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ENT Flashcards > Allergy, Etc. > Flashcards

Allergy, Etc. Flashcards

1
Q

Type I Hypersensitivity

A

IgE mediated
Ex: Anaphylaxis, angioedema, food allergy, insect bite

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2
Q

Type II Hypersensitivity

A

IgG or IgM mediated
Complement activation involved
Ex: Transfusion reaction, hemolytic disease of newborn

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3
Q

Type III Hypersensitivity

A

IgG or IgM mediated
Antigen-antibody complexes
PSGN, RA, SLE

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4
Q

Type IV Hypersensitivity

A

Th1 cell mediated
DELAYED
Contact dermatitis (poison ivy), MS

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5
Q

“Contraindications” to allergy testing

A

Must stop antihistamines, beta agonists, TCAs prior to testing
No glycerin sensitivity (serves as control), no skin conditions (i.e. dermatographia)

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6
Q

Intradermal Dilutional Testing - what is the endpoint?

A

Endpoint is when you get > 2 mm from “control” - helps determine safe starting point for immunotherapy.
If you don’t get ANY 2 mm or more difference, it’s a negative test!

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7
Q

Only two branches of ICA in the nose

A

Anterior and posterior ethmoids (from ophthalmic branch of ICA) - you do NOT embolize these!

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8
Q

What is the dose of epi in an epi pen?

A

0.3 mg

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9
Q

Most prevalent allergens in:
Spring
Summer
Fall
Year Round

A

Spring: Tree pollen
Summer: Grasses
Fall: Ragweed
Mold: All year round

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10
Q

Kiesselbach’s Plexus

A

Septal b. of sup. labial (from facial –> ECA)
Anterior ethmoid (from ICA)
Sphenopalatine (from IMAX –> ECA)
Greater palatine (from IMAX –> ECA)

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11
Q

What fungus is associated with the Ohio and Mississippi river valley?

A

Histoplasmosis

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12
Q

Which chemokines are responsible for IgE recruitment and what type of inflammation is this?

A

IL-4, 5 and 13
Type TWO inflammation (CRSwNP)

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13
Q

Mechanism of Atrovent and uses?

A

Anticholinergic agent, aka ipratropium bromide, used for vasomotor rhinitis but also can be used for allergic rhinitis. Less effective for coughing, sneezing, etc.

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14
Q

One intranasal corticosteroid that is NOT safe for pregnancy?

A

Triamcinolone.

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15
Q

Mechanism of Montelukast + uses?

A

Leukotriene receptor antagonist, used for seasonal allergies.
Black box warning for psych side effects
OK to continue with allergy testing.

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16
Q

What has cross reactivity with latex?

A

Avocado, chestnut, banana, kiwi and papaya can exhibit allergy cross reactivity with latex.

17
Q

Which interleukins are involved in TH1 vs TH2 response?

A

TH1: IL10, IL12, IFN gamma
TH2: IL4, 5 and 13 (dont forget IL33 is involved in activation of these)

18
Q

CVID Features?

A

-Decreased IgG, IgA, some have low IgM
-Think young adults with respiratory disease, granulomas, malignancy
-TX: IVIG

19
Q

Brutton’s agammaglobulinemia features?

A

-Tyrosine kinase issue affects B cells - can’t produce antibodies
-~6 months of age presentation, usuall in young boys
-Lots of sinopulmonary infections
-X linked!

20
Q

What do TH1 and TH2 cells secrete?

A

TH1: IFN-gamma (–> macrophage activation, Il-2 expression)
TH2: IL-4, IL-5, IL-13

21
Q

Type V hypersensitivity features and examples?

A

Ab resembles a ligand
Ex: Graves, Hashimotos, Myesthenia Gravis

22
Q

Pathway for sublingual or subcutaneous immunotherapy and timeline? Contraindications? How to monitor?

A

Upregulated T reg cells produce IL-10, INHIBIT Th-2 (and switches to TH1 pathway).
3-5 years for TX
Serum total IgE/total IgE for monitoring
Contraindications: Pregnancy, autoimmune, anaphylaxis

23
Q

How does RAST work and who is it good for?

A

In VITRO blood testing
Blood test looking at how much of patient’s IgE in serum binds to Ag (basically…). Compares IgE to specific allergen/Total IgE
-Must wait 4-6 weeks post allergic reaction
-Good for people who can’t stop certain medications, have high risk of anaphylaxis, dermatographia, etc.
-More SPECIFIC, LESS sensitive than skin testing
-Interpretation:
0-2 insignificant
3-6 significant
5-6 severed

24
Q

Intradermal Dilution Testing

A

-Helpful for determining immunotherapy dosages
-Endpoint = first wheal > 2 mm from control (confirms where to start). You do one additional injected which should be > 2 mm from endpoint, thus CONFIRMING prior endpoint.
-Used as primary testing for penicillin, insect venoms (do 1-2 months after sting)

25
Q

Three key findings in central compartment atopic disease?

A

-Nasal cavity edema/polyps (not so much in the sinuses)
-Hx of Asthma
-Elevated total + specific IgE
*Likely requires allergy management as a core treatment component!

26
Q

When do you STOP the following for allergy testing?
Topical Steroid
TCA
Oral Antihistamine
Topical Antihistamine

A

Topical steroid: 3 weeks prior
TCA (the tryptilines): 2 weeks prior
Oral Antihistamine: 5-7 days prior
Topical Antihistamine: 3 days prior

27
Q

What drugs are OK to continue with allergy testing?

A

Oral steroids, Leukotriene inhibitors, asthma inhalers, topical nasal steroids

28
Q

Treatment for anaphylaxis?

A

Epinephrine, steroids, antihistamines, albuterol inhaler, monitor closely for biphasic reaction!
Tryptase will stay elevated up to 6 hrs (released from mast cells)

29
Q

Components of:
Innate immunity?
Adaptive immunity?

A

Innate: Skin, TLR, phagocytes, natural killer cells, compliment, neutrophils, macrophages
Adaptive: B + T Cells

30
Q

Draw an antibody and explain which part is responsible for antigen binding?

A

Two parts:
1. Fab - Heavy and ligh chain, binds antigen. N terminal
2. Fc - Heavy chain ONLY, C terminal
IgG = just one
IgM = Pentamer
IgA= Dimer

31
Q

What cells does IgE bind to to release histamine?

A

Basophils + mast cells

32
Q

What does immunotherapy alter (cytokines, etc)?

A

INCREASES IgG4
INCREASES IL-10
Shifts from TH2 TO TH1

33
Q

Which Ig deficiency is most common in PEDS vs ADULTS?

A

PEDS: IgG2
Adults: IgG3

34
Q

What is the only food allergy approved for SLIT?
What allergies are ok for SCIT?

A

Peanut allergy. Food allergies are NOT approved for SCIT.

SCIT: Allergic asthma, perennial allergic rhinitis, seasonal allergies unresponsive to other meds, hymeroptra venom

35
Q

Wiskott Aldrich Syndrome Features?

A

WATER
X linked
Thrombocytopenia
Eczema
Recurent infection
LOW IgM, NORMAL IgG, ELEVATED IgE + IgA
WASP gene

36
Q

LEAST and MOST drowsy second generation antihistamine?

A

Fexofenidine (Allegra) - LEAST
Certirizine (Zyrtec) - MOST

37
Q

What allergy is least likely to resolve with age?

A

Tree nuts

38
Q

What is the MOST common primary immune deficiency and SX?

A

IgA!
Can be A-sx or have sinopulmonary Infections
At risk of anaphylaxis with blood transfusion that contains IgA

ENT Flashcards (12 decks)

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