NAECB Allergy & Asthma 3 — Questions and Answers
Question 1: Which skin test technique is the standard first-line method for diagnosing IgE-mediated allergic sensitization?
- Intradermal test
- Patch test
- Percutaneous (prick) test (Correct answer)
- Scratch-chamber test
Correct answer: Percutaneous (prick) test
The percutaneous (prick/puncture) test is the standard first-line method for detecting IgE-mediated sensitization due to its safety, speed, and reliability.
Question 2: A patient with known peanut allergy accidentally ingests peanuts and develops urticaria, vomiting, and stridor. What is the first-line treatment?
- Diphenhydramine IM
- Epinephrine 1:1000 IM into the anterolateral thigh (Correct answer)
- Methylprednisolone IV
- Nebulized albuterol
Correct answer: Epinephrine 1:1000 IM into the anterolateral thigh
Intramuscular epinephrine 1:1000 into the anterolateral thigh is the first-line and life-saving treatment for anaphylaxis.
Question 3: Which component of the allergic response occurs 4–8 hours after allergen exposure and involves eosinophil infiltration?
- Immediate hypersensitivity reaction
- Late-phase reaction (Correct answer)
- Delayed-type hypersensitivity
- Cytotoxic reaction
Correct answer: Late-phase reaction
The late-phase reaction occurs 4–8 hours post-exposure, characterized by eosinophil and basophil infiltration causing sustained airway inflammation.
Question 4: In asthma management, which long-acting beta-2 agonist (LABA) is approved as add-on therapy and must always be combined with an inhaled corticosteroid?
- Albuterol
- Levalbuterol
- Salmeterol (Correct answer)
- Ipratropium
Correct answer: Salmeterol
Salmeterol is a LABA that must always be used with an inhaled corticosteroid, as monotherapy increases the risk of asthma-related death.
Question 5: A 35-year-old presents with itchy, watery eyes and sneezing each spring. Skin prick testing shows a 12mm wheal to oak pollen. What is the most appropriate initial treatment?
- Oral prednisone burst
- Subcutaneous immunotherapy
- Intranasal corticosteroid plus oral antihistamine (Correct answer)
- Omalizumab injection
Correct answer: Intranasal corticosteroid plus oral antihistamine
First-line treatment for seasonal allergic rhinitis is an intranasal corticosteroid, often combined with a non-sedating oral antihistamine for symptom control.
Question 6: Which cell type is the primary effector in chronic eosinophilic airway inflammation seen in asthma?
- Neutrophil
- Basophil
- Eosinophil (Correct answer)
- Natural killer cell
Correct answer: Eosinophil
Eosinophils are the primary effector cells in chronic asthmatic airway inflammation, releasing cytotoxic granule proteins that damage the airway epithelium.
Question 7: Omalizumab targets which molecule to reduce allergic asthma exacerbations?
- IL-5
- IL-13
- IgE (Correct answer)
- IgG4
Correct answer: IgE
Omalizumab is a monoclonal antibody that binds free IgE, preventing it from binding to mast cell receptors and triggering allergic reactions.
NAECB Allergy & Asthma 3
Which skin test technique is the standard first-line method for diagnosing IgE-mediated allergic sensitization?