ALLERGY

Question . 1. Which of the following are characteristic of allergens? a) Proteins of molecular weight <10 kd b) Proteins of molecular weight 10-70 kd c) Proteins of molecular weight >70 kd d) Lipopolysaccharides e) Carbohydrates Question . 2. Which of the following factors is characteristic of an atopic response? a) Th1 release of cytokines promoting phagocytosis b) Th1 release of cytokines promoting synthesis of opsonising antibodies c) Th1 and Th2 release of cytokines promoting synthesis of complement-fixing antibodies d) Th2 release of cytokines promoting phagocytosis e) Th2 release of cytokines promoting synthesis of IgE antibodies Question . 3. Which of the following types of cells are distributed throughout connective tissues, often adjacent to blood vessels and below epithelial surfaces that are exposed to the external environment, and release a diverse array of mediators of allergic inflammation? a) Eosinophils b) Basophils c) Mast cells d) Th2 cells e) Dendritic cells Question . 4. Which of the following antigen-presenting cells are actively phagocytic and reside in peripheral sites such as the skin, intestinal lamina propria, and lungs? a) Eosinophils b) Basophils c) Mast cells d) Th2 cells e) Dendritic cells Question . 5. Which of the following statements best describes the relationship between allergic disorders and a possible genetic basis? a) Allergic disorders are a response to only environmental factors b) Allergic disorders are a response to only environmental factors and infectious agents c) Asthma and allergic rhinitis are the only allergic disorders with a familial predisposition d) Any familial predisposition is related to polymorphisms of a single gene located on chromosome 10 e) Any familial predisposition is related to many genetic loci and also many polymorphisms

Question . 6. Which of the following factors may contribute to the worldwide rise in prevalence of allergic diseases, particularly in Westernized metropolitan areas? a) Increasing genetic polymorphisms of CD14 b) Increased numbers of children in group daycare c) Excessive use of antibiotics in first 2 yr of life d) Reduced exposure to pollutants in Westernized metropolitan areas since 1980 e) Reduced exposure to indoor allergens Question . 7. All of the following may be signs of moderate to severe airway obstruction resulting from allergic response except: a) Dennie lines (Dennie-Morgan folds) b) Supraclavicular and intercostal retractions c) Cyanosis d) Pulsus paradoxus e) Respiratory distress with minimal wheezing and a few crackles Question . 8. A 7-yr-old boy with asthma has roughness over the extensor surfaces of the upper arms and thighs, which is caused by keratin plugs lodged in the openings of hair follicles. This physical finding is termed: a) Keratosis pilaris b) Fibroepitheliosis c) Hidradenitis d) Xerosis e) Acrochordon Question . 9. The radioallergosorbent test (RAST) determines: a) Bronchial reactivity to subcutaneous serotonin b) Bronchial reactivity after inhalation bronchial provocation test c) The proportion of total allergic immunoglobulin d) Antigen-specific serum IgE concentrations e) The overall allergic risk profile based on absolute eosinophil count, total IgE, and skin test results Question . 10. All of the following statements regarding skin testing for allergic reactivity are true except: a) Antihistamines given prior to testing may inhibit the reaction b) Intradermal tests are more sensitive than puncture tests c) Positive skin test results by intradermal testing correlate better than results by puncture tests with clinical symptoms d) The reaction peaks within approximately 20 min and usually resolves over 20-30 min e) Larger reactions have greater clinical relevance Question . 11. Which of the following is an advantage of skin testing over RAST to determine specific IgE? a) Skin testing is not affected by administration of antihistamines b) Skin testing has greater sensitivity than RAST c) Skin testing is semiquantitative d) Skin testing is associated with less risk of allergic reaction

e) Skin testing is not confounded by dermographism Question . 12. Which of the following physical findings would be least likely on examination of a child with moderate to severe asthma? a) Tachypnea b) Wheezing c) Clubbing d) Decreased air exchange over the right middle lobe e) An increased anterior-posterior diameter of the chest Question . 13. Recommendations to the parents of a child with dust mite allergy to help reduce dust mite exposure should include all of the following except: a) Use a humidifier regularly b) Place the mattress and pillow in allergen-proof encasements c) Wash bed linens in hot water weekly d) Remove the old carpet from the bedroom Question . 14. All of the following statements regarding decreasing exposure to cat allergens are true except: a) Removing the cat from the home is the most effective means of reducing exposure to cat allergen b) Keeping the cat out of the child's bedroom and other rooms where the sensitized child spends large amounts of time reduces cat allergen exposure c) Washing the cat regularly reduces cat allergen exposure d) Using HEPA-filtered air cleaners does not reduce cat allergen exposure e) Removing carpet decreases cat allergen exposure Question . 15. A 12-yr-old girl with moderate to severe asthma is sensitive to cat dander. Her family elects to remove the pet cat from the house, but to retain the present carpeting and upholstered furniture. What is the length of time required before the levels of cat allergen drop to levels found in homes without a cat? a) Immediately b) 2 days c) 2 wk d) 2 mo e) 6 mo Question . 16. Which of the following statements regarding antihistamines is true? a) Classification of antihistamines from type I to type VI is based on increasing antihistamine activity b) Second-generation antihistamines are distinguished by greater effectiveness than first-generation antihistamines c) Antihistamines should not be administered in combination with decongestants d) Antihistamines are more effective in treating than preventing the action of histamine e) The choice of antihistamines should be based on associated adverse effects and cost

Question . 17. Which of the following is an advantage of second-generation antihistamines over first-generation antihistamines? a) Second-generation antihistamines are often less expensive b) Second-generation antihistamines are more frequently available in oral preparations c) Second-generation antihistamines have less of a sedative effect and produce less cognitive impairment d) Many more second-generation antihistamines are available as over-the-counter medications e) Second-generation antihistamines are generally more effective than first-generation antihistamines Question . 18. Which of the following statements regarding the use of cromolyn in the management of asthma is true? a) Cromolyn prevents antibody-mediated mast cell degranulation and mediator release b) Cromolyn prevents non-antibody-mediated mast cell degranulation c) Cromolyn has no bronchodilator properties d) The incidence of adverse effects is low e) All of the above Question . 19. The type of adrenergic activity of drugs most desirable in treatment of asthma is: a) 1 b) 2 c) 1 d) 2 e) 3 Question . 20. A 4-yr-old boy experiences perennial clear rhinorrhea, nasal congestion, conjunctival injection, allergic shiners, nasal and ocular pruritus, and occasional fits of sneezing. An environmental history is significant for two cats in the home and flooding of the basement when it rains. He keeps twenty stuffed animals on his bed and sleeps with a feather pillow on an old mattress. He lives in a warm climate. Seasonal worsening of his symptoms has not been observed. He has perennial allergic rhinitis. Which of the following groups of allergens would be the most likely to contribute to his symptoms? a) Dust mites, tree pollens, and weed pollens b) Dust mites, animal danders, and molds c) Tree, weed, and grass pollens d) Tree pollen, grass pollen, and milk protein Question . 21. A 7-yr-old girl presents with allergic nasal symptoms that are prominent from the middle of August through the first frost. Which of the following allergens is the most likely cause of her symptoms? a) Milk protein b) Tree pollen c) Grass pollen d) Weed pollen

Question . 22. A teenage boy presents in April with symptoms consistent with seasonal allergic rhinitis. On examination of his nose, which of the following findings suggest the need for further evaluation to exclude another diagnosis? a) Nasal polyps b) Pale-to-purple nasal mucosa c) Thin, clear nasal secretions d) A transverse nasal crease e) Continuous open-mouth breathing Question . 23. A 12-yr-old presents with sneezing, clear rhinorrhea, and nasal itching. Physical examination reveals boggy, pale nasal edema with a clear discharge. The most likely diagnosis is: a) Foreign body b) Vasomotor rhinitis c) Neutrophilic rhinitis d) Nasal mastocytosis e) Allergic rhinitis Question . 24. Two weeks later, the patient described in Question 23 complains of headache, poor nasal airflow requiring mouth breathing, fever, and a change in the nature of the nasal discharge to mucopurulent discharge. The most likely diagnosis is: a) Sinusitis b) Foreign body c) Rhinitis medicamentosa d) Choanal stenosis e) Ciliary dyskinesia Question . 25. A 12-yr-old child presents with watery rhinorrhea, paroxysmal sneezing, and nasal obstruction. The serum IgE level is normal, and skin test results are negative. The physical examination is remarkable only for swollen turbinates and clear nasal secretions. A trial of antihistamine-decongestant therapy for 3 wk has not relieved symptoms. Which of the following is the recommended management? a) Institute strict measures to avoid outdoor allergen exposure. b) Begin seasonal use of oral sympathomimetic drugs. c) Begin seasonal use of topical intranasal corticosteroids. d) Give a 10-day course of amoxicillin e) Give a 10- to 14-day course of cefpodoxime Question . 26. Which of the following is most useful in establishing the diagnosis of seasonal allergic rhinitis? a) History of good clinical response to an intranasal corticosteroid preparation b) History of exacerbation of symptoms in the spring c) Elevated serum IgE level

d) Positive result on skin testing for the house dust mite allergen e) Nasal eosinophils

Question . 27. Common triggers of asthma in children include all of the following except: a) Secondary tobacco smoke b) Ozone c) Cold air d) Exercise e) Gelatin Question . 28. The parents of a 3-yr-old girl with a history of several previous coughing and wheezing exacerbations are wondering if their toddler is likely to develop persistent asthma. Which of the following is a strong risk factor for persistent asthma in toddlers with recurrent wheezing? a) Eczema b) Colic c) Living on a farm d) Female gender e) Otitis media with effusion Question . 29. A 4-yr-old boy with asthma has had mild wheezing only four times since you began treating him 6 mo ago with theophylline (Slo-bid Gyrocaps) twice each day. He previously experienced coughing and wheezing at least three times each week. (A peak serum theophylline concentration 5 mo ago was 16 g/mL). For the past 4 days, he has again experienced mild coughing and wheezing responsive to inhaled albuterol. Two days ago, an emergency department physician began treatment with erythromycinsulfisoxazole (Pediazole) for otitis media. This morning the youngster began vomiting. The likely cause of the vomiting is: a) Provocation by coughing (post-tussive emesis) b) Sequelae of otitis media c) Theophylline toxicity d) Albuterol toxicity e) Pediazole intolerance Question . 30. A 10-yr-old child has intermittent symptoms of mild asthma. The most appropriate treatment option is: a) Environmental control and patient education only?no medication is indicated b) Oral theophylline c) Cromolyn d) Inhaled 2-agonist as needed for symptoms e) Daily inhaled corticosteroid Question . 31. The child described in Question 30 experiences worsening of symptoms, which are now persistent and of moderate severity. The most appropriate treatment option is:

a) b) c) d) e)

Oral theophylline Inhaled 2-agonist as needed for symptoms Daily inhaled corticosteroid and oral theophylline Daily inhaled corticosteroid and a long-acting inhaled 2-agonist Daily inhaled corticosteroid, a long-acting inhaled 2- agonist, and oral theophylline

Question . 32. A 12-yr-old asthmatic boy has developed an asthma exacerbation in the past few days. Asthma symptoms have continued to progress despite frequent albuterol use at home. He comes to the emergency department with chest tightness, dyspnea, and wheezing, and in moderate respiratory distress. In this setting, management should include all of the following except: a) Close monitoring b) Supplemental oxygen c) Inhaled albuterol d) Theophylline e) Systemic glucocorticoids Question . 33. A 7-yr-old girl has had intermittent asthma symptoms over the past 5 yr. Her asthma symptoms have been treated with inhaled albuterol as needed. She mostly has exercise-induced asthma symptoms, which happens on most school days except when she uses her albuterol inhaler before going to recess and physical education classes. In the past year, she has had two asthma exacerbations with viral upper respiratory tract infections, and she has used a total of 5 albuterol metered-dose inhalers. The most appropriate management for this asthmatic girl is: a) Continue albuterol as needed and before physical exercise activities b) Begin daily controller medication with an inhaled glucocorticoid, initially used more frequently to gain control, then a reduced amount in a few months to maintain control c) Begin daily inhaled glucocorticoid in a low dose, increasing the dose monthly until good control is obtained d) Administer daily oral glucocorticoid treatment for one week, with concurrent daily inhaled glucocorticoid e) Begin use of a long-acting inhaled -agonist each morning Question . 34. Components of the U.S. National Asthma Education & Prevention Program (NAEPP) guidelines include all of the following except: a) Regular assessment and monitoring b) Control of factors contributing to asthma severity c) Asthma pharmacotherapy, especially the use of anti-inflammatory controller medications d) Genetic profiling e) Patient education

Question . 35. Features characteristically associated with atopic dermatitis include all of the following except: a) Allergic rhinitis or asthma b) Elevated serum IgE level c) Peripheral blood eosinophilia d) Lymphopenia .

Question . 36. Major features of atopic dermatitis in children include all of the following except: a) Pruritus b) Facial and extensor eczema c) Angioedema d) Chronic or relapsing course e) Personal or family history of atopic disease Question . 37. A 2-yr-old is diagnosed with atopic dermatitis. Which of the following environmental modifications is recommended? a) A bland diet, especially minimizing meats b) Installation of wool carpeting instead of synthetic carpeting c) Use of a liquid rather than powder laundry detergent, and adding a second rinse cycle d) Use of soaps that are especially effective in removing fatty substances e) Bathing less often than daily Question . 38. The most appropriate prognosis to convey to the parents of the 2-yr-old with atopic dermatitis described in Question 37 is: a) The child will be asymptomatic with environmental modifications b) Symptoms will gradually worsen during childhood and persist stably through adulthood c) Symptoms will exhibit a remittent but progressively worsening course through adulthood d) Symptoms will gradually decrease over the next several years with an approximately 50% chance of spontaneous improvement e) Symptoms will resolve completely at puberty Question . 39. Which of the following is the major feature of atopic dermatitis? a) Onset shortly before or during puberty b) Pruritus c) Staphylococcus aureus cutaneous infections d) Elevated serum IgE e) Immediate skin test reactivity to allergens

Question . 40. A 5-yr-old boy with severe atopic dermatitis develops illness with dozens of vesicles primarily covering areas of skin previously affected by atopic dermatitis. The distribution crosses many dermatomes. Findings include fever and lymphadenopathy. The most likely diagnosis is: a) Chickenpox b) Zoster c) Kaposi varicelliform eruption d) Eczema vaccinatum e) Coxsackievirus infection Question . 41. A 14-yr-old presents with acute-onset urticaria that has gradually worsened over the past 10 days. Detailed history reveals no clues to the possible etiology. Findings on physical examination are normal except for urticaria. Which of the following diagnostic options is recommended? a) Systematic elimination diets to determine a possible ingestant cause b) Allergy skin testing c) Serum IgE and RAST d) Skin biopsy e) None of the above Question . 42. Which of the following treatment options is recommended for the patient described in Question 42? a) A bland diet b) Wearing cotton garments c) Oral antihistamine d) Oral prednisone e) Topical corticosteroid Question . 43. Which of the following laboratory tests is most likely to give abnormal results in a patient with chronic urticaria? a) Serum IgE level determination b) Skin prick testing for egg sensitivity c) C4 level assay d) Assay for antibodies to thyroglobulin e) Heterophile antibody testing Question . 44. A 12-yr-old girl with repeated episodes of streptococcal pharyngitis experiences another episode of sore throat. The rapid strep test result is positive, and oral amoxicillin is started, with the first dose given in the office. One hour later, she experiences a "funny feeling" and a tingling sensation around her mouth. Next she becomes apprehensive, has difficulty swallowing, and develops a hoarse voice. On arrival at the emergency department, she has giant urticaria and the following vital signs: pulse 130,

respiratory rate 32/min, blood pressure 70/30 mm Hg, and temperature 37.2C. The most appropriate therapy is administration of: a) Epinephrine b) Prednisone c) Diphenhydramine d) Albuterol e) Lactated Ringer's solution Question . 45. The most likely diagnosis for the patient described in Question 45 is: a) Streptococcal toxic shock b) Scarlet fever c) Stevens-Johnson syndrome d) Reye syndrome e) Anaphylaxis

Question . 46. The mother of an 8-yr-old boy with acute streptococcal tonsillitis calls to report that now, within 15 min after the first dose of oral penicillin V that you prescribed, he is complaining of itching and has developed hives. Which of the following should you recommend? a) A dose of oral Benadryl, with instructions to call again if he has not improved within 30 min b) Immediate return to your office or the nearest emergency department c) Careful monitoring at home, with instructions to return to your office or the nearest emergency department if he becomes short of breath or loses consciousness d) Schedule a visit for a laboratory test to determine serum trypticase level e) Substitution of erythromycin for penicillin Question . 47. All of the following statements regarding anaphylaxis are true except: a) Virtually any foreign substance can elicit an anaphylactic reaction b) Most anaphylactic reactions are due to drugs, latex, foods, and Hymenoptera venom c) Oral drugs carry a higher risk of anaphylaxis than that associated with injected drugs d) Anaphylactic reactions to foods usually begin within minutes to 2 hr of exposure e) Exercise alone can elicit an anaphylactoid reaction Question . 48. Administration of which of the following drugs is the treatment of choice for anaphylaxis? a) Diphenhydramine orally b) Diphenhydramine by intravenous infusion c) Aqueous epinephrine (1:1,000) by subcutaneous injection d) Aqueous epinephrine (1:1,000) by intramuscular injection e) Aqueous epinephrine (1:1,000) by intravenous infusion Question . 49. A 16-yr-old with history of anaphylaxis to Hymenoptera suffers a sting on an extremity. The first-aid kit that is available includes aqueous epinephrine 1:1,000 and other necessary medical supplies. All of the following measures for management of this sting are appropriate except:

a) Infiltration of one half of the epinephrine dose subcutaneously around the site of the sting b) Repeat doses of aqueous epinephrine at 15-min intervals if necessary c) Placement of a tourniquet above the site of the sting d) Incision of and suction of venom from the site of the sting e) Transport to an emergency department Question . 50. The most common single cause of anaphylaxis outside of the hospital is: a) Insect sting allergy b) Drug allergy c) Food allergy d) Latex allergy e) Food-associated exercise-induced anaphylaxis Question . 51. A 12-yr-old child with a history of allergy to yellow jackets is stung and immediately begins experiencing tightness in the chest and wheezing. The drug of first choice for management of this child is: a) Inhaled albuterol b) Subcutaneous epinephrine c) Intramuscular diphenhydramine d) Intramuscular epinephrine e) Oral corticosteroids Question . 52. Which of the following would be the optimal long-term management of the child described in Question 51? a) Daily oral non-sedating antihistamine b) Daily low-dose oral corticosteroid c) Daily inhaled corticosteroid d) Inhaled corticosteroid immediately upon insect sting e) Immunotherapy Question . 53. A 2-yr-old child who has completed 8 days of a 10-day course of cefaclor presents with low-grade fever, malaise, irritability, lymphadenopathy, and a generalized erythematous rash that is mildly pruritic. The most likely diagnosis is: a) Partially treated meningitis b) Infectious mononucleosis c) Kawasaki disease d) Type I hypersensitivity reaction e) Type III hypersensitivity reaction Question . 54. A 14-yr-old child received equine-derived antivenom for a snake bite 5 yr ago and now requires it again. Results of skin testing to the product are negative. Which of the following statements is true? a) Premedication with corticosteroids is warranted to prevent serum sickness b) Negative skin tests indicate that it is highly unlikely that he will develop serum sickness c) He should not receive this product more than once

d) Serum sickness may begin within a few days of administration of the antivenom Question . 55. Risk factors for adverse drug reactions include: a) Topical administration (compared with parenteral administration) b) Low dose (compared with high dose) c) Frequent, intermittent dosing frequency (compared with prolonged, continuous dosing) d) No previous exposure (compared with previous administration) e) All of the above Question . 56. Which of the following statements concerning adverse drug reactions is true? a) Adverse drug reactions are primarily IgE mediated b) Drug-induced thrombocytopenia results from circulating immune complexes c) Both parental and topical exposures to a drug increase the risk for an adverse reaction

Question . 57. A 7-yr-old boy presents with fever and otalgia. On examination, he has a bulging right tympanic membrane. As you hand his mother a prescription for amoxicillin, she informs you that when the child was 4 yr old, he broke out in an itchy rash during treatment with amoxicillin. The most appropriate approach to management of this patient would be: a) Reassure the mother that since more than 2 yr have passed, it is highly unlikely that the child is still allergic andhe can now take the amoxicillin safely b) Explain to the mother that most adverse drug reactions to amoxicillin are not IgE mediated and that amoxicillin can be safely given. c) Prescribe a cephalosporin and explain to the mother that there is no cross-reaction between penicillins and cephalosporins d) Prescribe a macrolide antibiotic and explain to the mother that there is no crossreaction between penicillins and macrolides Question . 58. The parents of a 6-yr-old girl relate a history of urticarial reaction and vomiting following administration of amoxicillin in the past. Skin testing to major and minor determinants of penicillin is positive. Which of the following statements regarding administration of a cephalosporin constitutes appropriate advice for the parents? a) The child can receive a cephalosporin with no greater risk of anaphylaxis than in the general population b) There is a 2% risk of anaphylaxis to a cephalosporin c) There is a 9% risk of anaphylaxis to a first-generation cephalosporin but an almost 0% risk of anaphylaxis to a fourth generation cephalosporin d) There is a 9% risk of anaphylaxis to a cephalosporin e) There is a 50% risk of anaphylaxis to a cephalosporin Question . 59. A 14-yr-old girl, who has a long-standing seizure disorder for which she takes phenytoin, develops fever and a urinary tract infection and is prescribed trimethoprimsulfamethoxazole. After 9 days of antibiotic treatment she has recurrence of fever and develops confluent purpuric macules on her face and trunk with erosive mucosal lesions of

her mouth and conjunctivae. A skin biopsy reveals 8% epidermal detachment. Which of the following best describes this disorder? a) Toxic shock syndrome b) Anticonvulsant hypersensitivity syndrome c) Allergy to sulfamethoxazole d) Stevens-Johnson syndrome e) Toxic epidermal necrolysis

Question . 60. All of the following may be manifestations of insect allergy except: a) Rhinitis and conjunctivitis b) Asthma c) Wheal and flare d) Anaphylaxis e) Uveitis

Question . 61. All of the following statements concerning allergic reactions to stinging insects are true except: a) The majority are due to Hymenoptera b) There is substantial cross-reactivity among vespid venoms c) Systemic reactions can occur after the first sting d) Most reactions are IgE mediated e) Negative results on skin testing and RAST reliably exclude the likelihood of anaphylaxis Question . 62. Immunotherapy provides symptomatic improvement in all of the following except: a) Ragweed allergy b) Local reaction to bee sting c) Tree pollen allergy d) House dust mite allergy e) Anaphylaxis to a wasp sting Question . 63. An 8-yr-old boy experienced immediate urticaria surrounding alarge local reaction to a honeybee sting 2 mo ago. He had no other symptoms. Skin testing with honeybee venom has been strongly positive at a weakconcentration. Appropriate recommendations include all of the following except: a) Hymenoptera venom immunotherapy b) An epinephrine auto-injector (EpiPen) for administration after a subsequent sting c) Wearing shoes when outdoors d) A Medic-Alert bracelet e) Wearing long pants

Question . 64. A 10-yr-old girl was stung on her left cheek by a yellow jacket. She is experiencing pain. By 4 hr following the sting the left side of her face is so swollen that her left eye is virtually closed. There are no other complaints.The best course of action would be: a) Apply cold compresses, and consider antihistamines and pain medication b) Perform or refer her for skin testing to Hymenoptera venom c) Prescribe self-injectable epinephrine and provide instructions to school/camp d) All of the above

Question . 65. A 7-yr-old boy was stung by an unidentified insect and within minutes developed generalized urticaria, a repetitive cough, difficulty breathing, and extreme dizziness. He was treated in the emergency department with antihistamines, epinephrine, and corticosteroids. Which of the following statements is accurate? a) If skin tests to Hymenoptera venom are performed 1 wk later and results are negative, he is not a candidate forvenom immunotherapy b) Testing and venom immunotherapy cannot be undertakenuntil the insect is identified c) Venom immunotherapy could reduce the risk for a severe anaphylaxis on a subsequent sting from more than 50% to less than 3% d) If results of venom skin tests are negative, he does not need to have selfadministered epinephrine readily available Question . 66. A 15-yr-old with a history of seasonal hay fever now also has itchy eyes, profuse tearing, and reddened and edematous conjunctivae. A treatment option effective for the ocular symptoms would be: a) Topical antihistamines b) Topical decongestants c) Topical mast cell stabilizers d) Topical nonsteroidal anti-inflammatory drugs e) All of the above?each is an effective secondary treatment regimen for ocular allergies Question . 67. The patient described in Question 66 continues to have symptoms. The most appropriate next step in management would be: a) Combination therapy such as with an antihistamine and a vasoconstrictive agent b) Immunotherapy c) Topical corticosteroids d) Oral corticosteroids e) All of the above?each is an effective tertiary treatment regimen for ocular allergies Question . 68. All of the following statements concerning allergic reactions tofoods are true except: a) Skin tests are of little diagnostic value for cell-mediated gastrointestinal hypersensitivity b) Cow's milk sensitivity is the most common cause of proteininduced enteropathy c) Gastrointestinal anaphylaxis is mediated by IgA

d) The majority of children with positive results on prick skin tests to a food will not react when the food is ingested e) Elimination diets are the only means to establish the diagnosis of food allergies Question . 69. Which of the following is an uncommon clinical manifestation of food allergies? a) Acute urticaria b) Angioedema c) Wheezing d) Diarrhea e) Chronic fatigue Question . 70. All of the following foods are characteristically associated with allergy except: a) Peanuts b) Tree nuts c) Legumes d) Eggs e) Seafood Question . 71. Because of a strong family history on both sides, the parents of a newborn baby ask for guidance about preventing their child from developing an allergy to peanuts. Which of the following approaches is recommended? a) Begin and extend breast-feeding until age 2 yr, with exclusion of peanuts from the mother's diet while breastfeeding b) Begin and extend breast-feeding until age 2 yr, with the mother ingesting gradually increasing amounts of creamy peanut butter from 18-24 mo of age c) Begin and continue breast-feeding as routinely d) recommended, with the mother regularly ingesting small amounts of peanuts but not introducing peanuts in the child's diet until age 1 yr e) Begin and continue breast-feeding as routinely recommended, excluding peanuts from the mother's diet while breast-feeding and from the child's diet until age 3 yr Use only creamy peanut butter and not chunky peanut butter or whole peanuts in the child's diet (after 1 yr of age) Question . 72. A 6-mo-old infant develops protracted projectile vomiting, and lethargy about 2 hr after ingesting a milk formula. The most likely diagnosis is: a) Generalized anaphylaxis b) Milk-induced enterocolitis syndrome c) Gastrointestinal anaphylaxis d) Allergic eosinophilic esophagitis e) Allergic eosinophilic gastroenteritis Question . 73. Which of the following is the most definitive test for diagnosing a food protein-induced enterocolitis? a) Positive clinical history b) Positive food challenge c) Positive result on skin prick test d) Positive RAST result

e) Quantitative IgE level