Florida Physician Allergy and
Immunology Certification Examination
Practice Questions & [Verified
Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 24-year-old woman develops generalized urticaria, wheezing,
throat tightness, hypotension, and vomiting within minutes of
receiving an intramuscular antibiotic. What is the most
appropriate initial treatment?
A. Intravenous diphenhydramine
B. Intravenous corticosteroids
C. Intramuscular epinephrine
D. Nebulized albuterol alone
Answer: C. Intramuscular epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It
should be administered promptly by the intramuscular route into the
mid-anterolateral thigh. Antihistamines and corticosteroids are
adjunctive therapies and must not delay epinephrine.
2. A 7-year-old child has recurrent episodes of sneezing, nasal
itching, clear rhinorrhea, and congestion that occur primarily
during pollen season. Which immunologic mechanism best
explains these symptoms?
1|Page
,A. IgG-mediated cytotoxicity
B. IgE-mediated immediate hypersensitivity
C. Immune-complex deposition
D. T-cell-mediated delayed hypersensitivity
Answer: B. IgE-mediated immediate hypersensitivity
Rationale: Seasonal allergic rhinitis is a type I hypersensitivity
reaction. Allergen-specific IgE binds mast cells and basophils, and
subsequent allergen exposure causes cross-linking of IgE with release
of histamine, leukotrienes, and other mediators.
3. A patient with persistent allergic rhinitis remains symptomatic
despite appropriate use of an intranasal corticosteroid. Which
additional therapy is most appropriate for prominent sneezing
and itching?
A. Intranasal antihistamine
B. Oral antibiotic
C. Leukotriene agonist
D. Systemic corticosteroid for several months
Answer: A. Intranasal antihistamine
Rationale: Intranasal antihistamines such as azelastine can provide
rapid relief of sneezing, itching, and rhinorrhea and may be used with
an intranasal corticosteroid when symptoms remain inadequately
controlled.
4. A 32-year-old man has recurrent episodes of angioedema without
urticaria. His father had similar episodes. Laboratory testing
shows low C4 and decreased C1 esterase inhibitor function.
Which diagnosis is most likely?
2|Page
,A. Chronic spontaneous urticaria
B. Hereditary angioedema
C. Mastocytosis
D. Allergic contact dermatitis
Answer: B. Hereditary angioedema
Rationale: Hereditary angioedema is usually caused by deficiency or
dysfunction of C1 esterase inhibitor, resulting in excessive bradykinin
generation. Low C4 is a useful screening clue. Unlike histamine-
mediated angioedema, attacks generally occur without urticaria or
pruritus.
5. A 28-year-old woman develops recurrent hives almost daily for 8
weeks without an identifiable trigger. Which diagnosis best
describes this condition?
A. Acute urticaria
B. Chronic spontaneous urticaria
C. Serum sickness
D. Physical urticaria only
Answer: B. Chronic spontaneous urticaria
Rationale: Chronic spontaneous urticaria is characterized by recurrent
wheals, with or without angioedema, occurring for more than 6 weeks
without a consistent identifiable external trigger.
6. A patient with chronic spontaneous urticaria continues to have
symptoms despite standard-dose second-generation H1
antihistamine therapy. What is the usual next pharmacologic
strategy?
A. Increase the second-generation H1 antihistamine dose
B. Begin long-term oral antibiotics
3|Page
, C. Discontinue antihistamines permanently
D. Begin chronic systemic corticosteroids
Answer: A. Increase the second-generation H1 antihistamine dose
Rationale: When standard-dose second-generation H1 antihistamines
are inadequate, guidelines commonly recommend increasing the dose,
often up to fourfold, before progressing to therapies such as
omalizumab. Long-term systemic corticosteroids are generally
avoided.
7. A 19-year-old patient with asthma develops wheezing and
respiratory distress after exposure to a cat. Which inflammatory
cell is particularly important in the late-phase allergic response?
A. Eosinophil
B. Neutrophil
C. Erythrocyte
D. Platelet
Answer: A. Eosinophil
Rationale: Eosinophils are central to allergic airway inflammation.
They release cytotoxic granule proteins, lipid mediators, and cytokines
that contribute to airway hyperresponsiveness and epithelial injury.
8. A patient with allergic asthma has elevated eosinophils and
frequent exacerbations despite inhaled corticosteroid and long-
acting beta-agonist therapy. Which biologic specifically targets the
interleukin-5 pathway?
A. Omalizumab
B. Mepolizumab
C. Dupilumab
D. Tezepelumab
4|Page
Immunology Certification Examination
Practice Questions & [Verified
Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 24-year-old woman develops generalized urticaria, wheezing,
throat tightness, hypotension, and vomiting within minutes of
receiving an intramuscular antibiotic. What is the most
appropriate initial treatment?
A. Intravenous diphenhydramine
B. Intravenous corticosteroids
C. Intramuscular epinephrine
D. Nebulized albuterol alone
Answer: C. Intramuscular epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It
should be administered promptly by the intramuscular route into the
mid-anterolateral thigh. Antihistamines and corticosteroids are
adjunctive therapies and must not delay epinephrine.
2. A 7-year-old child has recurrent episodes of sneezing, nasal
itching, clear rhinorrhea, and congestion that occur primarily
during pollen season. Which immunologic mechanism best
explains these symptoms?
1|Page
,A. IgG-mediated cytotoxicity
B. IgE-mediated immediate hypersensitivity
C. Immune-complex deposition
D. T-cell-mediated delayed hypersensitivity
Answer: B. IgE-mediated immediate hypersensitivity
Rationale: Seasonal allergic rhinitis is a type I hypersensitivity
reaction. Allergen-specific IgE binds mast cells and basophils, and
subsequent allergen exposure causes cross-linking of IgE with release
of histamine, leukotrienes, and other mediators.
3. A patient with persistent allergic rhinitis remains symptomatic
despite appropriate use of an intranasal corticosteroid. Which
additional therapy is most appropriate for prominent sneezing
and itching?
A. Intranasal antihistamine
B. Oral antibiotic
C. Leukotriene agonist
D. Systemic corticosteroid for several months
Answer: A. Intranasal antihistamine
Rationale: Intranasal antihistamines such as azelastine can provide
rapid relief of sneezing, itching, and rhinorrhea and may be used with
an intranasal corticosteroid when symptoms remain inadequately
controlled.
4. A 32-year-old man has recurrent episodes of angioedema without
urticaria. His father had similar episodes. Laboratory testing
shows low C4 and decreased C1 esterase inhibitor function.
Which diagnosis is most likely?
2|Page
,A. Chronic spontaneous urticaria
B. Hereditary angioedema
C. Mastocytosis
D. Allergic contact dermatitis
Answer: B. Hereditary angioedema
Rationale: Hereditary angioedema is usually caused by deficiency or
dysfunction of C1 esterase inhibitor, resulting in excessive bradykinin
generation. Low C4 is a useful screening clue. Unlike histamine-
mediated angioedema, attacks generally occur without urticaria or
pruritus.
5. A 28-year-old woman develops recurrent hives almost daily for 8
weeks without an identifiable trigger. Which diagnosis best
describes this condition?
A. Acute urticaria
B. Chronic spontaneous urticaria
C. Serum sickness
D. Physical urticaria only
Answer: B. Chronic spontaneous urticaria
Rationale: Chronic spontaneous urticaria is characterized by recurrent
wheals, with or without angioedema, occurring for more than 6 weeks
without a consistent identifiable external trigger.
6. A patient with chronic spontaneous urticaria continues to have
symptoms despite standard-dose second-generation H1
antihistamine therapy. What is the usual next pharmacologic
strategy?
A. Increase the second-generation H1 antihistamine dose
B. Begin long-term oral antibiotics
3|Page
, C. Discontinue antihistamines permanently
D. Begin chronic systemic corticosteroids
Answer: A. Increase the second-generation H1 antihistamine dose
Rationale: When standard-dose second-generation H1 antihistamines
are inadequate, guidelines commonly recommend increasing the dose,
often up to fourfold, before progressing to therapies such as
omalizumab. Long-term systemic corticosteroids are generally
avoided.
7. A 19-year-old patient with asthma develops wheezing and
respiratory distress after exposure to a cat. Which inflammatory
cell is particularly important in the late-phase allergic response?
A. Eosinophil
B. Neutrophil
C. Erythrocyte
D. Platelet
Answer: A. Eosinophil
Rationale: Eosinophils are central to allergic airway inflammation.
They release cytotoxic granule proteins, lipid mediators, and cytokines
that contribute to airway hyperresponsiveness and epithelial injury.
8. A patient with allergic asthma has elevated eosinophils and
frequent exacerbations despite inhaled corticosteroid and long-
acting beta-agonist therapy. Which biologic specifically targets the
interleukin-5 pathway?
A. Omalizumab
B. Mepolizumab
C. Dupilumab
D. Tezepelumab
4|Page
