Aani Immuno: Hypersensitivity Flashcards by Aaniya Ahmed

Mnemonic for remembering the types of Hypersensitivity Reaction?

ACID

Allergic - IgE
Cytotoxic (ab mediated) - IgG or IgM
Immune complex mediated -IgG or IgM
Delayed - T cell mediated

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Which Abs are involved in Type 1 Hypersensitivity Reaction?

IgE

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Which Abs are involved in Type 2 Hypersensitivity Reaction?

IgG or IgM

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Which Abs are involved in Type 3 Hypersensitivity Reaction?

IgG or IgM

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Symptoms of Type 1 Hypersensitivity reaction?

Angiodema, Rash, Urticaria, Wheeze, Diarrhoea, Rhinoconjunctivitis, Anaphylaxis

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4 Most common Type 1 Hypersensitivity reaction in Children?

Asthma
Allergic Rhinitis (hayfever)
Eczema
Food

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What is atopy?

Triad eczema, asthma, hayfever. Predisposition to developing allergic hypersensitivity reactions.

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Can a baby get a peanut reaction the first time they’ve had peanuts?

No, you need to be sensitised first. IgE sensitised.

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what is Oral allergy Syndrome? (OAS)

When exposure to pollen can induce food allergy e.g. Birch Pollen Allergy Syndrome.
IgE are directed to proteins in fruit/nuts following respiratory exposure to birch pollen

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what are the types of allergic rhinitis?

Seasonal (grass pollen etc)
Perennial (pets, house dust mites)
Occupational (latex, lab animals)

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How long does it take for Acute Urticaria to resolve?

Wheals resolve within 6 weeks. If they last longer than 6 weeks, this is Chronic Urticaria

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What is anaphylaxis?

A severe systemic allergic reaction

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What are the symptoms of anaphylaxis?

Respiratory: Wheeze, cough, throat swelling, breathing difficulty
Hypotension: Faint/raised HR
Skin: Erythema, Urticaria, Swelling, Itch

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Why does anaphylaxis happen?

Following exposure to allergen, you get IgE mediated mast-cell degranulation. You can also get Non-IgE mediated anaphylaxis

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Common causes for IgE mediated Anaphylaxis?

Wasps
Peanuts
Latex
Penicillin

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Common causes for Non-IgE mediated Anaphylaxis?

NDAIDs
IV Contrast medium
Opioids

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Which tests are used in Allergy?

Skin Prick Test
RAST
Complement Resolved Diagnostics
Challenge Test

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What is the criteria for diagnosing Anaphylaxis?

Amina Said So
Airways affected (Life threatening breathing impairment)
Sudden onset/rapid progression
Skin involvement

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Management of Anaphylaxis?

8 things

IM Adrenaline 500 micrograms
100% Oxygen
Raise legs
Hydrocortisone 100mg IV
Inhaled bronchodilators
Antihistamine e.g. Chlorphenamine
Refer to allergy specialist
IV Fluids

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What is an important criteria for the Skin Prick test to work?

Must stop antihistamines for 48 hours before test

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If you cannot stop your anti-histamines what can you do instead of the skin prick test?

RAST.

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What does RAST do?

Measures IgE made against a certain allergen

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What is the gold standard investigation for food allergy?

Challenge Test

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What can you measure in the blood to check if anaphylaxis has occured?

Mast Cell Tryptase. (Peaks at 1-2 hours. Goes back down by 6 hours).
It is a protein released by mast cells that have undergone degranulation

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Other differentials for anaphylaxis?

``` Pheochromacytoma Anxiety ACE inhibitors (low BP) Inhaled foreign body Chronic Urticaria ```

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Haemolytic Disease of the Newborn

Antigen on neonatal erythrocytes e.g. A, B, Rh

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Goodpasture's Syndrome

Glomerula basement membrane of Collagen 4

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Graves Disease

TSH receptor | not just TSH

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Churg Strauss Syndrome

Medium & Small Vessels

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Wegener's Granulomatosis

Medium & Small Vessels

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Pernicious Anaemia

Intrinsic Factor or Gastric Parietal Cells

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Pemphigus Vulgaris

Epidermal Cadherin

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Autoimmune Thrombocytopaenic Purpura

Glycoprotein 2a/3b on platelets

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Chronic Urticaria

Allegerns e.g. drugs, bites etc

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Autoimmune Haemolytic Anaemia

Blood Group Antigens on Erythrocytes

What is Evans syndrome?

Autoimmune Haemolytic Anaemia + Immune Thrombocytopaenic Purpura

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Myasthenia Gravis

Acetylcholine receptor

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Microscopic Polyangitis

Pauci-immune necrotizing small vessels

Which antigen is attacked by an Ab in the following type 2 hypersensitivity disease: Acute Rheumatic Fever

M proteins on Group A Strep

Which specific test(s) can be carried out for: Myasthenia Gravis

1. Anti Ach R Abs 2. Tensilon Test 3. Abnormal EMG

Which specific test(s) can be carried out for: Goodpasture's Syndrome?

1. Anti GBM Ab | 2. Smooth linear line visible on IF staining (IgG deposits on BM)

Which specific test(s) can be carried out for: Wegener's Granulomatosis?

c-ANCA granulomas

Which specific test(s) can be carried out for: Churg-Straus Syndrome?

p-ANCA

Which specific test(s) can be carried out for: Microscopic Polyangiitis?

p-ANCA

What are the clinical features of Rheumatic Fever?

Myocarditis Arthritis Sydenham's Chorea

Name some Type 3 hypersensitivity Reactions

``` SLE (DNA/histone complexes) Polyarteririts Nodosa (hepatitis B/C virus antigen complexes) ```

How do Type 4 hypersensitivity Reactions work?

Antigens attacked by T cells.

Which antigen is attacked by an Ab in the following type 4 hypersensitivity disease: T1DM

1. Pancreatic Beta Cell | 2. Glutamate Decarboxylase (GAD)

Which antigen is attacked by an Ab in the following type 4 hypersensitivity disease: MS

1. Myelin Basic Protein | 2. Proteolipid Protein

Which antigen is attacked by an Ab in the following type 4 hypersensitivity disease: Rheumatoid Arthritis

Synovial Membrane Antigens

Which antigen is attacked by an Ab in the following type 4 hypersensitivity disease: Contact Dermatitis

Chemicals in environment that touch you init

Which antigen is attacked by an Ab in the following type 4 hypersensitivity disease: Mantoux test

Tuberculin

Which test can be done to diagnose the following Type 4 Hypersensitivity Reaction: MS

Oligoclonal band of igG on electrophoresis

Which test can be done to diagnose the following Type 4 Hypersensitivity Reaction: T1DM

Ketones in urine Blood glucose Islet cell Abs Glutamate Decarboxylase Abs

Which test can be done to diagnose the following Type 4 Hypersensitivity Reaction: RA

Anti-CCP Rh Factor X Ray High CRP and ESR

Which test can be done to diagnose the following Type 4 Hypersensitivity Reaction: Contact Dermatitis

Clinical diagnose, patch test

Which HLA is associate with: Ankylosing Spondylitis

HLA B27

Which HLA is associate with: SLE

HLA DR3

Which HLA is associate with: T1DM

HLA DR3 and DR4

Which HLA is associate with: RA

HLA DR4

Which HLA is associate with: Graves

HLA DR3

Which HLA is associate with: Goodpasture's Syndrome?

HLA DR15/DR2

What is limited cutanous scleroderma?

``` CREST Calcinosis Reynauds Esophageal Dysmotility Sclerodactily (thickening of skin) Telangiectasia ```

Which Abs are present in Limited Cutaneous Scleroderma?

Anti Centromere

Which Abs are present in Diffuse Cutaneous Scleroderma?

Anti Topoisomerase | Anti Fibrilarin

What is Diffuse Cutaneous Scleroderma?

CREST but scleroderma can occur anywhere and there is also multiorgan involvement

What is Sjogren's Syndrome?

Dry mucous membranes, mouth, eyes, skin etc.

Which Abs are present in Sjogren's Syndrome?

Anti-Ro | Anti-La

Which test is done for Sjogren's Syndrome?

Schirmer test: tear measurement test

What is IPEX?

Immune dysregulatopn Polyendocrinopathy Enteropathy Xlinked

Which mutation is ass. with IPEX?

FOXP3

What is the gold standard test for Coeliac Disease?

Duodenal Biopsy

What do you see on a Coeliac Duodenal Biopsy?

Villous Atrophy | Crypt Hyperplasia

Which Abs are ass. with Coeliac Disease?

Anti Endomesial Abs (EMA) Anti Tissue transglutaminase (Anti TTG) Anti Gliadin

Which Ig type is Anti-EMA in Coeliac?

IgA

Which Ig type is Anti-TTG in Coeliac?

IgA

Which Ig type is Anti-Gliadin in Coeliac?

IgG

Which HLA is associate with: Coeliac Disease

DQ2 DQ8

Describe the autoantibody(s) found in: | Limited Cutaenous Scleroderma (CREST)

Anti-Centromere Ab IgG

Describe the autoantibody(s) found in: | Myasthenia Gravis

Anti-Acetylcholine Receptor Ab IgG

Describe the autoantibody(s) found in: Pernicious Anaemia

Anti-Intrinsic Factor (50%) OR Anti-Gastric Parietal Cell (more common- 90%) IgG

Describe the autoantibody(s) found in: T1DM

Anti-Glutamate Decarboxylase OR Anti Pancreatic Beta Cell IgG

Describe the autoantibody(s) found in: Dermatomyositis

Anti-Jo-1 IgG (t-RNA synthetase) | Same as Polymositis

Describe the autoantibody(s) found in: Dermatitis Herpatiformis

Anti-Endomesial (EMA) IgA

Describe the autoantibody(s) found in: Anti-Phospholipid Syndrome

Anti-Cardiolipin IgG OR Anti B2 Glycoprotein IgG

Describe the autoantibody(s) found in: Churg-Strauss Syndrome

p-ANCA IgG

Describe the autoantibody(s) found in: Polymyositis

Anti-Jo-1 IgG (t-RNA synthetase) | Same as Dermatomyositis

Describe the autoantibody(s) found in: SLE

Anti-dsDNA IgG OR Anti-Histone IgG AND Ro, La, U1RNP

Describe the autoantibody(s) found in: | RA

Anti-CCP IgG | Rh Factor also found

Describe the autoantibody(s) found in: Sjogren's Syndrome

Anti-Ro IgG Anti-La IgG (60% have + Rheumatoid Factor)

Describe the autoantibody(s) found in: Microscopic Polyangitis (MPA)

p-ANCA IgG

Describe the autoantibody(s) found in: Wegener's Granulomatosis (GPA)

c-ANCA IgG

Describe the autoantibody(s) found in: | Hashimoto's Thyroiditis

Anti-Thyroperoxidase (TPO) Or Anti-Thyroglobulin IgG

Describe the autoantibody(s) found in: | Mixed Connective Tissue Disease

Anti-U1RNP IgG

Describe the autoantibody(s) found in: Autoimmune hepatitis

Anti-Smooth Muscle IgG Anti- Liver Kidney Microsomal-1 (LKM-1) IgG Anti- Soluble Liver Antigen (SLA) IgG

Describe the autoantibody(s) found in: Coeliac Disease

Anti-EMA IgA Anti-TTG IgA Anti-Gliadin IgG

Describe the autoantibody(s) found in: Congenital Heart Block in infants of mothers with SLE

Anti-Ro IgG

Describe the autoantibody(s) found in: Diffuse Cutaneous Scleroderma

Anti-Topoisomerase IgG | Anti- Fibrillarin IgG

Describe the autoantibody(s) found in: Goodpasture's Syndrome

Anti-GlomerularBasement Membrane (GBM) IgG

Describe the autoantibody(s) found in: Graves Disease

Anti-TSH Receptor Ab IgG

Describe the autoantibody(s) found in: Primary Billiary Cirrhosis

Anti-Mitochondrial Ab IgG

Describe the autoantibody(s) found in: Autoimmune Thrombocytopaenic Purpura

Anti Glp 2b/ Anti Glp 3a IgG | or Ib-9-Ab IgG

Describe the autoantibody(s) found in: | Auto-immune Haemolytic Anaemia

Anti-Rh Blood Group Antigen IgG