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Year 3 - Clinical Science and Professionalism > Allergy 2 > Flashcards

Allergy 2 Flashcards

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1
Q

What is atopy

A
  • Genetic predisposition to develop IgE antibodies against common environmental antigens
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2
Q

What are the clinical correlates of atopy

A
  • Hayfever
  • asthma
  • atopic eczema
  • increased likelihood of developing allergic urticaria
  • angioedema
  • anaphylactic shock
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3
Q

Out of TH1/TH2 which one is more dominant

A

TH2 is more dominant in atopic individuals

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4
Q

you do not need to be atopic to develop

A

anaphylactic shock

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5
Q

what type of hypersensitivity are allergic conjunctivitis, rhinitis, sinusitis

A
  • Type 1 hypersensitivity - IgE mediated
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6
Q

What antigens are responsible for allergic conjunctivitis, rhinitis, sinusitis

A
  • Grass pollens, tree pollens. Seasonal exposure.
  • Animal danders.
  • House dust mite
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7
Q

How do you diagnose allergic conjunctivitis, rhinitis, sinusitis

A
  • history.
  • If seasonal: pollens, hayfever.
  • Skin prick tests and specific IgE confirmatory, but history is main thing! May develop nasal polyps
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8
Q

What is the treatment of allergic conjunctivitis, rhinitis, sinusitis

A

Treatment

  • topical or systemic antihistamines
  • topical mast cell stabilisers e.g. disodium chromoglycate
  • topical steroids
  • antigen exclusion
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9
Q

What are other causes of rhinitis and sinusitis

A
  • Viral and bacterial infections: common. Leprosy (rare).
  • Vaso-motor rhinitis
  • Non-allergic rhinitis with eosinophilia (NARES)
  • Drug induced: alpha agonist sprays, cocaine abuse.
  • Irritant fumes & solvents
  • Vasculitis, Wegener’s granulomatosis.
  • Septal deviation, foreign bodies.
  • Late pregnancy (oestrogens)
  • CSF leak.
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10
Q

what can cause asthma

A
  • Allergy & Th1/Th2,
  • neurogenic
  • smooth muscle factors,
  • irritants
  • occupational exposure,
  • acute & chronic inflammatory response characteristics all important.
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11
Q

what type of asthma is allergy more important

A
  • Allergy is more important in childhood asthma especially if there are other atopic features such as antigens pollens, animal danders, HDM
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12
Q

What can trigger asthma allergies

A
  • antigen pollens
  • animal dangers
  • HDM
  • acute bronchospasm
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13
Q

what are the treatments of asthma

A
  • Topical (inhaled) beta 2 agonists
  • topical (inhaled) steroids
  • nebulised theophylline
  • systemic steroids
  • monoclonals against IL4R , IL5, IL5R
  • ventilation in extremis
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14
Q

What happens in atopic dermatitis

A
  • Dry cracked very itchy raised lichenified weeping lesions.

- Initially may be on extensor surfaces, then flexures, also cheeks.

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15
Q

What mutation is involved in atopic dermatitis

A
  • filaggrin mutation appear to predispose to dermatitis
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16
Q

how much does IgE raise in atopic dermatitis

A

IgE often raised 1000ku/l (NR <81)

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17
Q

what markers are increased in atopic dermatitis

A
  • IgE
  • eosinophils
  • mast cells
  • Langerhan cells in skin express Fc elipson
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18
Q

What can cause aspirin sensitivity

A
  • aspirin can cause angioedema like other NSAIDS

- since prostaglandin formation is blocked there is a deviation towards leukotriene formation

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19
Q

What is the triad of symptoms you get with aspirin sensitivity

A
  • asthma
  • nasal polyps
  • sinusitis
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20
Q

How do you treat aspirin

A
  • Polyps may need surgery or topical steroids

- avoid aspirin and salicylates

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21
Q

What food contain salicylates

A
  • tea
  • coffee
  • herbs and spices
  • black pepper
  • sharp green apples
  • cherries
  • strawberries
  • dried fruit
  • tomatoes
  • fruit juices
  • cider
  • wine
  • peppermints
  • liquorice
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22
Q

aspirin can enhance the ability of…

A

Aspirin can enhance the ability of other allergens to cause anaphylaxis.

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23
Q

What is oral allergy syndrome

A

Itching and local swelling in oropharynx within minutes of eating food. Rarely may progress to urticaria & angioedema of face, and even anaphylaxis.

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24
Q

What type of hypersensitivity in oral allergy syndrome

A

Mediated by specific IgE: type I hypersensitivity

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25
Q

Describe what food types cause oral allergy syndrome

A
  • Birch pollen allergy + hazelnut, apple, pear, carrot.
  • Birch pollen allergy + plums, peaches, cherries, almonds.
  • Ragweed allergy + melon, banana.
  • Grass pollen allergy + tomato, melon.
  • Mugwort pollen allergy + celery, carrot, spices.
26
Q

What is the treatment of oral allergy syndrome

A
  • Avoid foods

- mostly heat labile so cooked ok

27
Q

what are other symptoms of food allergy that do not cause oral allergy

A
  • gut (abdo pain, diarrhoea, vomiting),
  • skin (urticaria & angioedema) - respiratory tract (bronchospasm and angioedema).
  • Should follow ingestion of food in minutes - an hour or two.
  • May cause anaphylaxis.
28
Q

what can food allergy cause in the gut

A
  • eosinophilic gastropathy

- enteritis

29
Q

What foods tend to cause food allergy

A

Peanuts & other legumes. True nuts – walnuts, cashew, almond, hazelnut. Shellfish & fish. Egg, milk. Latex, banana, avocado, kiwi, chestnut, potato, tomato. Omega gliadin.

30
Q

How do you treat food allergy that is not in the mouth

A
  • avoidance

- Steroids for eosinophilic enteritis.

31
Q

what are skin prick tests useful in

A
  • milk
  • egg
  • fish
  • peanut
  • true nuts
32
Q

What is latex present in

A
  • gloves
  • many medical products
  • condoms
33
Q

What does latex cross react with

A

Cross- reaction with bananas, avocado, Kiwi.

34
Q

What type of hypersensitivity is latex

A

IgE type 1 hypersensitivity

35
Q

What are the symptoms of a latex allergy

A
  • Contact urticaria,
  • rhino-conjunctivitis,
  • asthma,
  • angioedema, anaphylaxis
36
Q

How do you test for latex allergy

A

Skin prick tests and specific IgE tests against recombinant antigens

37
Q

What is the treatment for a latex allergy

A
  • avoidance

- Hospital environment difficult.

38
Q

what can happen in a drug allergy

A
  • fevers
  • fixed drug reactions - a rash on the skin in a particular place where you have the drug
  • stevens-johnson syndrome
  • erythema multiforme
39
Q

what hypersentivities can penicillin cause

A
  • Type I hypersensitivity: anaphylaxis
  • Type II haemolytic anaemia.
  • Type III Serum sickness
  • Type IV interstitial nephritis.
40
Q

How do you test for penicillin allergy

A

For IgE against penicillin, test for antibodies, skin prick tests, desensitisation possible

41
Q

what other drugs can cause allergies

A

co-trimoxazole in AIDS, rash, IgE to sulphonamide.

42
Q

describe what happens in an insulin allergy

A
  • if the manufacturing produces a slightly altered insulin structure then antibodies can develop towards insulin
  • local urticarial
  • induration
  • may get some general anaphylactic type symptoms
43
Q

what do you do if patient has allergy to anaesthetics

A
  • measure tryptase

- save serum

44
Q

What is DRESS syndrome and its symptoms

A

Drug reaction with eosinophils & systemic symptoms.
- After several weeks: fever, rash, lymphadenopathy. Liver, kidney or lung, eosinophilia, lymphopenia or lymphocytosis, thrombocytopenia

45
Q

What type of hypersensitivity is extrinsic allergic alveolitis

A

Type III Hypersensitivity

46
Q

describe extrinsic allergic alveolitis

A
  • Inhaled foreign antigens, occupational exposure.
  • Animal, fungi, bacterial plant, chemical.
  • Eg bird fanciers’ lung, farmers’ lung (fungi).
  • Symptoms start about 6 hours after exposure & often worst at 24-48 hours. Fever, cough, shortness of breath.
  • May have asthma as well: type I hypersensitivity.
  • May develop type IV hypersensitivity as well. Chronic exposure leads to worsening interstitial pulmonary disease.
47
Q

What hypersensitivity is allergic bronchopulmonary aspergillosis.

A

Type III & type I reaction to Aspergillus

48
Q

What are the symptoms of allergic bronchopulmonary aspergillosis

A
  • Wheeze
  • cough
  • fever
  • haemoptysis
49
Q

what can develop in allergic bronchopulmonary aspergillosis

A

Bronchiectasis may develop.

50
Q

what antibodies rise in response to allergic bronchopulmonary aspergillosis

A

High IgG & IgE to Aspergillus.

51
Q

What type of hypersensitivity is serum sickness

A

Type III hypersensitivity

52
Q

What can cause serum sickness

A

Infused human serum or serum products eg IVIG, monoclonal antibodies, and any drug that can bine to patients’ own proteins, altering the (eg penicillin)

53
Q

what are the symptoms of serum sickness

A
  • Fever
  • poly-arthritis
  • vasculitis
  • lymphadenopathy
  • urticarial
54
Q

When does serum sickness first show

A

7-14 days after primary exposure, 1-3 days after secondary exposure.

55
Q

What type of hypersensitivity is contact hypersensitivity

A

Type IV hypersensitivity

56
Q

describe the types of contact hypersensitivity

A
  • Nickel “allergy”
  • Topical drug applications
  • Aniline dyes in leather.
  • Chromium from cement: builders.
  • Latex & rubber material: various chemicals.
  • Hair dyes, fragrances, cosmetics.
  • Plants: ivy, sumac, chrysanthemum.
  • Exposure to sunlight may be required to trigger sensitivity
57
Q

What tests do you carry out for allergies

A
  • First take a good history!
  • Skin prick tests.
  • Specific IgE in vitro tests.
  • Autoantibody screen etc.
  • Patch testing.
  • Tryptase
  • D-dimers - also rises in angioedema
  • Complement: C1 esterase inhibitor quantity and function. C3 & C4, C1q, C2, autoantibodies to C1q.
58
Q

what is the mainstay of treatment in allergies

A
  • antihistamines against H1 receptor
59
Q

What does ranitidine do

A
  • antihistamine against H2 receptor
60
Q

What is disodium chromoglycate used in

A
  • mast cell stabiliser

- used as drops in allergic rhinitis and conjunctivitis

61
Q

name the monoclonal antibodies used in allergies

A

Dupilumab (monoclonal against IL4 receptor)
Mepolizumab (monoclonal against IL5)
Benralizumab (monoclonal against IL5 receptor)
- used in asthma and eczema

Year 3 - Clinical Science and Professionalism (32 decks)

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