BRONX-LEBANON HOSPITAL CENTER

Mamta Reddy, M.D

Yudy Persaud, M.D., M.P.H

Primary Goals for this Rotation

Prevention, Counseling and Screening

Understand the role of the pediatrician in preventing allergy and immunologic diseases, and in counseling and screening individuals at risk for these diseases.

Identify individuals at risk for developing allergic or immunologic disease by providing routine allergy/immunology screening of all patients and parents and offering prevention counseling.

Normal Versus Abnormal

Develop a working knowledge of normal development of the immune system, and recognize pathophysiologic and other clinical findings that indicate deviations from the norm.

Include discussion of family history and genetic factors.

Interpret clinical and laboratory tests to identify allergic disease or immunologic dysfunction, including: screening tests for immune deficiency (e.g. CBC with absolute lymphocyte and neutrophil counts, Immunoglobulin levels, DTH skin tests); delayed hypersensitivity; allergy skin testing; serology (e.g., screening with RAST); and pulmonary function tests.

Anaphylaxis, Angioedema, and Urticaria

Understand the role of the general pediatrician in the assessment and management of anaphylaxis, angioedema, and urticaria.

Recognize the signs and symptoms of urticaria, angioedema, and anaphylaxis.

Distinguish anaphylaxis from anaphylactoid reactions.

Discuss the pathophysiology of urticaria, angioedema, and anaphylaxis.

Identify triggers for urticaria, angioedema, and anaphylaxis and provide counseling about avoidance.

Identify the indicators for an allergy referral of a child with urticaria, angioedema, and anaphylaxis.

Allergic Rhinitis and Conjunctivitis

Diagnose and manage patients with allergic rhinitis and conjunctivitis.

 Identify the signs and symptoms of allergic rhinitis and conjunctivitis, including differentiation of allergic from other causes of rhino rhea and red eyes.

Identify co-morbidities associated with allergic rhinitis and conjunctivitis, including asthma, eczema, sleep-disordered breathing, sinusitis, etc.

Identify the indicators for an allergy referral of a child with allergic rhinitis and conjunctivitis.

Asthma. Diagnose and manage patients with asthma

Identify the signs, symptoms, and pathophysiology of asthma, and differentiate asthma from other causes of cough, wheezing, shortness of breath, and exercise intolerance.

Identify associated diseases or co-morbid conditions related to asthma (e.g. GER, allergic rhinitis, etc.).

Identify triggers that exacerbate a patient’s asthma (environmental, seasonal, infectious) and provide counseling about avoidance where feasible.

Compare the indications, effectiveness, side effects and costs of the different pharmacologic agents used in the treatment of asthma, and discuss “reliever” and “controller” therapy.

Identify the indicators for an allergy or pulmonary referral of a child with asthma.

Drug Allergy. Understand the principles, diagnosis, and management of drug allergy

Recognize the signs and symptoms of drug allergies, including differentiating drug allergy from other causes of skin rash, joint swelling, and anaphylaxis.

Identify the indicators that would lead to sub specialist referral for a child with drug allergy.

Food Allergy

Understand the role of the general pediatrician in the assessment and management of patients with food allergy.

Identify the signs and symptoms of food allergy and differentiate food allergy from other causes of skin rash, GI, and pulmonary symptoms.

Differentiate IgE-mediated food allergy from non-IgE mediated food allergy.

Identify the indicators that would lead to sub specialist referral for a child with food allergy.

Immunodeficiency

Understand the role of the general pediatrician in the assessment and management of patients with immunodeficiency.

Identify the signs and symptoms of immunodeficiency diseases, and differentiate immunodeficiency from other causes of acute and chronic disease, as well as primary from secondary immunodeficiency disorders.

Organize immunodeficiency diseases into five pathophysiologic categories (antibody, cellular-mediated, combined, complement, phagocyte) and distinguish etiologic types (e.g., genetic, post-infectious, post-chemotherapy).