical Examination
Allergy Skin Testing
Component Resolved Diagnosis (CRD)
Allergen Component on Microarray
Serum Specific IgG Antibodies
Conditions which Mimic Food Allergies
Histamine Toxicity
APPROACH TO A CHILD WITH FOOD ALLERGY
TREATMENT
Food Allergen Specific Immunotherapy
Non-allergen-specific Treatment
Prevention
PROBLEMS OF FOOD ALLERGIES IN INDIA
Prognosis
POINTS TO REMEMBER
8:
Anaphylaxis
INTRODUCTION
EPIDEMIOLOGY
DEFINITIONS
PATHOPHYSIOLOGY
Cardiovascular effects of Anaphylaxis
ETIOLOGY
Idiopathic Anaphylaxis
Biphasic and Persistent Anaphylaxis
Exercise-Induced Anaphylaxis
CLINICAL FEATURES
SIGNS AND SYMPTOMS
DIAGNOSIS
Clinical Criteria for Diagnosing Anaphylaxis
Laboratory Testing
Serum Tryptase Levels
TREATMENT
At the Time of Discharge
Prognosis
POINTS TO REMEMBER
9:
Ocular Allergies
INTRODUCTION
PREVALENCE
Definitions and Classification
PATHOPHYSIOLOGY
CLINICAL FEATURES
TREATMENT
Surgical Treatment
Prevention
POINTS TO REMEMBER
10:
Clinical Features and Diagnosis of Allergic Rhinitis
INTRODUCTION
CLINICAL FEATURES
CLINICAL CLASSIFICATION
Diagnosis
Differential diagnosis (Table 6)
Investigations
To Confirm Atopy
CONFIRM LOCAL ALLERGY
Nasal Eosinophil Count
Comorbidities with allergic rhinitis
Allergic Rhinitis and Asthma
Allergic Rhinitis and sinusitis
Allergic Rhinitis and Otitis Media
Allergic Rhinitis and Quality of Life
POINTS TO REMEMBER
11:
Treatment of Allergic Rhinitis
TREATMENT
Allergen Avoidance
Indoor and Outdoor Air Pollutants
PHARMACOTHERAPY
Oral H1 Antihistamines
Topical H1-antihistamines
Intranasal Glucocorticosteroids
Cromones
NASAL DECONGESTANTS
Ipratropium Bromide
Nasal Saline
ORAL STEROIDS
NEWER DRUGS
POINTS TO REMEMBER
APPROACH TO ALLERGIC RHINITIS
12:
Genetics of Allergy and Asthma
GENETIC APPROACHES FOR STUDYING ALLERGY AND ASTHMA
Candidate Gene Approach
Genome-Wide Linkage Analysis
Genome Wide Association Studies (GWAS)
Asthma Susceptibility Genes
Meta-analysis of GWAS
Gene-gene Interactions
Gene-environment Interactions
EPIGENETICS
FUTURE DIRECTIONS
POINTS TO REMEMBER
13:
Preschool Asthma
PREVALENCE OF ASTHMA
ASTHMA IS A SYNDROME
Asthma Underdiagnosed
Difficulties in Diagnosis of Asthma
Conditions Which Mimic Asthma
Comorbid Conditions
PHENOTYPES OF ASTHMA
DIAGNOSIS OF ASTHMA
Objective Tests
CONCLUSION
14:
Diagnosis of Asthma
INTRODUCTION
FEATURES OF AIRFLOW OBSTRUCTION
MEASUREMENT OF AIRFLOWOBSTRUCTION
A Normal Flow-Volume Loop
Peak Flow Meters and Peak Flow Monitoring
Diagnosing asthma withInflammatory Markers
FeNO
Provocation tests
POINTS TO REMEMBER
15:
Treatment of Asthma in Children
COMPONENTS OF ASTHMA TREATMENT
PHARMACOLOGIC THERAPY
Inhaled Corticosteroids
Long-acting β2 Agonist
Leukotriene Receptor Antagonist
ASTHMA SEVERITY AND CONTROL
Monitoring and Weaning of ICS
Avoidance of Trigger Factors
Inhaled Therapy and Device
Asthma Education
Difficult to Control Asthma
CONCLUSION
16:
Acute Asthma Exacerbations
DEFINITION AND SEVERITY CONCERNS
Who is at risk for Asthma Exacerbations?
PREVENTING ASTHMA EXACERBATIONS
TREATING ASTHMA EXACERBATIONS
CONCLUDING REMARKS
17:
Management of Acute Asthma
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL PRESENTATION AND ASSESSMENT
MANAGEMENT OF ACUTE SEVERE ASTHMA
PHARMACOTHERAPY (TABLE 3)
Parenteral Bronchodilator
Anticholinergics
Corticosteroids
Magnesium Sulfate
Methylxanthines
Nonstandard Therapies
Nonpharmacologic Management
Mechanical Ventilation
Weaning of Drugs
Summary of Acute Asthma Management
Conclusion
POINTS TO REMEMBER
18:
Difficult to Treat Asthma
WHAT IS DIFFICULT TO TREAT ASTHMA?
Epidemiology of Difficult to Treat Asthma
Why these Asthmatics are Refractoryfor Proper Treatment?
CONCLUSION
19:
Drug Allergy
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
CLASSIFICATION
DRUG ALLERGY
Genetics of Drug Allergy
Approach
Pathophysiology
Factors Influencing Drug Allergies
Clinical Features in Skin (Table 3)
Maculopapular Skin Eruptions
Fixed Drug eruptions
Contact dermatitis
Urticaria and Angioedema
Interstitial Granulomatous dermatitis
Erythema multiforme
Stevens-Johnson syndrome
Toxic Epidermal Necrolysis (TEN)
Clinical spectrum Other thanSkin involvement
Serum Sickness Syndrome
Drug-Induced Hepatitis
Red Man Syndrome
Hematological Manifestations
Anaphylaxis
Acute Interstitial Nephritis
Differential diagnosis
Diagnosis of Drug Allergy
Skin test
Provocation test
Management
Hyposensitization
Prevention
POINTS TO REMEMBER
20:
Allergens
INTRODUCTION
Terminology of Allergens
Aeroallergens
HISTORY
INDOOR ALLERGENS
Dust Mite
Dust Mite and Lifestyle
Sources of Allergens
Dust Mite Control
Efforts to Denature Allergens
Efforts to Avoid Mite Allergens
Cockroach
Allergen Source
Animal Dander
Allergen Source
Cat
Dog
Prevention of Animal Dander
Major Indoor Allergens
Control of Indoor Air Pollution
Air Cleaning Device
Type of Air Cleaning Devices
Indoor Aero Allergen Avoidance
OUTDOOR ALLERGENS
Fungus (Mould)
Outdoor Fungi
Indoor Fungi
Common Indoor Fungus
STANDARDIZATION OF ALLERGENS
POINTS TO REMEMBER
21:
Environment and Respiratory Allergies
INTRODUCTION
ENVIRONMENTAL ISSUES
Air pollution
Outdoor Air Pollution
Indoor Air Pollution
IRRITANTS
Environment Control In Prevention Allergic Disease
22:
Allergen Specific Immunotherapy
DEFINITION
INTRODUCTION
HISTORY
Conditions where Immunotherapy Effective
Safety and Efficacy of Immunotherapy
Adverse reactions
Schedule of Immunotherapy
Age at which Immunotherapy Started
Allergens
ALTERNATIVE ROUTES
Intralymphatic Immunotherapy (ILIT)
Epicutaneous Immunotherapy
Rush Immunotherapy
POINTS TO REMEMBER
Sample Schedule
23:
Approach to Primary Immunodeficiency Diseases
INTRODUCTION
DEFINITION
Epidemiology
Genetics of PIDs
CLASSIFICATION
B-cell Defects
DIAGNOSIS
HISTORY
Onset of Symptoms
Physical Examination
Workup
Tests for PID
Tests for B Cell Deficiency
Expected Response
Tests for Combined Immunodeficiency
Complete Blood Count
X-ray Chest PA and Lateral View
Delayed Type Hypersensitivity Skin Tests (DTH Skin Test)
Tests for Complement Deficiency
Quantitative Flow Cytometry
Genetic Studies
CD Antigen's Target Cell
TREATMENT
IVIG
Gamma Interferon
Use of Irradiated Blood Products
Stem Cell Transplantation
Selective IgA Deficiency (SIgAD)
X-linked Agammaglobulinemia (Bruton's Syndrome)
Severe Combined Immunodeficiency (SCID)
Hyper IgM Syndrome
Leukocyte Adhesion Defect (LAD)
Chronic Granulomatous Disease (CGD)
Common Variable Immunodeficiency (CVID)
POINTS TO REMEMBER
24:
Vitamin D and Allergy
INTRODUCTION
HISTORY
Vitamin D Metabolism
Extra-skeletal Functions of Vitamin D
Fallacies of Vitamin D Insufficiency
How Vitamin D Deficiency Leads to Allergic Diseases
Vitamin D and T Regulatory Cells
Allergic Diseases
Food Sensitization
Maternal Vitamin D and Early Wheeze
Airway Inflammation and Vitamin D
Seasonal Allergic Rhinitis
Anaphylaxis
Vitamin D and Asthma
Vitamin D and Exercise induced Bronchospasm
Role of Vitamin D in Asthma Phenotypes
Vitamin D and Airway Remodeling
Vitamin D and Allergen Specific Immunotherapy
Vitamin D and Atopic Dermatitis
POINTS TO REMEMBER
25:
Drugs Commonly Used in Allergy and Asthma
26:
Selected Lab Values in Allergy and Immunology
NITROBLUE TETRAZOLIUM TEST/NBT TEST/TETRAZOLIUM REDUCTION TEST
TESTS FOR PHAGOCYTOSIS
Normal Range: Phagocytosis > 95%
Neutrophil Oxidative Burst test
27:
Devices in Allergy and Asthma
METERED DOSE INHALER
Priming the MDI
POINTS TO REMEMBER
Advantages of MDI
Disadvantages of MDI
Difficulties Encountered with MDIs
Care and Cleaning
Metered Dose Inhaler with Spacer
Spacers with Baby Mask
NEBULIZERS
Types of Nebulizers
Nebulizer Parts
Advantages of Nebulizers Compared to MDI
Disadvantages of Nebulizers
Cleaning the Nebulizer
Compressor
Tubing
Nebulizer Chamber
Facemask or Mouthpiece
DRY POWDER INHALATION DEVICES
Types of DPIs
Rotahaler
Cleaning the Rotahaler
Advantages of Rotahaler
Disadvantages of Rotahaler
INTRANASAL STEROID DEVICE
Technique of Using Intranasal Steroid Device
PEAK EXPIRATORY FLOW METER
How to Use Peak Flow Meter
Usefulness of the PEF
Take Peak Flow Reading
Peak Nasal Inspiratory Flow Meter
Procedure
INDEX
TOC
Index
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