NAECB Allergy & Asthma 4 — Questions and Answers
Question 1: A child with asthma has an FEV1 of 65% predicted on spirometry during a flare. According to NAEPP, this exacerbation severity is classified as:
- Mild
- Moderate (Correct answer)
- Severe
- Life-threatening
Correct answer: Moderate
An FEV1 of 40–69% predicted indicates a moderate asthma exacerbation according to NAEPP guidelines.
Question 2: Which environmental control measure has the strongest evidence for reducing house dust mite allergen exposure?
- Air purifiers with HEPA filters
- Allergen-impermeable mattress and pillow covers (Correct answer)
- Weekly vacuuming with standard vacuum
- Removing carpets from bedrooms
Correct answer: Allergen-impermeable mattress and pillow covers
Allergen-impermeable encasements for mattresses and pillows have the strongest evidence for reducing dust mite allergen concentrations in bedding.
Question 3: Which finding on methacholine challenge testing is considered a positive result indicating bronchial hyperresponsiveness?
- ≥10% fall in FEV1 at any concentration
- ≥20% fall in FEV1 at ≤16 mg/mL (PC20 ≤16 mg/mL) (Correct answer)
- ≥15% improvement in FEV1 after bronchodilator
- ≥10% improvement in peak flow variability
Correct answer: ≥20% fall in FEV1 at ≤16 mg/mL (PC20 ≤16 mg/mL)
A PC20 of ≤16 mg/mL (≥20% fall in FEV1 at ≤16 mg/mL methacholine) is considered a positive methacholine challenge indicating bronchial hyperresponsiveness.
Question 4: A patient on subcutaneous allergen immunotherapy (SCIT) develops generalized urticaria and hypotension 15 minutes post-injection. After epinephrine administration, what is the next critical step?
- Discharge home with antihistamines
- Observe for at least 4 hours for biphasic reaction (Correct answer)
- Administer a second immunotherapy injection
- Perform skin testing to identify the causative allergen
Correct answer: Observe for at least 4 hours for biphasic reaction
After treating anaphylaxis from SCIT, patients must be observed for at least 4 hours due to the risk of a biphasic anaphylactic reaction.
Question 5: Which biologic agent targets IL-5 to reduce eosinophil counts and is approved for severe eosinophilic asthma?
- Omalizumab
- Dupilumab
- Mepolizumab (Correct answer)
- Tezepelumab
Correct answer: Mepolizumab
Mepolizumab is an anti-IL-5 monoclonal antibody that reduces eosinophil production and is approved for severe eosinophilic asthma.
Question 6: A patient with allergic rhinitis reports that antihistamines are not adequately controlling nasal congestion. Which mechanism explains why antihistamines poorly control congestion?
- Antihistamines do not cross the nasal mucosa
- Nasal congestion is primarily mediated by leukotrienes and bradykinin, not histamine (Correct answer)
- Antihistamines are metabolized before reaching nasal tissue
- Nasal congestion is caused by IgG antibodies that antihistamines cannot block
Correct answer: Nasal congestion is primarily mediated by leukotrienes and bradykinin, not histamine
Nasal congestion is primarily driven by leukotrienes, bradykinin, and vascular engorgement rather than histamine, explaining the limited effect of antihistamines.
Question 7: In exercise-induced bronchoconstriction (EIB), when does peak bronchoconstriction typically occur?
- During exercise
- 5–10 minutes after stopping exercise (Correct answer)
- 30–60 minutes after stopping exercise
- 1–2 hours after stopping exercise
Correct answer: 5–10 minutes after stopping exercise
EIB typically peaks 5–10 minutes after cessation of exercise as the airways cool and dry, triggering mast cell degranulation and bronchoconstriction.
NAECB Allergy & Asthma 4
A child with asthma has an FEV1 of 65% predicted on spirometry during a flare.
According to NAEPP, this exacerbation severity is classified as: