Dip Allerg(SA)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Examination for the Diploma in Allergology of the

College of Family Physicians of South Africa

25 August 2015
Paper 2

Long Questions/Cases

(3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required for
the one answer)

Discuss Allergic Rhinitis in South Africa under the following headings

a)
Prevalence.
(2)
b)
Clinical Presentation.
(4)
c)
Relevant investigations for different regions.
(5)
d)
A structured approach to treatment.
(10)
e)
Discuss the features on history, presentation or response to treatment that should make
one consider a differential diagnosis, and indicate which alternative diagnoses these
would be.
(4)
[25]

A teenager on budesonide 400ug via metered dose inhaler has symptoms of uncontrolled
asthma. Discuss potential causes for this as well as all measures you will put in place to
secure control.
[25]

Discuss allergy and asthma prevention strategies in childhood.

[25]

Discuss IgE-mediated cows milk protein allergy under the following headings
a)
Pathophysiology.
b)
Clinical manifestations.
c)
Diagnosis.
d)
Management.

[25]

Dip Allerg(SA)
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No/Nr 1955/000003/08

Examination for the Diploma in Allergology of the

College of Family Physicians of South Africa

25 August 2015
Paper 2
True/False

Candidate number: __________________________________

Answer all questions in the space provided

-2Section B
True/false
1

House dust mites: Indicate true or false

a) Dust mites are 6-legged arthropods that fall in the acarid order of insects
( )
b) Species of house dust mites include Dermatophagoides pteronyssinus, Dermatophagoides
farinae, Euroglyphus maynei and Blomia tropicalis.
( )
c) Dust mite allergens are found in fine particles that may remain airborne for up to 6 hours.
( )
d) House dust mites are parasitic insects that in addition to causing allergic symptoms are
capable of biting or stinging humans.
( )
e) House dust mites contain allergens that cross-react with crustaceans and cockroaches.
( )

Immunology. Indicate true or false

a) IgE is transmitted freely through the placenta.
( )
b) IgE is synthesised though signallin by either IL-4 or IL-13, and costimulation with CD40
ligand.
( )
c) Atopy is defined by the presence of IgE antibodies in serum.
( )
d) TH2 cytokines such as IL2, IL4 and IL6 are key cytokines in adaptive protection against
helminthic parasites, but in a maladaptive response cause allergic inflammation.
( )
e) Regulatory T cells secrete IL10 and TBF beta.
( )

Immunotherapy. Indicate true or false

a) Specific immunotherapy, which has been used for the treatment of allergic diseases for
nearly 100 years, consists of administering increasing concentrations of extracts of
allergen over a long period.
( )
b) To reduce the risk of anaphylactic reactions during injection immunotherapy, allergen
extracts can be pretreated with agents such as formaldehyde resulting in the formation of
so-called allergoids.
( )
c) Immunotherapy decreases symptom and medication scores for rhinitis and asthma, but
does not alter the natural history of disease.
( )
d) Immunotherapy is contra-indicated in patients with asthma.
( )
e) Routes of immunotherapy include sublingual, subcutaneous, epicutaneous and
intralymphatic.
( )

Allergy medication. Indicate true or false

a) Desloratadine is active metabolite of Cetirizine.
( )
b) SMART therapy or Salmeterol maintenance and reliever treatment refers to the use of
Salmeterol as the long acting beta 2 agonist that can be used for acute attacks as well as
for long term control.
( )
c) Ciclesonide a prodrug.
( )
d) Omalizumab is a humanised recombinant anti-IgE monoclonal antibody that is especially
effective in adults and children with severe allergic asthma with extremely high IgE levels
>= 2000 Iu/ml.
( )
e) Pimecrolimus binds to macrophyllin -12 and inhibits calcineurin.
( )
PTO/ Page 3 Question 5

-35

With regard to atopic eczema, indicate true or false

a) In infantile eczema the face and nappy area are usually involved.
b) In primary care settings, atopic eczema is usually caused by food allergy.
c) A food allergy trigger may be confirmed by the use of specific IgE or skin prick tests.
d) Atopic eczema is best managed with topical application of aqueous cream.
e) Bleach baths may be beneficial in children with recurrent staphylococcal infection.

(
(
(
(
(

)
)
)
)
)

With regard to urticaria pigmentosa, indicate true or false

a) Characteristic features include an urticarial rash that is painful rather than itchy.
( )
b) Is an IgE mediated disease.
( )
c) Urticaria pigmentosa is characterised by normal number of mast cells that are abnormally
activated as so called mast cell activation syndrome.
( )
d) Systemic forms of mastocystosis may present with symptoms including facial flushing,
itching, nausea, vomiting, diarrhoea and abdominal pain.
( )
e) Dariers sign comprises permanent post-inflammatory hyper-pigmentation found with
mastocytosis lesions.
( )

Allergy to peanuts and tree nuts. Indicate true or false

a) Peanuts and tree nuts are botanically closely related.
( )
b) Reactions caused by tree nuts in peanut allergic patients are usually caused by cross
contamination and could be avoided by more stringent labelling practices.
( )
c) Subjects with peanut allergy should be investigated for tree nut allergy if they have not
consumed tree nuts.
( )
d) Peanut and tree nut allergy is more common in adults than in children.
( )
e) Specific IgG4 antibodies to whole peanut protein extract are strongly correlated with peanut
allergy.
( )

Lung function tests

a) Total lung capacity = tidal volume + residual volume.
( )
b) According to the American Thoracic Society, in adults improvement of > 12 % and an
absolute change of > 200mls constitutes significant reversibility of small airway obstruction
after bronchodilator administration.
( )
c) In asthma, the descending expiratory curve of a flow-volume loop, instead of being
straight, becomes concave or scooped out.
( )
d) Reduction in the FVC with a normal or elevated FEV1 -to-FVC ratio is suggestive of a
restrictive lung disease.
( )
e) The forced expiratory flow occurring in the middle 50% of the patient's exhaled volume
(FEF25-75%) may fall below its lower limit of normal even when the FVC, FEV1, and
FEV1/FVC% are all normal, and is indicative of small airway obstruction.
( )

PTO/ Page 4 Question 9

-49

Non IgE mediated food allergy

a) Although infantile colic is a common symptom of cows milk protein allergy, it is almost
always seen in combination with other features of cows milk protein allergy.
( )
b) Infants with eosinophic oesophagitis present predominantly with dysphagia and food
impaction.
( )
c) Demonstration of eosinophilic infiltrate of >= 15 eos/hpf (high power field) in an
oesophageal biopsy is always diagnostic of eosinophilic oesophagitis.
( )
d) Allergic proctocolitis is a severe non IgE mediated food allergy manifesting with bloody
stools, growth impairment and/or anaemia.
( )
e) Allergic eosinophilic gastroenteritis presents with food refusal, dysphagia and food
impaction.
( )

10

Food allergens
a) Casein is a heat labile milk allergen.
( )
b) Ara H6 is a peanut allergen associated with persistence and severity of reactions.
( )
c) Alpha lactalbumin is an important egg allergen.
( )
d) Fish muscle parvalbumin is present in white muscle of many fish species and is
responsible for much of the cross-reactivity among different fish species.
( )
e) Semolina, Couscous and Bulgur are grain species that contain no wheat protein and are
suitable both for subjects with wheat allergy as well as for subjects with celiac disease. ( )

Dip Allerg(SA)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Examination for the Diploma in Allergology of the

College of Family Physicians of South Africa

26 August 2015
Paper 3

Short Questions

(3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required for
the one answer)

Discuss oral allergy syndrome and describe 2 examples.

[10]

Classify and describe the manifestations of non-IgE mediated cows milk protein allergy.

[10]

Discuss barrier dysfunction in eczema and treatment strategies that address this aspect of
pathophysiology.
[10]

Discuss the diagnosis of latex allergy.

You have a patient presenting to you in casualty with signs and symptoms of anaphylaxis. You
decide to start pharmacotherapy in your patient
a)
What is the first medication/drug that you will give?
(2)
b)
Discuss the pharmacological effect/mechanism of action of this medication/drug in the
management of anaphylaxis.
(8)
[10]

Write short notes on a classification system for Ocular Allergy.

[10]

Write short notes on vaccination advice for food allergic children and adults.

[10]

Write short notes on chronic urticaria.

[10]

Classify and discuss non-allergic adverse reactions to seafoods.

[10]

10

Discuss the 2 main groupings of skin reactions to foods in patients with atopic dermatitis, and
briefly discuss how you would diagnose each type.
[10]

[10]