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Respiratory > 15. Lung immunology > Flashcards

15. Lung immunology Flashcards

1
Q

List 3 allergic airway diseases and the region involved

A

Upper airways: Allergic rhinitis (hay fever)
Bronchi: Asthma
Alveoli: Allergic alveolitis

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2
Q

Define allergy

A 
an exaggerated immunological response to a foreign substance (allergen) which is either inhaled, swallowed, injected, or comes in contact with the skin or eye. 
A mechanism (not a disease)
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3
Q

Early and late responding cells in allergy

A

Early: Mast cells, Basophils
Late: Eosinophils

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4
Q

What are the 2 divisions of hypersensitivity?

A

Immunological (allergy)

Non-immunological (intolerance, enzyme deficiency, pharmacological)

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5
Q

Define hypersensitivity

A

Exaggerated response

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6
Q

What is required for an allergic response to arise?

A

Sensitisation process

Subsequent exposure results in allergic response

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7
Q

Describe the pathophysiology of Seasonal Allergic Rhinitis (SAR)

A

Nasal epithelium disrupted, allergens enter through mucosa, dendritic cells capture the allergen and migrate towards draining lymph nodes.
Innate cells e.g. ILC2s help DCs mature, prime naïve T cells into Type 2 T cells. These release cytokines: cause immunoglobulin class switch to IgE, sensitise mast cells and basophils in target organ
Following subsequent exposure to allergen, there is degranulation of these cells

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8
Q

Define Atopy

A

Hereditary predisposition to produce IgE antibodies against common environmental allergens

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9
Q

How can someone be atopic but not allergic?

A

Have IgE antibodies, but don’t exhibit symptoms when exposed to allergen

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10
Q

List 3 atopic diseases

A

Allergic rhinitis
Asthma
Atopic eczema

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11
Q

What are allergic tissue reactions in atopic subjects characterised by?

A

Infiltration of Th2 cells and eosinophils

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12
Q

What is Allergic march?

A

term describing the common progression of atopic diseases from atopic dermatitis to allergic asthma

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13
Q

Why does seasonal allergic conjunctivo-rhinitis occur?

A

There are different allergens that appear in different seasons

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14
Q

List 3 common causes of perennial allergic rhinitis and asthma

A

House dust mite
Cats
Dogs

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15
Q

Nature of asthma

A

Heterogenous (many phenotypes)

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16
Q

Classifying asthma based on control/ severity

A

Intermittent, mild: allergy frequently important
Persistent, manageable: allergy often important
Chronic severe: uncontrolled by treatment

17
Q

Classifying asthma based on endo-type or endo-phenotype

A

Allergic, atopic or eosinophilic asthma
Neutrophilic asthma
Exercise induced asthma

18
Q

Define Endotype

A

A subtype of a condition defined by a distinct pathophysiological mechanism.

19
Q

Describe the airways of an asthmatic patient

A

Inflammation due to exposure to allergen (allergic response)
Contraction of smooth muscle
Secretion of mucous by goblet cells
Infiltration of eosinophils and T Cells

20
Q

List 5 symptoms of asthma

A 
Cough
Shortness of breath
Wheezing
Chest tightness
Secretions
21
Q

How common is extrinsic allergic alveolitis?

A

Effects 0.1% of the population

22
Q

What is the mechanisms in Extrinsic Allergic Alveolitis?

A

Exposure to small allergenic particles that enter alveolus
Captured by antibodies
Various hypersensitivity responses that lead to pro-inflammatory response

23
Q

List 3 examples of extrinsic allergic alveolitis

A

Farmer’s lung (mouldy hay)
Bird Fancier’s lung (bird droppings)
Mushroom workers lung (mushroom compost)

24
Q

3 principle treatments of allergic diseases

A

Allergen Avoidance
Anti-allergic medication
Immunotherapy (allows desensitisation/hypo-sensitisation)

25
Q

How common is seasonal allergic rhinitis (SAR)?

A

Affects 40% of global population

26
Q

List 4 symptoms of SAR

A

Runny and itchy nose
Sneezing
Congestion
Sleep deprivation

27
Q

List 4 treatments for allergic rhinitis

A

Allergen avoidance
Oral/ local non-sedative H1-blocker
Intra-nasal steroid
Immunotherapy

28
Q

Which form of allergen immunotherapy is safer and can be taken at home?

A

Sublingual

29
Q

Give 2 advantages of allergen-injection immunotherapy

A

Effective

Produces long lasting immunity

30
Q

Give 3 disadvantages of allergen-injection immunotherapy

A

Occasional severe allergic reaction
Time consuming
Standardisation problems

31
Q

Describe the mechanism underlying allergen-injection immunotherapy

A 
High dose immunotherapy modulates DCs that produce IL-10 and IL-27 (drive T cells towards Type 1 response) 
Results in induction of interferon gamma and regulatory T cells. 
Immune deviation (from type 2 to type 1 response). Induction of regulatory responses (T and B cells) 
Suppresses pro-allergic responses and induction of antibody production e.g. IgG captures allergen and prevents IgE from cross linking high affinity receptors on basophils and mast cells
32
Q

Describe the anti-inflammatory action of IL-35

A

IL-35 can supress Type 2 responses, T cell responses, B cell responses (in terms of IgE) and can inhibit mast cell and basophil early phase response

33
Q

Specific effect of IL-35 on B cells

A

stimulates B cells to produce IL-10

IL-10 is a suppressive cytokine, dampens immunological response

34
Q

Describe facilitated antigen presentation in an allergic response

A

IgE forms complex with allergen, binds to CD23 receptor on B cells.
Complexes internalised and presented to T cells as MHC Class II molecules
Initiates Type 2 response

35
Q

How does immunotherapy alter the antibody interactions of an allergic response?

A

Many IgG antibodies, compete with IgE
So complexes don’t form
Avoid activation of Type 2 response

36
Q

How common is asthma?

A

Effects 10% of population

Respiratory (21 decks)

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