Allergo-Immuno-Derma Flashcards
Atopy is not a risk factor for anaphylaxis from ____ and ____
drug reactions or hymenoptera stings
Atopy is not generally thought to be a risk factor for anaphylaxis from drug reactions or Hymenoptera stings, but it is associated with radiocontrast sensitivity, exercise-induced anaphylaxis, idiopathic anaphylaxis, and allergy to foods or latex.
Dose of epinephrine for anaphylaxis
Epinephrine 0.3-0.5 ml of 1:1000 concentration IM
More favorable outcomes are seen in patients with anaphylaxis who are given epinephrine within the first ____ minutes
20
If with persistent hypotension (anaphylactic shock): IV infusion of ___ mL epinephrine, diluted ______ at 5- to 10-min intervals
2.5 mL epinephrine, diluted 1:10,000, at 5- to 10-min intervals
key effector cell in asthma and allergic rhinitis?
mast cells
How do you differentiate SJS vs TEN
Extent of surface area involved
SJS – total body surface area of blistering and eventual detachment is <10%
SJS/TEN overlap – 10–30% epidermal detachment
TEN – >30 epidermal detachment
Poor prognostic factors for SJS/TEN
Intestinal and upper respiratory tract involvement
older age
greater extent of epidermal detachment
most common variety of psoriasis
plaque type
most common cause of urticaria
idiopathic
Most important preventive strategy in px with prev hx of anaphylaxis
avoidance of trigger
Key pathway for ADR based on immune pathway
I
II
III
IVa
IVb
IVc
IVD
I - IgE
II - IgG mediated cytotoxicity
III- Immune complex
IVa- T cell mediated macrophage inflammation
IVb- T cell mediated eosinophil inflammation
IVc- T cell mediated Tcell inflammation
IVd- T cell mediated neutrophil inflammation
mnemonic: may MEeTiNg at 4pm
macrophage-eosino-t cell-neutro
Urticaria, angioedema and anaphylaxis are under what type of classification of adverse drug reaction
Type I
Drug induced hemolysis and thrombocytopenia are under what type of classification of adverse drug reaction
Type II
Vasculitis, Serum sickness, Drug induced lupus are under what type of classification of adverse drug reaction
Type III
TST and Contact dermatitis are under what type of classification of adverse drug reaction
Type IVA
DIHS and Morbiliform eruption are under what type of classification of adverse drug reaction
Type IVB
SJS and TEN and morbiliform eruption are under what type of classification of adverse drug reaction
Type IVC
AGEP is under what type of classification of adverse drug reaction
Type IVD
Most common presentation of anaphylaxis
urticarial eruption
Aspirin exacerbated respiratory illness has 3 clinical features which include
Asthma
Sinus dse with recurrent nasal polyps
Sensitivity to aspirin and other NSAIDs
When treatment center that lacks access to recombinant C1NH, bradykinin 2 receptor antagonist, kallikrein inhibitor, what could be given for acute attacks of hereditary angioedema?
FFP
Most potent APC of the immune system
dendritic cells
Which conditions may present with periungual telangiectasia as a pathognomonic sign?
scleroderma
% risk of atopic dermatitis for patients with both parents with AD
> 80%
One parent >50%
Most common site affected by seborrheic dermatitis
scalp
Number of weeks to classify urticaria and/or angioedema as chronic
> 6 weeks
Type of urticaria which presents in response to a sustained stimulus such as a shoulder strap or belt, running (feet), or manual labor (hands).
Pressure urticaria
Type of urticaria that is distinctive in that the pruritic wheals are of small size (1–2 mm) and are surrounded by a large area of erythema; attacks are precipitated by fever, a hot bath or shower, or exercise and are presumptively attributed to a rise in core body temperature.
Cholinergic urticaria
Angioedema without urticaria can be idiopathic or due to the generation of bradykinin in the setting of ______ deficiency that may be inborn as an autosomal dominant mutation or may be acquired through the appearance of an
autoantibody in the setting of malignancy or autoimmune disease
C1 inhibitor (C1INH)
Urticarial eruptions are distinctly pruritic, may involve any area ofthe body from the scalp to the soles of the feet, and appear in crops of _ h duration, with old lesions fading as new ones appear.
12- to 36-h
Urticarial lesions that last longer than 36 h, result in scarring, and are reported as painful and not pruritic warrant ____ to evaluate for cellular infiltration, nuclear debris, and fibrinoid necrosis of the venules consistent with urticarial vasculitis.
biopsy
antifibrinolytic agent that may be used for preoperative prophylaxis of hereditary angioedema but is contraindicated in patients with thrombotic tendencies or arterial atherosclerosis.
ε-aminocaproic acid
most effective drugs available for the relief of established rhinitis, seasonal or perennial, and are effective in relieving nasal congestion as well as ocular symptoms
Intranasal high-potency glucocorticoids
Their most frequent side effect is local irritation, with fungal overgrowth being a rare occurrence.
In allergic rhinitis, the efficacy of SLIT is comparable to SCIT but only for the three allergen formulations currently available which include what?
dust mite, timothy/northern grasses, and short ragweed
most common presentation of anaphylaxis (>90% of cases)
Cutaneous manifestation
Example of delayed anaphylatic reaction
anaphylaxis to meats in alpha-gal–sensitized patients.
In anaphylaxis, The most obvious serum biomarker to assay,_____ , has an extremely short half-life with a measurable time-window that expires <1 h from the onset of anaphylaxis.
histamine
In anaphylaxis, A more practical and useful biomarker is ______ , which peaks 60–90 min after the onset of anaphylaxis and can be measured as long as 5 h after the onset of anaphylaxis
serum tryptase
it is recommended that patients who suffer from anaphylaxis be placed in the ____ position before receiving epinephrine.
Supine
an upright or sitting posture may lead to “empty ventricle syndrome” in which there is insufficient venous return to the heart from sudden-onset hypotension secondary to intravascular volume depletion. Epinephrine can further accelerate empty ventricle syndrome due to its chronotropic effects.
80% of children with _____ allergy remain sensitive for life
peanut
While most allergy to egg, milk, soy, and/or
wheat resolves spontaneously during childhood
Most forms of the disease (mastocytosis) are characterized by somatic gain-of-function mutations in the _____ gene.
stem cell factor receptor (KIT)
Systemic mastocytosis (SM) refers to involvement of a noncutaneous site usually _____
bone marrow
Type of systemic mastocytosis that accounts for the majority of adult patients.
Indolent systemic mastocytosis
Smoldering systemic mastocytosis (SSM) is characterized by high mast cell burden as evidenced by a bone marrow infiltration of > ___ % and a baseline serum tryptase > ___ ng/mL (B findings), but absence of systemic mastocytosis associated with clonal hematologic non–mast cell lineage disease (SM-AHNMD) or aggressive systemic mastocytosis (ASM)
> 30%
200 ng/mL
the rarest form of systemic mastocytosis and is invariably fatal at present
Mast cell leukemia (MCL)
The cutaneous lesions of Maculopapular cutaneous mastocytosis (MPCM) are reddish-brown macules, papules, or plaques that respond to trauma with urtication and erythema AKA ____ sign
Darier’s sign
Serum levels of this aracidonic acid dervided product diretcly correlates with anaphylaxis severity
Platelet activating factor
Mediator of anaphylaxis that causes hypotension and tachycardia when released in high concentration
Histamine
Type of psoriasis frequently after URTI
with B-hemolytic streptococci
Eruptive/Guttate psoariasis
also most common in children
What is the tx of choice for non pregnant px with pustular psoariasis
oral retinoid
why should you avoid oral glucocorticoids in severe widespread psoriasis
risk of life- threatening pustular psoriasis when therapy is discontinued
4 key elements of pathogenesis of acne vulgaris
- Follicular epidermal hyperprofliferation
- Excess sebum production
- Inflammation
- Presence and activity of Propionibacterium acnes
Most common form of pemphigus
pemphigus vulgaris
Autoantibodies for pemphigus vulgaris
desmoglein 3 and 1
Prevalent allele in bullous pemphigoid
MHC Class II allele HLA-DQβ1*0301
Autoantibodies for bullous pemphigoid
hemidesmosomes
Type of urticaria precipitated by fever, a hot bath or shower, or exercise
Cholinergic
contraindication for immunotherapy for allergy
significant cardiovascular disease or unstable asthma
Appropriate regimen for radiocontrast allergy prophylaxis
Prednisone 40mg/tablet, 1 tablet at 13hrs, 6 hrs, 1hr prior to CT scan.
*some sources say 50 mg 1 tab at 13 hrs , 7 hrs, 1 hr prior
What antibody is protective against scleroderma renal crisis
Anti U1RNP
This syndrome is characterized by recurrent bacterial infections, eczema and bleeding from thrombocytopenia
Wiskott-Aldrich Syndrome
What should be given to patients with systemic mastocytosis with abdominal pain and diarrhea?
oral cromolyn sodium
What should be given to patients with systemic mastocytosis with ssx of malabsorption
systemic steroids
most potent known vasoconstrictor
LTD4
lipid mediator responsible for leukocyte-endothelial cell adhesion and subsequent directed migration
LTB4
lipid mediator responsible for vascular leak and mediates the recruitment of eosinophils to the bronchial mucosa
LTE4
vascular leeeeeak
eeeeosinophils
How do you differentiate urticaria vs angioedema
known risk factors for ACE I related angioedema
Black race, organ transplant, female gender, smoking, increasing age
Heridary angioedema is aFully penetrant, autosomal dominant disease due to a mutation in the _____ gene (C1INH)
SERPING1
Bradykinin-mediated angioedema, whether caused by ACE inhibitors or by C1INH deficiency, is noteworthy for these characteristics (3)
> conspicuous absence of concomitant urticaria or pruritus
frequent involvement of the gastrointestinal tract
duration of symptoms >24 h
Recommended diagnostic tests for hereditary angioedema/ urticaria
CBC with assessment for eosinophilia, ESR and TSH level are recommended by consensus guidelines
Other tx options for urticaria unresponsive to systemic glucocorticoids
Hydroxychloroquine, Dapsone, Colchicine
-Added to the regimen after hydroxyzine and before or along with systemic glucocorticoids
Cyclosporine
-Chronic idiopathic urticaria that is severe and poorly responsive to other modalities and/or where glucocorticoids are a requirement
Known predisposing risk factors for allergic rhinitis
Female sex, particulate air pollution exposure, maternal tobacco smoking
What constitues Aspirin-exacerbated respiratory disease (AERD), also known as Samter’s Triad
triad of asthma, rhinosinusitis, respiratory reactions to COX-1 inhibitors
Contraindications for immunotherapy for allergic rhinitis
significant cardiovascular disease or unstable asthma
Atopic triad
Bronchial asthma, allergic rhinitis, atopic dermatitis
Major criteria for atopic dermatitis
CHIP
Chronicity
History of atopy
Involvement of face and flexures
Pruritus
Mutation associated with atopic dermatitis
filaggrin mutation
Difference between irritant vs allergic contact dermatitis
See table
Allergic contact dermatitis also goes beyond area of exposure
Common sites of involvement of psoriasis
Scalp, elbows, knees, hands, feet,
trunk and nails
Phenomenon in psoriasis wherein Traumatized areas develop lesions
Koebner phenomenon
Sign in psoriasis wherein there is Bleeding after scale is removed
Auspitz sign
Organisms involved in dermatophytosis
Trichophyton
Microsporum spp
Epidermophyton
Treatment for pemphigus vulgaris
Treatment: Systemic glucorticoids alone/ in
combination with other immunosuppressive
agents
rituximab; azathioprine, mycophenolate mofetil,
or cyclophosphamide
Tx resistant disease: Plasmapheresis and/ IVIg
Autoantibodies associated with bullous pemphigoid
hemidesmosomal proteins BPAG 1,2
Treatment for bullous pemphigus
Local disease: Potent topical lucocorticoids
Extensive disease: Systemic Glucocorticoids alone/ with other adjuncts
Doxycycline, azathioprine, Mycophenolate mofetil, Rituximab
Which is nikolsky positive Pemphigus vulgaris or bullous pemphigoid?
pemphigus vulgaris
Risk factors for adverse drug reactions
Elderly patient
Patients with autoimmune disease
Hematopoietic stem cell transplant recipient
With acute EBV and HIV infection
Most common type of drueg eruptions
morbiliform eruptions
Common culprit drugs for drug induced hypersensitivity syndrome
Anticonvulsants, sulfonamides, allopurinol, minocycline
