NAECB NAECB Immunotherapy & Allergen Management 2 — Questions and Answers
Question 1: A grade 3 systemic reaction during SCIT is characterized by:
- Local erythema only at injection site
- Rhinitis and urticaria with no hypotension
- Bronchospasm, stridor, or hypotension requiring epinephrine (Correct answer)
- Mild pruritus at a distant site
Correct answer: Bronchospasm, stridor, or hypotension requiring epinephrine
A grade 3 systemic reaction involves bronchospasm, laryngeal edema, or hypotension and mandates immediate epinephrine administration.
Question 2: The first-line treatment for a systemic anaphylactic reaction following an immunotherapy injection is:
- Oral diphenhydramine 50 mg
- Inhaled albuterol alone
- Epinephrine 0.3–0.5 mg IM into the lateral thigh (Correct answer)
- IV corticosteroids immediately
Correct answer: Epinephrine 0.3–0.5 mg IM into the lateral thigh
Intramuscular epinephrine 0.3–0.5 mg injected into the anterolateral thigh is the first-line and life-saving treatment for anaphylaxis.
Question 3: Which allergen sensitization pattern in a US asthma patient most strongly supports initiating immunotherapy?
- Single food allergen sensitization causing GI symptoms only
- Perennial aeroallergen sensitization (dust mite, cockroach) with year-round symptom burden (Correct answer)
- Latex contact dermatitis without respiratory symptoms
- Drug hypersensitivity to NSAIDs
Correct answer: Perennial aeroallergen sensitization (dust mite, cockroach) with year-round symptom burden
Perennial aeroallergen sensitization causing year-round asthma and rhinitis symptoms provides the strongest indication for immunotherapy.
Question 4: Before administering a scheduled SCIT injection, the asthma educator or nurse should verify that the patient's peak flow is:
- At any level regardless of symptoms
- At or above 80% of personal best (Correct answer)
- Below 70% to confirm active inflammation
- Between 50–60% of predicted
Correct answer: At or above 80% of personal best
Peak flow should be at or above 80% of personal best before administering SCIT to ensure the patient is not in a compromised respiratory state that increases reaction risk.
Question 5: House dust mite (HDM) allergen avoidance measures recommended for sensitized asthma patients include:
- Removing all plants from the bedroom only
- Encasing mattresses and pillows in allergen-impermeable covers and washing bedding in hot water weekly (Correct answer)
- Using humidifiers to maintain >60% indoor humidity
- Keeping carpets in bedrooms to trap dust
Correct answer: Encasing mattresses and pillows in allergen-impermeable covers and washing bedding in hot water weekly
Allergen-impermeable mattress/pillow encasings and weekly hot-water washing of bedding significantly reduce HDM allergen exposure in sensitized patients.
Question 6: Cockroach allergen sensitization is particularly prevalent among which US patient population?
- Rural farm communities
- Inner-city, low-income urban residents (Correct answer)
- Coastal fishing communities
- Mountain or high-altitude residents
Correct answer: Inner-city, low-income urban residents
Cockroach allergen sensitization disproportionately affects inner-city, low-income urban children and adults due to housing conditions that favor cockroach infestation.
NAECB NAECB Immunotherapy & Allergen Management 2
A grade 3 systemic reaction during SCIT is characterized by: