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.
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
How do you differentiate urticaria vs angioedema
Difference between irritant vs allergic contact dermatitis
See table
Allergic contact dermatitis also goes beyond area of exposure
