Allergy and Immunology 🤧 Flashcards
Tacrolimus side effects
Hyperkalemia, glucose intol, HTN, glucose intol, irate high, neurotoxicity (tremor), lil N/V,
Do you need to do allergy testing in the first episode of urticaria. When would we do testing
No, just give anti H. Only if severe or if sus specific trigger or if fails anti H
Is it significant that lymph nodes or adenoids are undeveloped in in SCID/x linked agammaglob, less than 2 yo
No. They are underdeveloped in all less than 2 yo
How to clinch the Dx of x linked agammaglob
BTK gene mutation
How to Tx x linked agammaglob
Treatment is immunoglobulin replacement therapy (eg, intravenous immunoglobulin) with or without
prophylactic antibiotics.
Transient hypogammaglobulinemia of infancy. Which Ig go up and which go down. When does it normalise? Which infx do they get
Transient hypogammaglobulinemia of infancy is characterized by decreased IgG, variable IgM, and
normal IgA and B-cell concentrations. Affected patients develop mild, recurrent sinopulmonary and gastrointestinal infections. Immunoglobulin levels generally normalize by age 9-15 months.
Wisdom aldrich Ig levels (clue = vowels)
immunoglobulin profile shows low to normal lG and IgM with elevated IgA and IgE.
Less than one month post transplant…. Infx cause?
<1 month: Bacterial causes from operative complications (eg, hepatic abscess, biliary leak, wound infection) or hospitalization (eg, intravascular catheter, external drain)
Months 1-6 post transplant. Cause of infx
Months 1-6: Opportunistic pathogens (g, Cytomegalovirus, Aspergillus, Mycobacterium tuberculosis) in the setting of high-dose immunosuppressive medication
More than 6 mo post transplant, cause of infx
> 6 months: Immunosuppressants usually at maintenance levels. Patients primarily at risk for typical
community-acquired pathogens (at a higher rate than the general population)
Most transplant fever and pain etc. how to really tel if bac infx or acute rejection
Look at hemodynamic,,,, shock would be seen in infx, not acute rejection
Chronic complications of CVID
- Autoimmune (eg, RA, thyroid disease)
• Pulmonary (eg, bronchiectasis, fibrosis)
• Gl (eg, chronic diarrhea, IBD-like
conditions)
How to Dx CVID
Diagnosis is made by quantitative measurement of immunoglobulin levels
XLA, CVID. Do quant Ig and flow cytom for which ones
Flow cytom for XLA
Quant Ig for CVID
Serum sickness like syndrome signs and symptoms. Any Tx needed? Main difference between serum sickness
Athralgia, urticaria, following a medication usually. Penicillin, ceph, TMP SMX. Compared to serum sickness, the fever, compliment activation and complex titre are more mild
CGD prphlx and cure
Prophylaxis: TMP-SMX, itraconazole, interferon gamma
• Active infection: culture-based, antimicrobial therapy
Hematopoietic cell transplant is curative
Two ways to prevent IgA def associated tranfusion anaphylaxis
wear medical alert bracelets and receive blood products that are washed of residual plasma or from an IgA-deficient donor.
Tx of transient hypo gamma glob of infancy
Observation; self-resolution in early childhood. Abx if severe infx
In transient hypogammaglob of infancy, what is the response to vx
Normal response to Vx, unlike XLA and SCID
Do we see atopic features in transient hypogamaglob of infancy
Yes
Early compliment disorders are marked by what type of infx? And what other disorders
Early complement disorders (eg, C1 complex) are marked by recurrent sinopulmonary bacterial
infection and childhood systemic lupus erythematosus.
HIV cd4/cd8 ratio
CD4/CD8 ratio would be low.
how do we screen for SCID
Therefore, SCID is included in routine newborn screening in the United States and is detected by the absence of T cell receptor excision circles (circular DNA excreted by developing T cells in the thymus) in dried blood.
HiB infx in fully vx person… should raise suspicion for what
Hum oral immunodeficiency
Vaccine responses…. XLA vs asplenic Patients
Vaccine antibody response is normal with anatomic or functional asplenia. Whereas in XLA they will have low Vx titres. Both have encapsulated bac infx, so this can help differentiate
CVID and XLA are usually easy to tell apart… but if they have overlap, what’s the main way to decide the dx
XLA will occur around 3-6 mo old
How to Dx hereditary angioedema
• 1 C4 level
• | C1 inhibitor protein or function
Mx for hereditary angioedema (3 components)
C1 inhibitor concentrate
• Bradykinin antagonist (eg, icatibant)
• Kallikrein inhibitor (eg, ecallantide)
Do patients with HIV have LN swell, and why?
HIV infection causes generalized lymphadenopathy in infants because B cells are produced normally.
Hereditary angioedema… is the edema itchy?
No, it’s angioedema, not mast cell stuff
Main bacteria seen in LAD
Staph A
High high neutrophil is in the face of recurrent mucocut infx
LAD
Weight requirement for infant to have hep B vx
The first hepatitis B vaccine is administered when the patient weighs 22 kg
Chronic enteroviral infx common in which immunodef
XLA
IFN receptor deficiency results in what
IFN-y receptor deficiency results in disseminated mycobacterial disease beginning in infancy.
CI for DTaP Vx
Previous enceph, or anaphylaxis after vx, or uncontrollled epilepsy
Abscesses difference in CGD and hyper IgE
Cold in hyper IgE
Normal caloric intake
(up to 32
ounces a day)
Tx of renal vein thrombosis. Consider if AKI present
Anticoag, or thrombolysis is AKI present
