Paeds Vivas · allergy-and-immunology
Urticaria and angioedema — branching viva
A branching viva following the question of urticaria and angioedema across the clinical spectrum, from acute viral-triggered urticaria in a young child, through chronic spontaneous urticaria and the stepwise ladder, to hereditary angioedema and the bradykinin pathway, and finally to anaphylaxis presenting as urticaria, with evidence and regional boundaries tested throughout.
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Study tools
Target exams
RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
The examiner releases the topic in stages, beginning with a young child with acute itchy wheals after a viral illness, moving to a school-age child with daily wheals for eight weeks, then to recurrent facial swelling without a rash, and finally to a child with acute urticaria and hypotension. The candidate must state the diagnosis and mechanism before the action, apply the stepwise ladder, justify the bradykinin versus histamine split, and build a safe disposition at each stage.
Viva format
The examiner takes the candidate through four escalating branches, each anchored to a patient. At each stage the candidate must state the reasoning before the action, name the active guideline, and respect the bradykinin versus histamine split. The examiner probes the why and the corners. [1]
References7ShowHide
- [1]Zuberbier T The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria Allergy, 2022.PMID 34536239
- [3]Ensina LF Managing Chronic Urticaria in Children: An Update Current Allergy and Asthma Reports, 2025.PMID 40192928
- [7]Maurer M Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria New England Journal of Medicine, 2013.PMID 23432142
- [8]Maurer M Dupilumab in patients with chronic spontaneous urticaria (LIBERTY-CSU CUPID): Two randomized, double-blind, placebo-controlled, phase 3 trials Journal of Allergy and Clinical Immunology, 2024.PMID 38431226
- [9]Farkas H International Guideline on the Diagnosis and Management of Pediatric Patients With Hereditary Angioedema Allergy, 2026.PMID 41618059
- [10]Maurer M The international WAO/EAACI guideline for the management of hereditary angioedema-The 2021 revision and update Allergy, 2022.PMID 35006617
- [13]Abrams EM Anaphylaxis Allergy, Asthma & Clinical Immunology, 2024.PMID 39654057