6657 Pediatric Allergic, Respiratory, Infectious, and Dermatologic Disorders:
High-Yield Diagnosis, Pathophysiology, Clinical Presentation, Risk Factors,
Severity Stratification, Age-Specific Manifestations, Laboratory Assessment,
Imaging Modalities, Pharmacologic Management, Environmental Mitigation,
Immunotherapy, Acute Exacerbation Management, Chronic Disease Control,
Self-Monitoring, Peak Flow Interpretation, Inhaler Technique, Vaccine-
Preventable Illnesses, Viral Exanthems, Bacterial Pharyngitis, Scarlet Fever,
Varicella, Hand-Foot-Mouth Disease, Roseola, Fifth Disease, Atopic Dermatitis,
Diaper Dermatitis, Contact Dermatitis, Fungal Infections, Candidiasis, Tinea
Capitis, Pediculosis Capitis, Scabies, Hemangioma, Congenital Pigmentation
Abnormalities Exam Questions Verified and Provided with Complete A+ Graded
Rationales Latest Updated 2026
Allergic rhinitis in children
•May exist alone, or with asthma - Closely associate with atopic disease
•Characteristics: Congestion, Sneezing, Rhinorrhea, pruritis
Increased risk for:
•Eustachian tube dysfunction
•Hearing loss
•sinusitits
Most often diagnosed based upon presentation/symptoms
Testing options: nasal cytology (useful when dx unclear), nasal secretion smear - positive with > 10% of
eosinophils, false negative with recent corticosteroid use
Leukocyte count - >5% on differential
Immunoglobulin E suggests atopic disease but can be normal with atopic disease as well
Allergic rhinitis: pediatric management
1. environmental mitigation
2. pharmacology
,goal - block histamine receptor on mast cells
Second generation antihistamines preferred
eg fexofenadine per 5ml
< 7 years 30mg
> 6 years 60mg
3. other antihistamines - cetirizine, loratadine
4. intranasal steroids
fluticasone/flonase (>4 years)
mometasone/nasonex (>2 years)
budesonide/plumicort
5. Leukotriene inhibitor
montelukast/singulair
6M-5Y 5mg oral granules or chewable
6-14yrs 5mg and > 14 years 10mg
6. mast cell stabilizers
cromolyn - 10mg nebulizer, 5.2mg/spary intranasal
7. intranasal antihistamine - azelastine
asthma presentation: infancy
Primary symptoms of asthma in infancy and early childhood include:
•Cough
•Wheeze
•shortness of breath
•Laborious breathing
•respiratory tract infections
Often have very few symptoms until they experience an upper respiratory infection which can trigger a
significant/severe inflammatory response
•It is well-established that asthma in this age group is frequently under-diagnosed and undertreated
,asthma presentation: Young child (0-6)
•80% of cases begin during the first 6 years of life
•symptoms are more often virally triggered rather than allergically triggered
•Recurrent croup
•Diagnosis relies upon accuracy of episodes, family history, presence of atopy
•Of note: One third of all children have symptoms before the age of six, but only 40% of these wheezing
preschoolers will continue to have asthma
asthma presentation: Older child 7-12
•children can more reliably perform spirometry
•exercise-induced symptoms are more likely to manifest
•More reliable use of peak flow meter after diagnosis
•fewer day-to-day symptoms and tend to have more severe responses to specific triggers (i.e. cold
weather, cigarette smoke, or seasonal allergies)
Presentation of asthma: adolescence (12-18 years)
Puberty has an impact on childhood asthma
•At the time of puberty, the risk of asthma is approximately equal between males and females, and
after puberty, girls have a higher risk of asthma
Symptoms in this age group are predominantly:
• shortness of breath with exertion
•wheezing in response to triggers
•chest pain - chest tightness
•Cough
Asthma symptoms can significantly impact sleep, school, sports, and social engagements
, Intermittent asthma
•Symptoms (difficulty breathing, wheezing, chest tightness, and coughing):
•Occur on fewer than 2 days a week. & Do not interfere with normal activities.
•Nighttime symptoms occur on fewer than 2 days a month.
•Lung function tests (spirometry) and peak expiratory flow (PEF) are normal when the person is not
having an exacerbation & tests are 80% or more of the expected value and vary little (PEF varies less
than 20%) from morning to afternoon.
Mild persistent asthma
•Symptoms occur on more than 2 days a week but do not occur every day or interfere with daily
activities.
•Nighttime symptoms occur 3 to 4 times a month.
•Lung function tests are normal when the person is not having an asthma attack. The results of these
tests are 80% or more of the expected value and may vary a small amount (PEF varies 20% to 30%) from
morning to afternoon.
Moderate persistent asthma
•Symptoms occur daily. Inhaled short-acting asthma medication is used every day or Symptoms
interfere with daily activities
•Nighttime symptoms occur more than 1 time a week, but do not happen every day
•Lung function tests are abnormal (more than 60% to less than 80% of the expected value), and PEF
varies more than 30% from morning to afternoon
severe persistent asthma
•Symptoms Occur throughout each day
•Symptoms Severely limit daily physical activities
•Nighttime symptoms occur often, sometimes every night
High-Yield Diagnosis, Pathophysiology, Clinical Presentation, Risk Factors,
Severity Stratification, Age-Specific Manifestations, Laboratory Assessment,
Imaging Modalities, Pharmacologic Management, Environmental Mitigation,
Immunotherapy, Acute Exacerbation Management, Chronic Disease Control,
Self-Monitoring, Peak Flow Interpretation, Inhaler Technique, Vaccine-
Preventable Illnesses, Viral Exanthems, Bacterial Pharyngitis, Scarlet Fever,
Varicella, Hand-Foot-Mouth Disease, Roseola, Fifth Disease, Atopic Dermatitis,
Diaper Dermatitis, Contact Dermatitis, Fungal Infections, Candidiasis, Tinea
Capitis, Pediculosis Capitis, Scabies, Hemangioma, Congenital Pigmentation
Abnormalities Exam Questions Verified and Provided with Complete A+ Graded
Rationales Latest Updated 2026
Allergic rhinitis in children
•May exist alone, or with asthma - Closely associate with atopic disease
•Characteristics: Congestion, Sneezing, Rhinorrhea, pruritis
Increased risk for:
•Eustachian tube dysfunction
•Hearing loss
•sinusitits
Most often diagnosed based upon presentation/symptoms
Testing options: nasal cytology (useful when dx unclear), nasal secretion smear - positive with > 10% of
eosinophils, false negative with recent corticosteroid use
Leukocyte count - >5% on differential
Immunoglobulin E suggests atopic disease but can be normal with atopic disease as well
Allergic rhinitis: pediatric management
1. environmental mitigation
2. pharmacology
,goal - block histamine receptor on mast cells
Second generation antihistamines preferred
eg fexofenadine per 5ml
< 7 years 30mg
> 6 years 60mg
3. other antihistamines - cetirizine, loratadine
4. intranasal steroids
fluticasone/flonase (>4 years)
mometasone/nasonex (>2 years)
budesonide/plumicort
5. Leukotriene inhibitor
montelukast/singulair
6M-5Y 5mg oral granules or chewable
6-14yrs 5mg and > 14 years 10mg
6. mast cell stabilizers
cromolyn - 10mg nebulizer, 5.2mg/spary intranasal
7. intranasal antihistamine - azelastine
asthma presentation: infancy
Primary symptoms of asthma in infancy and early childhood include:
•Cough
•Wheeze
•shortness of breath
•Laborious breathing
•respiratory tract infections
Often have very few symptoms until they experience an upper respiratory infection which can trigger a
significant/severe inflammatory response
•It is well-established that asthma in this age group is frequently under-diagnosed and undertreated
,asthma presentation: Young child (0-6)
•80% of cases begin during the first 6 years of life
•symptoms are more often virally triggered rather than allergically triggered
•Recurrent croup
•Diagnosis relies upon accuracy of episodes, family history, presence of atopy
•Of note: One third of all children have symptoms before the age of six, but only 40% of these wheezing
preschoolers will continue to have asthma
asthma presentation: Older child 7-12
•children can more reliably perform spirometry
•exercise-induced symptoms are more likely to manifest
•More reliable use of peak flow meter after diagnosis
•fewer day-to-day symptoms and tend to have more severe responses to specific triggers (i.e. cold
weather, cigarette smoke, or seasonal allergies)
Presentation of asthma: adolescence (12-18 years)
Puberty has an impact on childhood asthma
•At the time of puberty, the risk of asthma is approximately equal between males and females, and
after puberty, girls have a higher risk of asthma
Symptoms in this age group are predominantly:
• shortness of breath with exertion
•wheezing in response to triggers
•chest pain - chest tightness
•Cough
Asthma symptoms can significantly impact sleep, school, sports, and social engagements
, Intermittent asthma
•Symptoms (difficulty breathing, wheezing, chest tightness, and coughing):
•Occur on fewer than 2 days a week. & Do not interfere with normal activities.
•Nighttime symptoms occur on fewer than 2 days a month.
•Lung function tests (spirometry) and peak expiratory flow (PEF) are normal when the person is not
having an exacerbation & tests are 80% or more of the expected value and vary little (PEF varies less
than 20%) from morning to afternoon.
Mild persistent asthma
•Symptoms occur on more than 2 days a week but do not occur every day or interfere with daily
activities.
•Nighttime symptoms occur 3 to 4 times a month.
•Lung function tests are normal when the person is not having an asthma attack. The results of these
tests are 80% or more of the expected value and may vary a small amount (PEF varies 20% to 30%) from
morning to afternoon.
Moderate persistent asthma
•Symptoms occur daily. Inhaled short-acting asthma medication is used every day or Symptoms
interfere with daily activities
•Nighttime symptoms occur more than 1 time a week, but do not happen every day
•Lung function tests are abnormal (more than 60% to less than 80% of the expected value), and PEF
varies more than 30% from morning to afternoon
severe persistent asthma
•Symptoms Occur throughout each day
•Symptoms Severely limit daily physical activities
•Nighttime symptoms occur often, sometimes every night
