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Physiology > Allergy and asthma > Flashcards

Allergy and asthma Flashcards

1
Q

where do all immune cells come from?

A

hematopoietic stem cells

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2
Q

which cytokines act on naive CD4 T cells to turn them into T regulatory cells?

A

IL-2

TGF-beta

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3
Q

which cytokines act on naive CD4 T cells to turn them into Th1

A

IL-12

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4
Q

which cytokines act on naive CD4 T cells to turn them into Th2

A

IL-4

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5
Q

which cytokines act on naive CD4 T cells to turn them into Th17

A 
TGF beta
IL-6
IL-21
IL-23
IL-1beta
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6
Q

which cytokines are produced by T reg cells

A 
TGF-beta
IL-10
IL-35
STAT6
FOXP3
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7
Q

which cytokines are produced by Th1 cells?

A

IFN-gamma
LT alpha
STAT4
T-bet

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8
Q

Which cytokines are produced by Th2 cells?

A 
IL-4
IL-5
IL-13
STAT6
GATA3
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9
Q

Which cytokines are produced by Th17 cells?

A 
IL-17A
IL-17F
IL-22
IL-21
CCL20
STAT3
ROR gamma T
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10
Q

what do T reg cells do?

A

suppresses tumour immunity
promotes immune tolerance
maintains lymphocyte homeostasis

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11
Q

what do Th1 cells do?

A

promotes tumour immunity
intracellular pathogens
drives autoimmunity

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12
Q

what do Th2 cells do?

A

extracellular pathogens
allergy
asthma
produce IgE

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13
Q

what do Th17 cells do?

A

controversial tumour immunity
breaks immune tolerance
extracellular bacteria
autoimmunity

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14
Q

T cell balance

A

equal numbers of Th1 and 2 cells

inhibit each other

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15
Q

autoimmune diseases

A

more Th1 cells than Th2

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16
Q

atopy

A

more Th2 cells than Th1

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17
Q

T reg cells

A

maintain the balance between Th1 and 2 cell populations by realsing IL-10 and TGF-beta

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18
Q

what is IgE used for?

A

kills helminths and parasites by activation eosinophils

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19
Q

what happens in initial sensitisation?

A 
allergen presented to DC cells which recognise them as foreign and so presents them on MHC 2 of DCs to naive T cells which makes them become Th2 cells which activates naive B cells that produce IgM and then they are class switched through DNA splicing so they produce IgE.
Clonal expansion - memory cells
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20
Q

IgE receptor

A

FCepsilonRI receptor which allows IgE to bind to cells

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21
Q

where are IgE receptors?

A

mast cells - tissue
basophils - blood
B lymphocytes - lesser extend

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22
Q

what cytokines cause class switching?

A

IL-4 and 5

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23
Q

how do B cells class switch?

A

DNA splicing

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24
Q

re-exposure to allergen

A

allergen/ antigen binds to IgE, has to cross link - bind to 2 IgE molecules and causes degranulation of the mast cell

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25
Q

mast cell mediators

A

biogenic amines
lipid mediators
cytokines
enzymes

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26
Q

biogenic amines released by mast cell

A

histamines

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27
Q

lipid mediators released by mast cells

A

Prostaglandins - PGD2

leukotrienes - LTC4

28
Q

cytokines released by mast cells

A

TNF alpha or beta

29
Q

Enzymes released by mast cells

A

exogenous tryptase

30
Q

what do histamines do?

A

vasodilation and vascular leak

31
Q

what do lipid mediators do?

A

bronchoconstriction

intestinal hypermotility

32
Q

what do cytokines do?

A

inflammation

33
Q

what do enzymes do?

A

tissue damage

34
Q

phases of allergy

A

immediate and late

35
Q

late phase

A

recruit Th17 cells which produces IL-17 and IL-22 which causes activation of eosinophils and recruitment of basophils

36
Q

what do eosinophils do?

A

release mediators, chemokines and proinflammatory cytokines

increased inflammatory cells migration and activation

37
Q

what do basophils do?

A

have their own IgE molecules

38
Q

how long does it take for inflammatory cells to be recruited?

A

6 hours after exposure

39
Q

eosinophils

A

elevated/ recruited in lungs and blood of asthmatics

allergy and parasitic infections

40
Q

what activates eosinophils?

A

activated by cytokines

41
Q

what do eosinophils release?

A

release toxins, leukotrienes and cytokines

42
Q

what do eosinophils cause?

A

activation causes bronchial hyperactivity - wheezing

43
Q

smooth muscle cell activation and hyperactivity

A

can also be caused by IFN gamma and TNF from Th1 cells when they are recruited due to imbalanced immune system

44
Q

What do Il-4,13 and CCL5 do?

A

cause increased endothelial-cell adhesion and inflammatory cell transmigration so even if allergen is removed inflammatory process will continue

45
Q

why does an allergy cause eczema?

A

atopic dermatitis
Th1 cells produced IFN gamma, TNF and CD95L which induces keratinocyte apoptosis and release of chemokines and proinflammatory cytokines

46
Q

chronic allergic reaction

A

persistent inflammation
prolonged or repetitive exposure to antigens
characterised by large numbers of innate and adaptive immune cells
substantial changes in the extracellular matrix and alterations in the number, phenotype and function of structural cells in the affected tissues

47
Q

fibroblasts

A

implicated in normal healing process and scar formation
deposit extracellular matrix
cause thickening of basement membrane

48
Q

fibroblasts in lungs

A

tryptase affects fibroblasts in lungs but this can cause increase in extracellular matrix and thickening of basement membrane, further narrowing the airways

49
Q

what happens in severe chronic asthma?

A 
vasodilation
hyperplasia and mucus hypersecretion
leukocyte infiltration
eosinophilia
hypertrophy of smooth muscle
collagen deposition
partial occlusion of bronchial lumen by mucus plug 
thickening of basement membrane 
oedema
desquamation/ degradation of epithelium
50
Q

what are the 2 types of asthma?

A

type 2 inflammation

non-type 2 inflammation

51
Q

non type/ Th 2 inflammation

A

caused by smoking
irritants
pollutants
infections

52
Q

what happens in non Th2 inflammation

A

similar reaction but call in Th1 cells quicker and recruit neutrophils

53
Q

clinical presentations of allergy

A

anything presented via dendritic cell can be perceived as non self or pathogenic antigens
which can then trigger an IgE mediated reaction. This can be anything

54
Q

causes of IgE mediated reactions?

A 
drug
hormones
genetics
systemic illness
food allergies
stress
55
Q

common drugs that cause IgE mediated reaction?

A 
antibiotics
NSAIDs - second most common allergy 
biologicals
contrast agents
blood
56
Q

what infections cause hives IgE mediated reaction?

A

infections - Hepatitis, EBV, herpes
chronic parasites
cutaneous fungal infections

57
Q

what foods cause allergies/ IgE mediated reaction?

A 
peanuts
tree nuts
milk
eggs
wheat
soy
fish
shellfish
sesame
58
Q

IgE mediated symptoms

A 
sneezing
runny nose
nasal congestion
discomfort in mouth
swelling of lipd
itching
hives
reddening
loss of consciousness
lethargy
blue-white lips/ nails
itchy eyes
redness of eyes
swelling of eyelids
raspy voice
wheezing
whistling sound when breezing
coughing
difficulty breathing
abdominal pain
nausea
diarrhoea
59
Q

hives

A

releasing of plasma into epidermis due to vascular leak

60
Q

clinical presentation of asthma

A

shortness of breath - exercise and interval
expiratory wheeze
cough, especially nocturnal
episodic
reversible
diagnosis based on likelihood and assessment

61
Q

when making an asthma diagnosis

A

rationale for the diagnosis needs to be documentation

62
Q

differential diagnoses in asthma

A 
hyperventilation in teenagers
viral induced wheeze
primary ciliary dyskinesia
bronchiectasis
cystic fibrosis
vocal cord dysfunction
persistent bacterial bronchitis
63
Q

asthma triggers

A 
exercise
pollen
house dust mites
saliva on fur 
stress
emotions - anger etc. 
insects 
cold air
infections
smoking
pollution 
person specific
64
Q

hypothetical causes of atopy

A

vitamin D hypothesis
antibiotics
dual allergen hypothesis - how you are exposed to allergens
hygiene hypothesis

65
Q

treating chronic asthma and chronic urticaria

A

monoclonal antibody - omalizumab - anti IgE

66
Q

treating chronic eczema

A

dupilumab

Physiology (46 decks)

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