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Pediatrics > Allergy and Immunology > Flashcards

Allergy and Immunology Flashcards

1
Q

Describe the innate immune system

A

Includes complement, macrophages and NK cells. Nonspecific, rapid acting and no memory

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2
Q

Describe the adaptive immune system

A

T and B cells and immunoglobulins. Much slower, very specific and has memory

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3
Q

What are the two major functions of t cells

A

1.) Destroy intracellular and other bacteria, viruses, fungi, parasites and mycobacteria 2.) The regulate antibody production by B cells

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4
Q

When do CD8 t cell recognize an antigen

A

If presented with HLA class I antigen

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5
Q

When do CD4 t cell recognize an antigen

A

If presented with HLA class II antigen

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6
Q

CD2+ and CD3+

A

t cells

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7
Q

CD19+ and CD20+

A

b cells

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8
Q

CD16+ and CD56+

A

NK cells

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9
Q

What do CD8+ t cells do?

A

cytotoxic to viruses and neoplastic cells

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10
Q

Which immunoglobulins can activate the complement pathway?

A

2 IgGs or 1 IgM pentamer. Activate the classical pathway.

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11
Q

Wiskott-Aldrich syndrome

A

x linked, eczema, thrombocytopenia and immunodeficiency

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12
Q

What is Bloom syndrome

A

Similar to ataxia-telangectasia in that it is a “chromosomal instability syndrome. Small stature, telangectasia, CNS abnormalities, immunodeficiency. High association with leukemia

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13
Q

What is x linked lymphoproliferative disease or Duncan syndrome?

A

x linked lymphoproliferative disease that cuases severe infeciton with EBV causing hepatitis, B cell lymphoma, agrnulocytosis, aplastic anemia. EBV triggers polyclonal expansion of T and B cells - those who survive are Antibody deficient.

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14
Q

Kostmann Syndrome

A

AR familial severe neutropenia. Treat with GMSF

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15
Q

Which situations should you not give give live attenuated vaccines to household contacts

A

kids with SCID, avoid live flu and VZV to household contacts.

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16
Q

Can kids with HIV gets live vaccines

A

If not severely immunocomp can get MMR and VZV at 12 months

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17
Q

Type 1 hypersensitivity

A

IGE mediated, immediate (anaphylactic, atopic)

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18
Q

Type 2 hypersensitivity

A

IgG mediated, cytotoxic

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19
Q

Type 3 hypersensitivity

A

Immune complex mediated

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20
Q

Type 4 hypersensitivity

A

cell -mediated

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21
Q

What are examples of non IgE anaphylaxis?

A

NSAIDs, asa, physical stress can cause the release of cytoplasmic granules from mast cells

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22
Q

How much epi is in Epipen and Epipen Jr?

A

Epipen = 0.3mg for pt>30kg, Epipen Jr = 0.15mg for pts

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23
Q

What is the concentration of IV epi vs IM epi

A

IM epi is 1:1000, 1mg/ml; IV is 1:10000, 1mg/10ml

24
Q

Cutaneous mastocystosis

A

rare disorder of increased mast cells in dermis causing urticaria pigmentosa which is diagnosed by formation of a wheal upon gentle stroking of a macule

25
Q

Systemic mastocystosis

A

Increased mast cells in skin and tissue. Have abdominal symptoms, flushing and fatigue in addition to urticaria pigmentosa

26
Q

Malignant mastocytosis

A

severe systemic symptoms but no skin changes. HSM and LAD. Elevated tryptase levels >20, BMB indicated

27
Q

which stinging insect is most likely to cause anaphylaxis?

A

yellow jacket

28
Q

episodic swelling at areas of trauma without pruritis, but with AD inheritance suggests what?

A

Hereditary Ci inhibitor deficiency. A function defect in C1 inhibitor consumes C4 continuously. Screen by checking C4 first

29
Q

What does urticaria after swimming suggest?

A

cold urticaria. There is no allergic component, an ice cube test confirms the presence of cold urticaria

30
Q

What fruits most often cross react with latex allergy?

A

banana, avocado, kiwi, chestnut

31
Q

What is oral allergy and which foods are most often implicated?

A

aka pollen-food allergy syndrome, is an IgE mediated condition that mostly affects the oropharynx. 2/2 cross reactivity between proteins in pollens and fresh fruits and vegetables.

32
Q

by how much can venom immunotherapy reduce the risk of a subsequent reaction?

A

to

33
Q

Is immunotherapy effective for hypersensitivity to foods?

A

No

34
Q

If a patient has hypotension, uritcaria, itching with radiocontrast dye, can they get it again?

A

This is likely not an IgE reaction. Most likely due to mast cell mediated mechanism. High risk patients should get prednisone and antihistamines - can decrease the risk to 1%

35
Q

What is type 3 hypersensitivity?

A

serum sickness - can be mediated by IgG or IgM antibody- antigen complexes. Can be deposited in various organs and activate the complement system.

36
Q

What amount of steroid prevents giving live attenuated vaccines

A

20mg/d or more for 14 days. Must wait one month after going off of it to give live vaccine

37
Q

Who needs irradiated blood

A

patients with defects in cell mediated immunity - SCID, DiGeorge, post transplant. They are at risk for GVHD when they receive nonirradiated products containing immunoreactive t cells from unmatched donors

38
Q

What are risk factors for persistent asthma

A

smoke exposure, obesity and early menarche in girls, maternal age less than 20 at time of birth

39
Q

What can decrease the risk of asthma

A

breast feeding for at least first 4 months, avoiding allergenic pets, avoid smoke exposure, reducing multiplle allergens

40
Q

What percent of asthma persists into adulthood

A

25-75%

41
Q

What percent of patients with allergic rhinitis will get asthma?

A

20% over 10 year f/u

42
Q

What percent of patients with asthma will get allergic rhinitis?

A

85%

43
Q

What is the difference between percutaneous and intradermal skin testing

A

intradermal is more sensitive, but less specific, more painful and higher risk for anaphylaxis. Used for hymenoptera venom sensitivity

44
Q

which meds need to be stopped before skin testing?

A

omalizumab, antihistamines, H1 and H2 blockers, strong topical corticosteroids, TCAs

45
Q

What is food protein induced enterocolitis syndrome

A

secondary to cows milk and soy. Presents at 1-3 months. Chronic severe symptoms: V/D, melena, FTT, acidosis, methemoglobin, toxic appearance; if stop causive food, symptoms resolve, recur with reintroduction. Resovles by 2-3 years but must rechallenge in the hospital

46
Q

What is better for suspected food allergy, RAST or skin testing?

A

skin testing has low PPV, RAST can identify 95% of patients with food allergy. Negative test of each makes allergy very unlikely. Immunotherapy not effective for food

47
Q

are air filters helpful for dust mite exposure prevention?

A

no because they are heavy and does not remain suspended for long. (however HEPA air filters help for dog hair)

48
Q

Does skin allergy testing help in chronic urticaria?

A

No a positive skin test in a patient with chronic urticaria does not necessarily mean that is the cause of the chronic urticaria.

49
Q

If you have a shellfish allergy, do you need to worry about contrast allergy?

A

No, even though both have iodine, this is a myth. RCM reaction is not IgE mediated either. No need for pretreatment

50
Q

If a patient had a life threatening allergic reaction should you do skin or RAST?

A

RAST

51
Q

Tell me about allergy testing for hymenoptera

A

25% false negative rate for both skin and RAST. Therefore if one is neg, go to the other. The testing should be done 4-6weks after the reaction to be reliable

52
Q

Do you have to stop antihistamines for RAST testing?

A

No

53
Q

In which patients is specific immunotherapy contraindicated?

A

Specific immunotherapy is contraindicated in patients with cardiac disease. Other conditions that should induce caution when using SIT include autoimmune conditions, immunodeficiency syndromes, and malignant disease

54
Q

which deficiency is associated with early onset SLE?

A

C2 deficiency

55
Q

Ataxia-telangestasia

A

AR disorder - ataxia early in life, telangectasia 5 years of age, elevated alpha -1 feta protein, multiple infections

56
Q

Job syndrome

A

hyper -IgE syndrome. asymmetric face, broad nose, traingular jaw, eczema, scoliosis, hyperextensible joints, recurrent cold abscesses, eosinophilia

Pediatrics (25 decks)

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