Allergic disease in children: integrated approach: Viva

Branch 1: Recognising the integrated problem

The candidate should recognise immediately that this is not three separate diseases but one atopic tendency expressed across skin, gut and airway. The severe early-onset eczema, the immediate reaction to egg, and the new nocturnal wheeze are the atopic march unfolding in real time, and the family atopy history confirms the genetic substrate. The single organising idea is to treat the whole child, not the presenting organ. ^[4]

The first priorities are to classify each manifestation by mechanism, to confirm the food allergy properly rather than on testing alone, to assess the severity and control of each organ, and to build one coordinated plan. The candidate should articulate a one-sentence problem representation: a three-year-old with multisystem atopic disease (eczema, IgE-mediated egg allergy, early asthma) following the atopic march, requiring an integrated plan and an adrenaline autoinjector pending clarification of the food allergy. ^[3]