• IgE mediated response
• clinical diagnosis based on presence of rhinorrhea, nasal puritis, and congestion, and sneezing
• Clincial findings: mouth breathing, snoring, nasal speech, pale to purplish and edema (boggieness) of nasal mucus membranes, clear, thin watery to seromucoid rhinorrhea, nasal crease, allergic salute, nasal stuffiness, post nasal drip, dennie lines. cobblestone pharynx. 
• treat: cetrizine

• H. influenzae is most common isolated in children <7
• S. p enumoniae, M. catarrhalis, and adenovairus are next in line. 
• Key findings: erythema of one or both eyes, usually starting unilaterally and becoming bilateral. yellow-green purulent discharge. encrusted and matted eyelids upon awakening. 
• Treatment:Polymyxin Triemthorprim B or erythromycin

Conjunctivitis-Otitis Syndrome

• 1st 24-72 hours of life
• symptoms: nonpurulent discharge and edematous bulbar and palpebral conjuntiva
• treatment: resolves spontaneously in 3-4 days

• Onset: 5-14 days of life
• Symptoms: conjunctival erythema, purulent discharge
• Treatment: topical opthalmic antibiotic ie) erythromycin 0.5% ointment (0.25-0.5 inch strip each eye) 3-4xs a day for at lest 5 days

• Onset: 5-14 days of life; can also occur in newborns via csection with intact membranes
• Symptoms: moderate eyelid swelling and palpebral or bulbar conjunctival injectiona nd moderate thick, purulent drainage
• Treatment: oral erythromycin or ethysuccinate 50/mg/kg/day in 4 divided doses for 14 days. No topical treatment.

• Onset: 1st 3-5 days of life (up to 28 days)
• Symptoms: acute conjuntival inflammation, lid edema, erythema, and excessive purulent discharge
• Treatment: 10-14 day course of IV/IM cefotaxime or (ceftriaxone--> not in hyperbilirubinemia) 

*** Ocular morbitidy can result in missed infections

• Agent: adenovirus, more common in kids >6 in spring and fall
• Key clinical findings: Profuse clear tearing, watery discharge, fever, headache, anorexia, malise, URI symptoms (pharyngitis-conjuntivitis-fever triad with adenovirus), pharyngitis with enlarge prearicular lymph nodes
• Treatment: good hand hygiene, warm or cold compresses. If HSV is suspected immediate referral.

• Onset: 1st 4 weeks of life
• Symptoms: mild conjuntivits, erythma, corneal opacity, serosangineous disccharge, vesicular rash on eye lids and is often unilateral. 
• Treatment: Hospitalizationa nd topical/systemic antivirals. 2/3 of cases can spread to CNS, mouth and eyes. 1/3 to skin.

• Key findings: sever itching and tearing, rhititis asthma eczema

Blepharitis

• Cause: S. aureus
• Acute or chronic inflammation of the eyelash folicles or sebaceous glands
• Treat: scrub eye lashes, throw away make-up, erythromycin optho ointment

• Cause: S. aureus
• Clincial findings: swollen red furnucle, painful
• Treatment: warm compress

• Cause: streptococcal and s. aureus (M. Cat if <4)
• Clincial findings: Actue febrile illness temp >102.2, swelling and erythema of tissues surrounding eye, uper lid affected more often than lower. Symptoms of bacteremia or sinusitis ( headache, decresed vision). Orbital discomfort or pain, proptosis, or parlysi of eoms
• Treatment: if mild outpatient ceftriaxone 50-75mg/kg IM
• Moderate-severe=inpatient tx

Otitis Externa 

(OE)

Cause: Pseudomonas aeruginosa and Staphylococcus aureus

Clinical Findings: itching irriation progressing to severe pain. Pressure and fullness

Treatment: Ear drops-quinolone ie)

Acute Otitis Media

(AOM)

• Cause: S. pneumoniae, H. Influenzae, M. Cat and S. pyogenes
• S&S: Recent abrupt signs and symptoms of middle ear inflammation and effusion ( ear pain, irritability, otorrhea and/or fever). Mee as confirmed by buldging TM; limited or absent mobility by pneumatic otoscopy; air-fluid level behind TM; othorrhea. erythema of TM.
• Treat: Amox 90-90 mg/kg x 10 days. Non-type 1 allergy cefdinir 14/mg/kg/day. type 1 azithromycin 10mgkg on day 1 and  5 mg/kg on days 2-5. Failed treatment Augmenting 90 mg/kg/day

Otitis Media with Effusion 

(OME)

Cause: Eustachian Tube Dysfunction

treat: Watch and wait