Allergy by liuqingyan


									Pediatric Allergy Goals and Objectives


1 = Patient care
2 = Medical Knowledge
3 = Interpersonal Communication skills
4 = Problem Based Learning and Improvement
5 = Professionalism
6 = Systems Based Practice

             Goals                                                  Objectives                                    Competencies                 Tasks                   PGY
5.1 GOAL: Prevention, Counseling    5.1.1 : Identify individuals at risk for developing allergic or               1,2,3,4,5,6    1.   Know the methods to           1,2,3
and Screening (Allergy/             immunologic disease by providing routine allergy/immunology                                       prevent allergic reactions.
Immunology). Understand the role    screening of all patients and parents and offering prevention                                2.   Be able to formulate plan
of the pediatrician in preventing   counseling that addresses:                                                                        for the patients
allergy and immunologic diseases,                                                                                                3.   Direct patient care
and in counseling and screening          1.   Breast-feeding and diet in the prevention of allergic disease
individuals at risk for these            2.   Introduction of solid foods in the prevention of allergic
diseases.                                     disease
                                         3.   Smoking and household chemicals/irritants that may
                                              exacerbate allergic diseases
                                         4.   "Myths" related to allergic disease, e.g., its role in behavioral
                                              disorders such as ADHD and autism
                                         5.   Risk factors for development of asthma and allergic diseases
                                              including family history

                                    5.1.2 : Provide allergy/immunology prevention counseling to parents                          1.   Be able to effectively        1,2,3
                                    and patients with identified allergic diseases, including:                                        communicate to the
                                                                                                                                      patients and family
                                         1.   Allergen avoidance and environmental control, e.g., pets and                            regarding the importance of
                                              indoor allergens                                                                        prevention and screening
                                         2.   Access to lay organizations and support groups                                     2.   Provide counseling to
                                         3.   Proper use of epinephrine self-injectors                                                patients and family
                                                                                                                                      regarding allergen
                                                                                                                                      avoidance and
                                                                                                                                      environmental control
5.2 GOAL: Normal Vs. Abnormal         5.2.1 : Describe the normal development and pathophysiology of the             1,2,4         1.   Know the pathophysiology       2,3
(Allergy/Immunology). Develop a       immune system, including the cellular, humoral, phagocytic and                                    of the immune system
working knowledge of normal           complement-based systems.
development of the immune
system, and recognize
pathophysiologic and other clinical
findings that indicate deviations
from the norm.
                                      5.2.2 : Discuss the classification of hypersensitivity reactions, e.g. Gell    1,2,4         Be able to discuss the              2,3
                                      and Coombs classification.                                                                   hypersensitivity reaction
                                      5.2.3 : Explain the clinical history and findings on physical examination      1,2,4         Be able to make a clinical          2,3
                                      that suggest the presence of allergic-based disease or immunologic                           assessment
                                      dysfunction that requires further evaluation and treatment. Include
                                      discussion of family history and genetic factors.
                                      5.2.4 : Develop a strategy for the work-up of suspected allergic               1,2,4         Be able to come up with a plan      1,2,3
                                      disease or immunodeficiency, based on presenting symptoms and
                                      5.2.5 : Interpret clinical and laboratory tests to identify allergic disease   1,2,4         Be able to interpret test results   2,3
                                      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.
                                      5.2.6 : Describe the relationship of allergic disease and                      1,2,4         Correlate allergic disease and      1,2,3
                                      immunodeficiency to otitis media, sinusitis, pharyngitis, meningitis                         immunodeficiency to common
                                      and pneumonia.                                                                               pediatric infections
5.3 GOAL: Undifferentiated Signs      5.3.1 : Create a strategy to investigate whether the following                 1,2,3,4,5,6   1. Be able to diagnose and          2,3
and Symptoms                          presenting signs and symptoms are caused by an allergic process or                               develop appropriate plan
(Allergy/Immunology). Evaluate,       immunologic dysfunction, and determine if the patient should be                                  for patients with allergy and
treat, and/or refer patients with     treated or referred:                                                                             immunodeficiency
presenting signs and symptoms                                                                                                      2. Direct patient care of
that suggest an allergic or           1.    Cough                          12. Syncope with exercise                                   patients seen in consults, in
immunologic disease process.          2.    Wheezing                       13. Snoring                                                 the clinic or in the outreach
                                      3.    Skin rash                                                                                  programs
                                      4.    Recurrent pneumonia                                                                    3. Be able to identify patient
                                      5.    Recurrent skin infections                                                                  who need referral to
                                      6.    Recurrent otitis, sinusitis, pharyngitis                                                   subspecialists
                                      7.    Rhinorrhea
                                      8.    Red eyes
                                      9.    GI symptoms (vomiting, diarrhea, abdominal pain, etc.)
                                      10.   Failure to thrive
                                      11.   Vomiting, diarrhea (including bloody or mucoid stools)

5.4 GOAL: Common Conditions Not    5.4.1 : Diagnose, explain and manage the following                            1,2,3,4,5,6   1.   Be able to diagnose and         2,3
Referred (Allergy/Immunology).     allergic/immunologic conditions when they are mild to moderate in                                develop appropriate plan
Diagnose and manage patients       severity and without complications:                                                              for patients with allergy and
with common                                                                                                                         immunodeficiency
allergic/immunologic conditions          1.    Allergic rhinitis                                                               2.   Direct patient care of
that generally do not require            2.    Allergic conjunctivitis                                                              patients seen in consults, in
referral.                                3.    Atopic dermatitis                                                                    the clinic or in the outreach
                                         4.    Asthma, mild intermittent and mild persistent                                        programs
                                         5.    Urticaria/angioedema                                                                 Be able to identify patient
                                         6.    Food allergies                                                                       who need referral to
                                         7.    Common drug allergies                                                                subspecialists
                                         8.    Insect sting allergy-local reactions
                                         9.    IgA deficiency
                                         10.   Transient hypogammaglobulinemia of infancy
                                         11.   Sinusitis and recurrent otitis media

5.5 GOAL: Conditions Generally     5.5.1 : Identify, explain, initially manage and refer the following           1,2,3,4,5,6   1.   Identify patients with          2,3
Referred (Allergy/Immunology).     allergic/immunologic conditions:                                                                 asthma, immunodefiency
Recognize, initiate management                                                                                                      and other allergic disorders
of, and refer patients with              1.    Allergic/immunologic conditions that are severe or refractory                   2.   Be able to discuss the
allergic/immunologic conditions                to therapy                                                                           pathophysiology of the
that generally require referral.         2.    Asthma, moderate or severe persistent                                                disorder
                                         3.    Patients who require diagnostic testing and/or                                  3.   Be able to diagnose and
                                               immunotherapy                                                                        come up with a plan for the
                                         4.    Chronic urticaria                                                                    patient. Refer if necessary
                                         5.    Hereditary or severe angioedema
                                         6.    Anaphylaxis
                                         7.    Latex allergy
                                         8.    Immunodeficiency (congenital, acquired, or metabolic) with
                                               compatible symptoms
                                         9.    Serum sickness

                                   2.5.2       Identify the role and general scope of practice of pediatric      1,2,3,4,5,6   Be able to recognize patients        2,3
                                               allergists and immunologists; recognize situations where                        needing referral to specialists.
                                               children will benefit from the skills of specialists trained in
                                               the care of children; and work effectively with these
                                               professionals to care for children with allergies, asthma, and
                                               immunologic disorders.
5.6 GOAL: Anaphylaxis,               5.6.1 : Recognize the signs and symptoms of urticaria, angioedema            1,2,3,4,5,6   1.   Be able to differentiate     2,3
Angioedema and Urticaria.            and anaphylaxis.                                                                                anaphylaxis, angioedema
Understand the role of the general   5.6.2 : Distinguish anaphylaxis from anaphylactoid reactions.                                   and urticaria
pediatrician in the assessment and   5.6.3 : Discuss the pathophysiology of urticaria, angioedema, and                          2.   Be able to develop a
management of anaphylaxis,           anaphylaxis.                                                                                    treatment plan
angioedema and urticaria.            5.6.4 : Identify triggers for urticaria, angioedema, and anaphylaxis and                   3.   Provide counseling to
                                     provide counseling about avoidance.                                                             patients and family
                                     5.6.5 : Develop a treatment plan for initial management of urticaria,                      4.   Be able to identify
                                     angioedema and anaphylaxis, including indications for use of                                    indications for referral
                                     epinephrine, antihistamines and steroids.
                                     5.6.6 : Establish an educational plan for a child with urticaria,
                                     angioedema, or anaphylaxis, including medical alert systems, trigger
                                     avoidance, and proper use of epi-pens and antihistamines.
                                     5.6.7 : Identify the indicators for an allergy referral of a child with
                                     urticaria, angioedema and anaphylaxis.
5.7 GOAL: Allergic Rhinitis and      5.7.1 : Identify the signs and symptoms of allergic rhinitis and             1,2,3,4,5,6   1.   Be able recognize patients   1,2,3
Conjunctivitis. Diagnose and         conjunctivitis, including differentiation of allergic from other causes of                      with allergic rhinitis and
manage patients with allergic        rhinorrhea and red eyes.                                                                        conjunctivitis. Know the
rhinitis and conjunctivitis.         5.7.2 : Describe causes of rhinitis and conjunctivitis other than allergic                      signs and symptoms.
                                     disease.                                                                                   2.   Develop a plan for the
                                     5.7.3 : Identify co-morbidities associated with allergic rhinitis and                           patient
                                     conjunctivitis, including asthma, eczema, sleep-disordered breathing,                      3.   Be able to counsel the
                                     sinusitis, etc.                                                                                 patient and family
                                     5.7.4 : Discuss the indications, clinical significance and limitations of
                                     diagnostic tests for allergic rhinitis and conjunctivitis. Interpret the
                                     results of these tests: total peripheral eosinophil count, prick and
                                     intradermal skin tests, RAST tests, IgE levels.
                                     5.7.5 : Educate families and child care facilities about environmental
                                     and allergen controls that can alleviate allergic and nonallergic rhinitis
                                     and conjunctivitis, and discuss non-infectious allergic conjunctivitis.
                                      5.7.6 : Compare pharmacologic options for treatment of allergic and
                                     non-allergic rhinitis and conjunctivitis, considering potential side
                                     effects and drug interactions. These therapies include: oral and topical
                                     antihistamines and anticholinergics, topical steroids and
                                     vasoconstrictive agents, mast cell stabilizers (crolomes),
                                     decongestants, anticholinergic agents, leukotriene modifiers,
                                     combination medications and emerging therapies (e.g. monoclonal
                                     5.7.7 : Identify the indicators for an allergy referral of a child with
                                     allergic rhinitis and conjunctivitis.
                                     5.7.8 : Discuss the guidelines for safe administration of
                                     immunotherapy. Administer immunotherapy prescribed by an
                                     allergist to a patient and establish a plan to monitor for untoward
5.8 GOAL: Asthma. Diagnose and       5.8.1 : Identify the signs, symptoms, and pathophysiology of asthma,         1,2,3,4,5,6   1.   Be able to discuss the         1,2,3
manage patients with asthma.         and differentiate asthma from other causes of cough, wheezing,                                  pathophysiology of asthma
                                     shortness of breath and exercise intolerance.                                              2.   Discuss the tests and
                                     5.8.2 : Discuss the indications, clinical significance, and limitations of                      procedures for diagnosis
                                     diagnostic tests and procedures for asthma. Interpret the results of                            and follow up
                                     these tests and procedures: arterial blood gas, pulse oximetry, chest                      3.   Be able to interpret the
                                     X-ray, pulmonary function testing, peak flow monitoring, spirometry,                            tests
                                     inhaler use (MDI, DPI), spacing devices (e.g. aero-chambers,                               4.   Be able to classify the
                                     inspirease,etc.), nebulizers, and asthma action plans.                                          severity of patients with
                                     5.8.3 : Classify the baseline disease severity of a patient with asthma                         asthma
                                     according to current national guidelines, e.g., mild-intermittent, mild-                   5.   Know the step wise
                                     persistent, moderate-persistent or severe-persistent. 5.8.4 : Identify                          treatment based on the
                                     associated diseases or co-morbid conditions related to asthma (e.g.,                            severity of asthma
                                     GER, allergic rhinitis, etc.).                                                             6.   Be able to identify triggers
                                     5.8.5 : Identify triggers that exacerbate a patient's asthma                               7.   Counsel patient and family
                                     (environmental, seasonal, infectious) and provide counseling about                              on the prevention and
                                     avoidance where feasible.                                                                       management of asthma
                                     5.8.6 : Compare the indications, effectiveness, side effects and costs                     8.   Develop a treatment plan
                                     of the different pharmacologic agents used in the treatment of
                                     asthma, and discuss "reliever" and "controller" therapy.
                                     5.8.7 : Establish a treatment plan for the child with asthma that
                                     includes routine follow-up for reassessment, and the initial treatment
                                     and referral of the patient with impending respiratory failure due to
                                     5.8.10 : Discuss the factors that affect patient/family and school
                                     adherence to treatment protocols and the key role of support services
                                     in reducing barriers to care.
                                     5.8.11 : Identify the indicators for an allergy or pulmonary referral of a
                                     child with asthma.
5.9 GOAL: Atopic Dermatitis.         5.9.1 : Recognize the signs and symptoms of atopic dermatitis,               1,2,3,4,5     1.   Recognize patients with        1,2,3
Understand the role of the general   differentiating atopic dermatitis from other causes of chronic skin                             atopic dermatitis
pediatrician in the assessment and   disease.                                                                                   2.   Develop a treatment plan
management of atopic dermatitis.     5.9.2 : Understand associations of atopic dermatitis with other allergic                   3.   Be able to refer if needed
                                     disorders, such as food allergy, rhinitis and asthma.
                                     5.9.3 : Identify triggers, both allergic and irritant, that worsen the
                                     atopic dermatitis condition and provide counseling for avoidance.
                                     5.9.4 : Design a treatment plan to manage atopic dermatitis that may
                                     include skin hydration and moisturization, options for topical anti-
                                     inflammatory medication, and use of antihistamines.
                                     5.9.5 : Develop a working knowledge of the side effects of topical
                                     ointments, in particular corticosteroids.
                                     5.9.6 : Identify the indicators for referral to allergy or dermatology
                                     specialists for the child with atopic dermatitis.
5.10 GOAL: Drug Allergy.             5.10.1 : Discuss the pathophysiology of drug allergy.                         1,2,3,4,5,6   1.   Discuss pathophysiology of     1,2,3
Understand the principles,           5.10.2 : Recognize the signs and symptoms of drug allergies, including                           drug allergy
diagnosis and management of drug     differentiating drug allergy from other causes of skin rash, joint                          2.   Know the signs and
allergy.                             swelling and anaphylaxis.                                                                        symptoms
                                     5.10.3 : Discuss the genetic basis, mechanisms and manifestations of                        3.   Identify atleast 5 common
                                     drug allergy including urticaria, serum sickness, Stevens Johnson                                medications and their
                                     Syndrome, and anaphylaxis.                                                                       corresponding allergic
                                     5.10.4 : List the medications most commonly used to treat drug allergy                           reaction
                                     and anaphylactic reactions.                                                                 4.   Develop an education and
                                     5.10.5 : Establish an education and treatment plan for a child with a                            treatment plan for a patient
                                     drug allergy that includes drug avoidance and the use of                                         with drug allergy
                                     antihistamines, epinephrine, steroids and supportive treatment.                             5.   Know the indications for
                                     5.10.6 : Identify the indicators that would lead to subspecialist referral                       referral
                                     for a child with drug allergy.

5.11 GOAL. Food Allergy.             5.11.1 : Identify the signs and symptoms of food allergy and                  1,2,3,4,5,6   1.   Discuss pathophysiology of     1,2,3
Understand the role of the general   differentiate food allergy from other causes of skin rash, and GI or                             food allergy
pediatrician in the assessment and   pulmonary symptoms.                                                                         2.   Know the signs and
management of patients with food     5.11.2 : Differentiate IgE-mediated food allergy from non-IgE                                    symptoms
allergy.                             mediated food allergy.                                                                      3.   Identify at least 5 common
                                     5.11.3 : List the foods and formulas most commonly associated with                               food allergy
                                     food allergy.                                                                               4.   Develop an education and
                                     5.11.4 : Discuss the indications, clinical significance, and limitations of                      treatment plan for a patient
                                     diagnostic tests and procedures to diagnose food allergies and                                   with food allergy
                                     interpret the results of skin testing, RAST testing, elimination diets,                     5.   Know the indications for
                                     food challenges.                                                                                 referral
                                     5.11.5 : Explain the natural history of food allergies, including when
                                     suspected allergens may be introduced into the diet.
                                     5.11.6 : Create a treatment plan for a child with food allergies that
                                     includes food avoidance, food challenges, management of allergic
                                     symptoms, and emergencies.
                                     5.11.7 : Identify the indicators that would lead to subspecialist referral
                                     for a child with food allergy.
5.12 GOAL: Immunodeficiency.         5.12.1 : Identify the signs and symptoms of immunodeficiency                                1.   Identify patients with
Understand the role of the general   diseases, and differentiate immunodeficiency from other causes of             1,2,3,4,5,6        immunodeficiency               2,3
pediatrician in the assessment and   acute and chronic disease, as well as primary from secondary                                2.   Be able to discuss the
management of patients with          immunodeficiency disorders.                                                                      pathophysiology of the
immunodeficiency.                    5.12.2 : Organize immunodeficiency diseases into five                                            disorder
                                     pathophysiologic categories (antibody, cellular-mediated, combined,                         3.   Know the tests and how to
                                     complement, phagocytic) and distinguish etiologic types (e.g., genetic,                          interpret them
                                     post-infectious, post-chemotherapy).                                                        4.   Be able to diagnose and
                                                                                                                                      come up with a plan for the
                                                                                                                                 5.   Refer if necessary
                                  5.12.3 : Discuss the indications, clinical significance and limitations of
                                  diagnostic tests and procedures to assess immune function. Interpret
                                  the results of tests of: CBC (especially evaluation for age-appropriate
                                  ALC and ANC), lymphocyte (T, B, NK cell) number and function,
                                  immunoglobulin levels, antibody function, mitogen and antigen assay
                                  for lymphocyte function, DTH skin testing, complement levels, and
                                  neutrophil assays, as well as laboratory evaluations for secondary
                                  immune disorders, such as HIV and CF.
                                  5.12.4 : Demonstrate the initial approach to evaluation, treatment
                                  and referral for a child with suspected immunodeficiency.
                                  5.12.5 : Discuss treatment options available for patients with primary
                                  immunodeficiency disorders and the potential harm of blood
                                  transfusions and vaccines in these patients.
                                  5.12.6 : Under supervision of an immunologist, develop a treatment
                                  plan for a child with immunodeficiency, including pharmacologic
                                  management, precautions, and immunizations.

7.1. GOAL: Technical and therapeutic procedures. Describe the following procedures, including how they work and when they should be used; competently
perform those commonly used by the pediatrician in practice.

Allergy: shot administration
Allergy: skin testing
Medication delivery: IM/SC/ID
Medication delivery: inhaled
Pulmonary function tests: peak flow meter
Pulmonary function tests: spirometry
Pulmonary function tests: perform
Pulse oximeter: placement

7.2. GOAL: Diagnostic and screening procedures. Describe the following tests or procedures, including how they work and when they should be used;
competently perform those commonly used by the pediatrician in practice.
 Pulmonary function tests: interpretation
Radiologic interpretation: chest X- ray
Radiologic interpretation: sinus films
Allergy Schedule
   AM: PV clinic am
   Noon: Chapter review with the fellows (optional since logistically might not be feasible) at KU
   PM: Dr. Bernabe's clinic
   PM: 1st week: Pre test
   AM: KU clinic with Dr Olson
   Noon: Journal club (resident will present)
   PM: KU clinic with Pat Stevens
   AM: PV with Dr. Olson
   PM: PV with Pat Stevens or Adult allergy clinic at KU
  AM: PV with Dr. Olson
  PM: Core
Friday: Grand Rounds
  One-Two Fridays All Day
                Dr. Levine, Private Allergist with Allergy and Asthma Care: one to two Fridays in private practice setting
                10787 Nall (corner of Nall and I435) in the same building as KU Med-Mid America Cardiology; 2nd floor, Suite 200
                Number is (913) 491-3300, contact Dr. Levine to set up exact dates
                Arrive at 8am, wear a white coat and bring a sack lunch
  Study time, Weekly prep questions
  Last Friday: post test

Allergy Diseases, by Roy Patterson

Updated Fall 2008

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