Allergy and Immunology

Question 1

Difference between anaphylaxis and anaphylactoid reaction

Answer 1

Anaphylaxis = IgE mediated with prior sensitization to the antigen

Anaphylactoid reaction = non-IgE related, clinically identical and treated the same way, but do not need preceding sensitization to the antigen

Question 2

Best initial therapy for anaphylaxis

Answer 2

1. Epinephrine
2. Antihistamines: diphenhydramine (H1-blocker) and ranitidine (H2-blocker)
3. Glucocorticoids
4. Emergent airway protection if needed

Question 3

Although angioedema is often idiopathic, what medication should you ask about in patients presenting with sudden swelling of their face/tongue/eyes/airway?

Answer 3

If they recently started an ACE inhibitor

Question 4

True/False

Hereditary angioedema DOES NOT respond to glucocorticoids

Answer 4

True

Question 5

Best initial test when suspecting angioedema

Answer 5

Decreased levels of C2 and C4

2/2 deficiency of C1 esterase inhibitor

Question 6

Treatment for angioedema

Answer 6

1. Protect the airway
2. FFP or Ecallantide
3. Androgens: danazol and stanazol

Question 7

Define Urticaria

Answer 7

Allergic reaction that causes sudden swelling of the superficial layers of the skin (considered part of anaphylaxis)

Question 8

Treatment for urticaria

Answer 8

1. Antihistamines
2. Leukotriene receptor antagonists

Question 9

Treatment for allergic rhinitis

Answer 9

1. Avoidance of allergen (e.g., cover mattresses and pillows)
2. Intranasal corticosteroid sprays
3. Antihistamines
4. Intranasal anticholinergic medications
5. Desensitization

Question 10

Low B cell output

Normal T cells

Answer 10

CVID

Question 11

Low B cells

Normal T cells

Young male

Answer 11

X-linked (Bruton) agammaglobulinemia

Question 12

Low B cells and T cells

Analogous to HIV

Answer 12

SCID

Question 13

Atopic disorders

Anaphylaxis

Answer 13

IgA deficiency

Question 14

Recurrent skin infections with Staph

Answer 14

Hyper IgE syndrome

Question 15

Normal T cells

Normal B cells

Low platelets

Eczema

Answer 15

Wiskott-Aldrich syndrome

Question 16

Infections, combined with:

Staph

Burkholderia

Nocardia

Aspergillus

Answer 16

CGD

Question 17

Recurrent sinopulmonary infections in adults (equal gender distribution) with normal amounts of lymphoid tissue (nodes, adenoids, and tonsils)

Answer 17

CVID

Increased risk of lymphoma

Treatment = IVIG

Question 18

Absence of tonsils, adenoids, and lymph nodes

Male children with increased sinopulmonary infections

Answer 18

X-linked (Bruton) Agammaglobulinemia

Treatment = IVIG

Question 19

Treatment for SCID

Answer 19

Bone Marrow Transplant (BMT)

Question 20

Anaphylaxis to blood transfusion

Answer 20

Think IgA deficiency

Question 21

Should you give IVIG to someone with IgA deficiency

Answer 21

No

They will not work because the amount of IgA in the product is too insignificant to be therapeutic and the trace amounts of IgA in IVIG may provoke anaphylaxis

Question 22

Treatment for Hyper IgE Syndrome

Answer 22

Prophylactic antibiotics (dicloxacillin or cephalexin)

Question 23

Treatment for Wiskott-Aldrich Syndrome

Answer 23

BMT (T lymphocytes are markedly deficient in the blood and lymph nodes)

Question 24

Diagnostic test for CGD

Answer 24

Abnormal nitroblue tetrazolium testing

Detects decrease in the respiratory burst 2/2 a decrease in NADPH oxidase