Key points of 17/03/2018’s CME

Key points of 17/03/2018’s CME
1. Generally no investigations required for acute Urticaria.
2. Commonest cause of Acute Urticaria- infections especially Viral.
3  2nd generation of antihistamines are the drug of choice for Urticaria.
4. 1st generation antihistamines not recommended mainly due to impairment of Cognitive function, affects R.E.M. sleep & tachyphylaxis.
5. Poor response to antihistamines is due to usage of inadequate doses.
6. Sometimes we may require double dose of antihistamines for better control of Urticaria.
7. Systemic steroids to be used in Short duration & low doses (0.3-0.5mg/kg) in case of Urticarias.
8. Montelukast is an add on drug in treating Urticaria.
9. No role of usage of Montelukast + Antihistamine combination in single tablet.
10. Immunotherapy is the only modality to prevent progression of IgE mediated Allergies.
11. Sublingual Immunotherapy is child friendly and requires about 50-350 times more antigen compared subcutaneous Immunotherapy. Cost will be high.
12. Use standarized quality antigens in Skin Prick test or in Immunotherapy to get very good clinical results.
13. It takes about 6-12 months to get improvement after starting Immunotherapy.
14. Epinephrine is the drug of choice for Anaphylaxis.
15. Epinephrine is light sensitive, but not heat. So loaded adrenaline can be kept in the spectacle box for 1-3 months depending upon the humidity.
16. Mometazone furoate & Fluticazone furoate are better INS than others and can be given from 2 years of age onwards and to be used at least 3 months.
17. Commonest cause of failure of INS is improper technique, may  lead to Epistaxis.
18. Always correlate the Skin Prick test or Serum Specific IgE tests results with history, before advising avoidance measures/ Immunotherapy.
19. ImmunoCAP/ Immulite/ Hycor techniques are used to measure the Serum Specific IgE. Out of which ImmunoCAP technique is the better.
20. See what technique used in the report of Serum Specific IgE before discussing with Patient.
21. RAST/ RIA/ ELIZA methods are outdated.
Dr Major K. Nagaraju