A 5-year-old girl has intermittent asthma, well controlled on short-acting beta-agonist as needed. She begins experiencing daytime symptoms more than two times weekly and one nighttime awakening per month. What is the next step in her pharmacologic management?
A 6-year-old boy with severe atopic dermatitis has recurrent deep-seated staphylococcal infections, skeletal fractures, and elevated IgE. What genetic disorder is most likely?
A 10-year-old boy with moderate atopic dermatitis has persistent itching and dry skin despite routine moisturizing. Which topical medication is most appropriate for acute flares?
A 13-year-old girl with severe, chronic atopic dermatitis develops several punched-out vesicular lesions on her face that fail to respond to oral antibiotics. What is the most likely cause?
A 10-year-old boy with poorly controlled asthma on medium-dose inhaled corticosteroid, long-acting beta-agonist, and montelukast has continued severe exacerbations. His total IgE is 1,100 IU/mL, with positive skin tests for multiple inhalant allergens. Which biologic therapy is FDA-approved for this phenotype?
A 5-year-old develops pruritic, erythematous wheals with angioedema and urticaria after eating peanuts, resolving within hours. What is the most likely immunologic mechanism?
A 15-year-old with moderate persistent asthma has symptoms more than two days per week and uses short-acting beta-agonist several times per day. Spirometry shows forced expiratory volume in 1 second 70% of predicted. How would you classify her asthma control?
A 4-year-old boy presents with lichenified, excoriated lesions in the antecubital fossae. He has frequent skin infections and his younger brother died from pneumonia. Platelet count is 50,000/μL. Which diagnosis should be considered?
A 6-year-old girl develops severe, generalized urticaria and hypotension within minutes of a bee sting. What is the most important immediate treatment?
A 5-year-old with persistent asthma is adherent to low-dose inhaled corticosteroid therapy but continues to have frequent night symptoms and activity limitation. What is the most appropriate next pharmacologic step?
