2012 Flashcards
what environmental changes in the past 3 decades have made more problems for people with allergies?
- Increased PM2.5 causes lung irritation and asthma exacerbations
- Increased pollution leads to increased asthma exacerbations
- Global warming causing longer seasons with increased pollination
- increased CO2 level increases pollination of plants
- warm temps expand hickory and oak habitats
- warmer temps can increase fungal allergens
what is the mechanism of chronic autoimmune urticaria, how might Xolair help?
- AA mechanism from aa’s to IgE and FECR1 causing release of mast cells, basophils and histamine leading to vasodilation and plasma extravasation
- Xolair works by binding the FC region of IgE and preventing further cross linked and release of mediators by forming IgE complexes the Xolair IGE complex is cleared by the hepatic reticuloendothelial system
DRESS:
- pathophysiology
- clinical features
- most common drug culprits
- type 3 t cell mediated delayed drug eruption that occurs secondary to an offending medication
- two major mechanisms: drug specific immune response, CD4 and CD8 cells produce INF-g and TNF and cause immune activation
- HHV6 reactivation with a subsequent anti viral immune response - fever, splenomegaly, lymphadenopathy, rash, elevated eosinophils, atypical lymphocytosis
- allopurinal, phenytoin, carbamazepine, lamotragine
name 4 types of occular allergy
- mechanism
- exam findings
- treatment
AKC
- type 1 and type 4
- conjunctival edema, dermatitis and pruritis, papillae are on lower tarsus and inferior fornix
- avoid triggers, cold compresses, topical AH and mast cell stabilizers
VKC
- type 1 and type 4
- cobblestoning papillae on the upper lid, horner trantas dots and corneal shield ulcers
- avoid triggers, cold compresses, topical AH, and mast cell stabilizers
- steroids by an optho only, AIT, topical calcineurin inhibitors
GPC
- type 1 and type 4
- tarsal pappilla, discharge and CL debris , giant papillae on upper tarrsal
perennial or seasonal allergic conjunctivitis
- type 1 (IgE mediated)
- conjunctival inflammation, redness and edema
red flags in occular allergy
- photophobia and pain with light
- pupillary abnormalities
- blurred vision
- ciliary flush
what is an at risk infant for atopy
food allergy
- first degree relative with atopy
- decreasing birth order
- AD
asthma
- allergen exposure
- fam hx of atopy
- maternal smoking
- prematurity
- wheeze without colds
AR
- high SES
- sIgE > 100 before age 6
- SPT to aeroallergen positive
- asthma
eczema
- family history
- loss of filagrin gene mutation
what is meant by primary prevention
- interventions to prevent a disease from occurring
what advice to you give to a mother to prevent allergies
2021 consensus for primary prevention of food allergy through nutrition
- consider infants with severe AD highest risk
- introduce peanut to all infants irrespective of relative risk at 6 months though not before 4 months
- introduce egg to all infants irrespective of relative risk at 6 months, but not before 4 months
- do not deliberately delay the intro of foods that are potentially allergenic
- infants should be fed a diverse diet as this may foster prevention of food allergy
- do not routinely recommended HF for prevention of food allergy
- do not recommend avoidance of allergenic foods during pregnancy of lactation as a means of prevention
how is IgA formed and describe its transport across the luminal surface of the gut
T cell dependant mechanism
- M cells transport antigen to peyers patches
- DCs in PP capture these antigens
- DC migrate and present the antigen to a naive CD4 T cell
- activated T cells become helper T cells and interact with B cells
- T cell CD40L binding to B cell CD40 stimulates class switching to IgA
differences between primary and secondary immune response
- Primary
- naive B cells
- smaller peak response
- IgM >IgG in terms of antibody isotype
- lower antibody affinity - Secondary
- Memory B cells
- larger peak response
- related increased in IgG (heavy chain isoswitching)
- high antibody affinity
what are some advantages of component testing
- can help identify if risks for systemic rxn
- OAS clarification
- can help with establishing suitability for OFCs
- do not have to stop medications for blood work
cryoglobulinemias name all 3 types
Type 1 - monoclonal Igs (IgG and IgM) (MGUS, MM)
Type 2 - monoclonal IgM, RF, polyclonal IgG (SLE, Hep C)
Type 3 - polyclonal IgG and IgM (Hep C)
