Pediatrics
Allergic Disorders
Paediatric allergy for NEET-PG: allergic rhinitis, atopic dermatitis, childhood asthma and anaphylaxis with adrenaline-first management, mapped to NMC PE31 codes.
MedNext Academy | 3 min read
Allergic Disorders
Paediatric allergy for NEET-PG: allergic rhinitis, atopic dermatitis, childhood asthma and anaphylaxis with adrenaline-first management, mapped to NMC PE31 codes.
This chapter covers paediatric allergic disease: allergic rhinitis, atopic dermatitis and childhood asthma with its investigation and delivery-device skills, culminating in urticaria, angioedema and the recognition and adrenaline-first treatment of anaphylaxis. It emphasises clinical diagnosis and safe escalation.
High-yield: Allergic Disorders
- Allergic rhinitis is IgE-driven nasal inflammation, not a harmless prolonged cold, and carries a preventable burden of mouth breathing, sleep disturbance, otitis media and asthma worsening.
- Allergic rhinitis is often diagnosed before laboratory testing from the allergic salute, nasal crease, pale boggy turbinates, clear secretions, allergic shiners and conjunctival itching.
- A total IgE value is a weaker clue than the classic clinical signs when diagnosing allergic rhinitis.
- Atopic dermatitis is an itchy barrier disease with immune amplification, and if the itch-scratch cycle is not broken, lichenification, infection and sleep loss perpetuate the flare.
- Atopic dermatitis management fails when the prescription is correct but the family does not know the quantity, order and duration of the topical treatments.
- Fever, toxicity, painful monomorphic vesicles or punched-out erosions in eczema suggest eczema herpeticum and need urgent same-day care.
- Childhood asthma is variable airflow limitation with airway inflammation and should explain recurrent wheeze, cough, triggers and reversibility rather than every noisy breath.
- The most dangerous asthma sign is not a loud wheeze but a quiet chest, exhaustion, cyanosis, poor speech, altered sensorium or falling oxygen saturation.
- A complete blood count and chest X-ray do not diagnose routine asthma and are reserved for severity, fever, focal signs, complications or alternative diagnoses.
- Nebulisation is a delivery method, not a diagnosis, and a metered-dose inhaler with a spacer is often equally effective for many attacks.
- An asthma treatment plan must state daily medicine, what to do when worsening, when to seek urgent care, how technique is checked and when the diagnosis is reconsidered.
- Urticaria is itchy dermal whealing and angioedema is deeper swelling, while anaphylaxis is diagnosed by systemic airway, breathing or circulation involvement.
- In anaphylaxis, intramuscular adrenaline must not wait for a rash to appear, and antihistamines and steroids must not delay it.
- Failure to thrive, clubbing, focal chest signs, persistent wet cough, neonatal onset or abrupt choking onset are referral features that should not be masked by increasing asthma medicines.
- A normal spirometry result does not exclude asthma when symptoms are intermittent, so testing must be interpreted with clinical context and effort quality.
Allergy emergency and phenotype anchors
- **Allergic rhinitis signs:** Allergic salute, nasal crease, pale boggy turbinates, clear secretions and allergic shiners.
- **Life-threatening asthma:** Silent chest, exhaustion, cyanosis, poor speech or falling saturation, not a loud wheeze.
- **Eczema herpeticum:** Fever, painful monomorphic vesicles and punched-out erosions needing urgent care.
- **Anaphylaxis:** Systemic airway, breathing or circulation involvement; intramuscular adrenaline must not wait for a rash.
NMC competencies in this chapter
- **PE31.1:** Allergic Rhinitis: Etiopathogenesis, Management and Prevention
- **PE31.3:** Atopic Dermatitis: Etiopathogenesis, Features and Treatment
- **PE31.5:** Childhood Asthma: Allergic Biology, Types and Prevention
- **PE31.7:** Asthma Treatment Plan by Presentation and Severity
- **PE31.12:** Urticaria, Angioedema, Anaphylaxis and Allergy Emergencies
Frequently Asked Questions
How is allergic rhinitis diagnosed?
It is often diagnosed clinically before laboratory testing, using signs such as the allergic salute, nasal crease, pale boggy turbinates, clear secretions, allergic shiners and conjunctival itching. These are stronger clues than a total IgE value.
What is the most dangerous sign in childhood asthma?
Not a loud wheeze, but a quiet or silent chest, exhaustion, cyanosis, poor speech, altered sensorium or falling oxygen saturation. These indicate life-threatening disease and require urgent escalation.
How is anaphylaxis treated?
Anaphylaxis is diagnosed by systemic airway, breathing or circulation involvement, and intramuscular adrenaline is the first-line treatment. It must not wait for a rash to appear, and antihistamines and steroids must not delay it.
Do a CBC and chest X-ray diagnose asthma?
No. They do not diagnose routine asthma and are used only when severity, fever, focal signs, complications or an alternative diagnosis make the result clinically relevant.
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