Allergy and Immunology Review Corner: Chapter 75 of Middleton s Allergy Principles and Practice, 7 th Edition, edited by N. Franklin Adkinson, et al.

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1 Allergy and Immunology Review Corner: Chapter 75 of Middleton s Allergy Principles and Practice, 7 th Edition, edited by N. Franklin Adkinson, et al. Chapter 75: Approach to Infants and Children with Asthma Prepared by Martha K. Elias, Mayo Clinic, and John Seyerle, Ohio State University 1. A child with a wheeziing episode in the first three years of life is most likely to be classified in which of the following categories? A. Transient early wheezing B. Non-atopic persistent wheezing C. IgE-associated persistent wheezing D. Late-onset wheezers 2. Which of the following are risk factors for the transient early wheezing phenotype? A. Absence of school-age older children B. Female sex C. Allergen exposure D. Breast feeding 3. Non-atopic persistent wheezing is found in what percentage of children who wheezed before age 3? A. 10% B. 20% C. 30% D. 40% 4. Which of the following phenotypes generally presents after age 1 year? A. Transient early wheezing B. Non-atopic persistent wheezing C. IgE-associated persistent wheezing D. Non-wheezers 5. In the Tuscon study, sensitivity to what allergen was associated with increased likelihood of persistent asthma by age 11? A. Dust mite B. Bermuda grass C. Cockroach D. Alternaria 6. What percentage of children who wheeze in the first 3 years of life have resolution of their symptoms by 6 years of age according to the Tucson Children s Respiratory Study (TCRS)? A. 40% B. 50%

2 C. 60% D. 70% 7. IgE- associated/atopic persistent wheezing phenotype is associated with which risk factors? A. Female sex B. Seborrheic dermatitis C. Eosinophilia at 9 months D. Parental contact dermatitis 8. Which is a risk factor for fatal asthma? A. Two or more asthma hospitalizations for asthma in the past year B. Five or more emergency department visits for asthma in the past year C. Hospitalization or ED visit for asthma in the past week D. Use of >3 canisters per month of short acting bronchodilator (SABA) 9. Which asthma susceptibility gene codes for a metalloproteinase? A. T-bet B. GPRA C. DENND1B D. ADAM Which is the only childhood asthma treatment that can potentially modify existing allergic sensitization and secondarily reduce allergic asthma in regard to specific exposures? A. Anti- histamines B. Specific subcutaneous allergen immunotherapy C. Inhaled corticosteroids D. Environmental controls Answers 1. A, page 1320 Some 60% of children who wheeze in the first 3 years of life have resolution of their symptoms by 6 years of age. 2. C, page 1321 Risk factors for the transient early wheezing phenotype include maternal smoking, school-aged older siblings, day-care attendance, house-dust endotoxin, allergen exposure, male sex, and bottle-feeding. 3. B, page 1321 Non-atopic persistent wheezing is found in 20 percent of children who wheezed before age C, page 1321 Atopic persistent wheezing is present in 20% of children who wheeze before age 3, with

3 symptoms typically presenting after 1 year of age. 5. D, page 1321 In the Tuscon study, sensitivity to Alternaria was associated with increased likelihood of persistent asthma by age C, page 1321 Some 60% of children who wheeze in the first 3 years of life have resolution of their symptoms by 6 years of age according to the TCRS. 7. C, page 1321 Risk factors associated with atopic wheeze include male sex, parental asthma, atopic dermatitis, eosinophilia at 9 months, early sensitization to food or aeroallergen and a history of wheezing with lower respiratory tract infections. 8. A, page 1322 Risk factors for fatal asthma are: Two or more asthma hospitalizations for asthma in the past year, three or more emergency department visits for asthma in the past year, Hospitalization or ED visit for asthma in the past month, Use of >2 canisters per month of SABA. 9. D, page 1324 Polymorphisms in the asthma susceptibility gene ADAM33, which codes for a metalloproteinase, have a role in the inflammatory response or smooth muscle hypertrophy or hyperreactivity in asthma. C_7947 polymorphism in T-bet regulates Th1 lineage development and is associated with airway hyperresponsiveness. GPRA is a G- protein coupled receptor that binds to neuropeptide S and has been linked to asthma susceptibility and allergy in children and adults. DENND1B encodes a protein that interacts with the tumor necrosis factor (TNF) α receptor and represses inflammatory-cell TNF-receptor signaling. 10. B, page 1333 Specific subcutaneous allergen immunotherapy is the only childhood asthma treatment that can potentially modify existing allergic sensitization and secondarily reduce allergic asthma in regard to specific exposures. Allergy and Immunology Review Corner: Chapter 76 of Middleton s Allergy Principles and Practice, 7 th Edition, edited by N. Franklin Adkinson, et al. Chapter 76: Approach to Adults with Asthma Prepared by John Seyerle, MD, Ohio State University 1. What is the approximate worldwide prevalence of asthma? A. 3 million

4 B. 15 million C. 150 million D. 300 million 2. Asthma is responsible for approximately how many deaths worldwide each year? A. 50,000 B. 150,000 C. 250,000 D. 350, Criteria for the diagnosis of asthma in adults generally include demonstration what minimum improvement in FEV1? A. 120mL B. 180mL C. 240mL D. 300mL 4. Diagnosis of asthma can also be made with what improvement in FEV1 over time following treatment with corticosteroids? A. 12% B. 15% C. 20% D. 24% 5. If using PEF instead of FEV1, what percentage increase following bronchodilator is considered suggestive of asthma? A. 12% B. 15% C. 20% D. 24% 6. Which of the following is the best method for diagnosing asthma and assessing control? A. Spirometry B. Physical exam C. Peak Expiratory Flow D. Chest Radiograph 7. For testing of airway responsiveness using methacholine or mannitol, the degree of responsiveness is measured as the dose required to induce what fall in FEV1? A. 12% B. 16% C. 20% D. 24% 8. Exhaled nitric oxide is a surrogate marker for what type of inflammation?

5 A. Eosinophilic B. Neutrophilic C. Bacterial D. Mast cell 9. What frequency of limitation of activity is allowed to occur to still call a person with asthma well-controlled? A. None B. Less than 2x per week C. Less than 2x per month D. Less than 2x per year 10. A person with asthma symptoms 3x per week, FEV1 of 85% predicted with a 15% increase following bronchodilator, and no exacerbations, nocturnal symptoms or limitations of activity would initially be classified as what type of asthma? A. Intermittent B. Mild persistent C. Moderate persistent D. Severe persistent Answers 1. D, page 1346 The approximate worldwide prevalence of asthma is 300 million. 2. C, page 1346 Asthma is responsible for approximately 250,000 deaths worldwide each year according to the World Health Organization. 3. B, page 1348 Criteria for the diagnosis of asthma generally include the demonstration of improvement in FEV1 of at least 12% post bronchodilator with a minimum of 180mL in adults. 4. C, page 1328 Diagnosis of asthma can also be made with 20% improvement in FEV1 over time following treatment with corticosteroids. 5. C, page 1348 If using PEF instead of FEV1, a 20% increase following bronchodilator is considered suggestive of asthma. 6. A, page 1350 Spirometry is the preferred method of measurement of airway obstruction. Physical exam is unreliable as it is only helpful during episodes of bronchoconstriction. Peak expiratory flow is effort dependent and may underestimate the degree of airflow limitation.

6 7. C, page 1350 For testing of airway responsiveness using methacholine or mannitol, the degree of responsiveness is measured as the dose required to induce a 20% fall in FEV1. 8. A, page 1350 Exhaled nitric oxide is a surrogate marker for eosinophilic inflammation. 9. A, page 1351 Any limitation of activity excludes calling asthma well-controlled. 10. B, page 1351 Mild persistent asthma is characterized by symptoms more than once a week but less than daily, nocturnal symptoms more than twice a month but less than once a week, FEV1 80%, or FEV1 variability <20%.