A. Prevalence

• i Regional
• ii Change Over Time

B. Populations at risk

• i Genetic associations
• ii Environmental associations

C. Socioeconomic impact of disease

• i Direct cost
• ii Indirect costs
• iii Quality of life

A. Anatomy, Histology, physiology, pathophysiology of:

• i Nose and paranasal sinuses
• ii Pharynx
• iii Ear/Eustachian Tubes
• iv Larynx/Trachea
• v Lungs
• vi Eye
• vii Skin
• viii Gastrointestinal tract

B. Basic physiology, pathophysiology, and principles of:

• i Mucociliary function
• ii Smell and taste
• iii Auditory/vestibular function
• iv Voice
• v Respiratory function
• vi Deglutition
• vii Ocular protection mechanisms
  • 1 Naso–lacrimal function
  • 2 Conjunctival function
• viii GI function

A. Basic components, concepts and applications pertinent to Allergy:

• i Immunology
  • 1. Function
    • a. General aspects
      • i Recognition
      • ii Surveillance
      • iii Amplification
      • iv Memory
    • b. Triggers of the immune response
      • i Allergens, haptens, epitopes, parasites, macromolecules
    • c. Categories of response
      • i Innate
      • ii Adaptive
  • 2. Components
    • a. Inflammatory cells
      • i Macrophages (APC)
      • ii Lymphoid
        • 1 T–cells
        • 2 B–Cells
        • 3 Null cells
      • iii Granulocytes
        • 1 Mast Cells/basophils
        • 2 Eosinophils
        • 3 Neutrophils
        • 4 Platelets
    • b. Immunoglobulins
      • i G
      • ii A
      • iii M
      • iv D
      • v E
    • c. Inflammatory mediators
      • i Cytokines
      • ii Chemokines
      • iii Vasoactive amines
      • iv Leukotrienes
      • v Prostaglandins
      • vi Complement
• ii Endocrinology
• iii Neurology
• iv Molecular cell biology
• v Genetics

B. Physiology and pathophysiology

• i Immunology
  • 1. Cellular communication
    • a. Direct contact
      • i Antigen specific
    • b. Cytokine/Chemokine mediated
      • i Non-antigen specific
  • 2. Inflammatory pathways
    • a. Cellular
      • i Microphage
      • ii Granulocyte
        • 1 Mast Cell/Basophils
        • 2 Eosinophil
    • b Non-cellular
      • i Complement
      • ii Arachadonic Acid cascade
      • iii Other
  • 3. Immune sensitization
    • a Memory
  • 4. Hypersensitivity (Gel and Coombs)
    • a I
    • b II
    • c III
    • d IV
    • e V
    • f VI
• ii Allergic response (Type I)
  • 1 Allergy sensitization
    • a Antigen processing
    • b T-cell
    • c B-cell
    • d IgE
    • e Mast cell
  • 2 Subsequent exposure—trigger
    • a Mast Cell
      • i Antigen crosslinking
      • ii Degranulation
        • 1 Preformed mediators
        • 2 Newly synthesized mediators
        • 3 Cytokines
    • b Early phase response
    • c Late phase response
      • i Cellular Components
    • d Priming
• iii Microbiology
  • 1 Parasitology
  • 2 Bacteriology
  • 3 Virology
  • 4 Mycology
• iv Endocrinology
• v Neurology
• vi Molecular cell biology
• vii Genetics
• viii Nutrition

A. Differential diagnosis of inflammatory disease:

• i Nose/paranasal sinus
• ii Otologic
• iii Laryngopharyngeal
• iv Tracheobronchial
• v Thoracic/Pulmonary
• vi Gastrointestinal
• vii Ocular
• viii Cutaneous

B. Immunologic disorders

• i. Allergic diseases
  • 1. Allergic Rhinitis
  • 2. Allergic conjunctivitis
  • 3. Otologic disease
    • a. Otitis media
    • b. Meniere’s
    • c. Otitis externa
    • d. Eustachian tube dysfunction
  • 4. Asthma
  • 5 Dermatitis
    • a. Eczema
    • b. Contact
    • c. Urticaria/Angioedema
  • 6. Allergic laryngitis
  • 7. Gastrointestinal
    • a. Eosinophilic esophagitis
• ii Co-morbid conditions impacted by allergy
  • 1. Rhinosinusitiss
  • 2. Otitis media
  • 3. Eustachian tube dysfunction
  • 4. Disordered sleep
  • 5. Laryngeal/pharyngeal/esophageal disorders
    • a. GERD
  • 6. Asthma
• iii Immunodeficiency
• iv Autoimmune diseases

A. History

• i Symptoms
  • 1. Onset, duration, severity
  • 2. Triggers
  • 3. Exacerbating or ameliorating factors
• ii Exposures
  • 1. Temporal relationships
    • a. Intermittent
    • b. Persistent
  • 2. Identifiable antigen
    • a. Aeroantigens (Inhalants)
    • b. Ingestants
    • c. Contactants
    • d. Injectants
• iii Co-morbid conditions
  • 1. Rhinosinusitiss
  • 2. Otitis media
  • 3. Eustachian tube dysfunction
  • 4. Disordered sleep
  • 5. Laryngeal/pharyngeal/esophageal disorders
    • a. GERD
  • 6. Asthma
  • 7. Ocular
• iv Family/childhood history

B. Physical examination

• i Face
• ii Ears
• iii Nose/Paranasal sinues
• iv Oro/Nasopharynx
• v Laryngotracheal
• vi Pulmonary
• vii Skin

C. Adjunctive testing: Indications, limitations, and normal and pathologic findings:

• i Ears
  • 1. Audiovestibular testing
• ii Nose
  • 1. Acoustic rhinometry/rhinomanometry
  • 2. Nasal cytology/biopsy
  • 3. Nasal/paranasal sinus culture
  • 4. Nasal endoscopy
  • 5. Olfactory testing
  • 6. Radiologic testing
• iii Larynx
  • 1. Laryngoscopy
• iv Pulmonary
  • 1. Pulmonary function testing
  • 2. Radiologic testing
• v Sleep
  • 1. Polysomnography

D. Allergy testing:

• • i Antigen selection
    • 1. Antigen characteristics
      • a. Aeroallergen physical characteristics
      • b. Biologic activity/potency
      • c. Antigen cross reactivity
      • d. Antigen extraction/standardization
    • 2. Aeroallergen distribution
      • a. Principles of distribution
      • b. Local and Regional differences
    • ii Aeroallergen tests
    • • 1. Expanded specific allergen testing
        • a. In vivo
          • i Principles of in vivo testing
            • 1. Pathophysiology of the skin whealing response
              • a. Immediate response
              • b. Delayed response
            • 2. Factors that affect the skin whealing response
          • ii Specific methodologies
            • 1. Percutaneous (Prick) testing
              • a. Single percutaneous (prick) testing
              • b. Multi percutaneous (prick) testing
            • 2. Intradermal testing
              • a. Single intradermal testing
              • b. Intradermal dilutional testing
            • 3. Blended techniques of in vivo testing
            • 4. Scratch testing (mentioned only for historical purposes)
            • 5. Provocation
        • b. In vitro
          • i Principles of in vitro testing
          • ii Methodologies
  • 2. Principles of the allergen screen
    • iii Ingestants (Food Allergy)
      • 1. History
        • a. Food diary
        • b. Anaphylaxis
      • 2. Testing
    • iv Injectants
    • v Contactants
      • 1. Contact tests (patch)

E. Immunologic Evaluation (including rheumatologic)

• • • i Humoral
    • ii Cellular

A. Environmental control
B. Pharmacotherapy/pharmacology

• • • i Antihistamines
    • ii Decongestants
    • iii Mast cell stabilizers
    • iv Mucolytics
    • v Leukotriene modifiers
    • vi Corticosteroids

C. Dietary control

D. Immunotherapy

• • i. Desensitization
    • 1. Route of delivery
      • a. Subcutaneous
      • b. Mucosal (e.g., sublingual)
    • 2. Mechanism of action/li>
    • 3. Indications/contraindications
    • 4. Antigen dosing
      • a. Starting dose
      • b. Escalation
      • c. Maintenance
      • d Withdrawal
    • 5. Mixing of treatment vial
    • 6. Duration of therapy
    • 7. Outcomes of immunotherapy
  • ii Monoclonal antibody

• i Risk factors
• ii Recognition
• iii Differential diagnosis

B. Management

• i High-risk population recognition
• ii Preparation
• iii Prevention
• iii Intervention