Allergy and Immunology
Review Corner

Chapter 2 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.

Chapter 2: Natural History of Allergic Diseases & Asthma

Prepared by Drs. Bret Haymore, Walter Reed Army Medical Center and Soo Hee Kim-Delio, Walter Reed Army Medical Center.

General Concepts:
• Allergy and asthma of earlier onset and greater severity are generally associated with disease persistence. (p.10)
• 80 percent of asthmatics report symptoms before 6 years of age. However, of all young children who experience recurrent wheezing, only a minority will go on to have persistent asthma. (p.13)
• The most common form of recurrent wheezing in preschool children occurs primarily with viral infections. These transient wheezers are not at increased risk of having asthma in later life. (p. 13)

Questions:

1. What is the most likely order of development of atopic disease from birth to young adulthood?
A. Asthma, food allergy, allergic rhinitis
B. Allergic rhinitis, atopic dermatitis, asthma
C. Cat allergen sensitization, asthma, atopic dermatitis
D. Food allergy, allergic rhinitis, asthma

2. What is the most common form of recurrent wheezing in preschool children and is it associated with increased risk of asthma in later life?
A. Transient wheezers; yes, an association
B. Persistent wheezers; no association
C. Transient wheezers; no association
D. Persistent wheezers; yes, an association

3. Which of the following is most likely to lead to asthma based on data from cohort studies:
A. Male children who became overweight between age 6-11 years of age
B. Female children who became overweight between age 6-11 years of age who had early-onset puberty
C. Female children who became overweight between age 6-11 years of age who had late-onset puberty
D. Children with nasal polyposis and NSAID hypersensitivity

4. A history of atopy is a risk factor for anaphylaxis/anaphylactoid reaction to which of the following:
A. Radiocontrast media
B. Penicillin
C. Insulin
D. Hymenoptera sting

5. Elevated serum IgE levels in infancy have been associated with what disease?
A. Atopic dermatitis
B. Peanut allergy
C. Persistent asthma
D. Allergic rhinitis

6. What percentage of asthmatic patients report disease onset before 6 years of age?
A. 20 percent
B. 40 percent
C. 60 percent
D. 80 percent

7. Which of the following statements is true?
A. In the Tucson cohort, breastfeeding generally increased the risk of recurrent wheeze up to 2 years of age.
B. A Tucson subgroup of atopic kids exclusively breastfed for 4 months by asthmatic moms have increased risk of persistent asthma between 6-13 years.
C. Infants breast fed by moms with high IgE had lower IgE levels.
D. Infants breast fed by moms with lower IgE had higher IgE levels.

8. Which of the following statements about atopic dermatitis is true?
A. <50% of patients have clinical manifestations before the age of 7.
B. Lesions in the first 2 months of life are rare.
C. The greatest remission occurs between the ages of 12 and 16.
D. Parental history of AD is not an important risk factor.

9. When at-risk infants had restriction of common allergenic foods, what resulted?
A. Reduced prevalence of atopic disease at 1 year only.
B. Reduced prevalence of atopic disease at 4 years.
C. Inhalant allergies was decreased at 4 years.
D. Allergic airway diseases were decreased at 4 years.

Answers
1. D, page10
2. C, page 13
3. B, page 17
4. A, page 19
5. C, page 12
6. D, page 13
7. B, page 16
8. B, page 17
9. A, page 19