Allergy / Imm Flashcards
anaphylactoid reactions
what are they
likely culprits
direct degranulation of mast cells, not IgE - can pretreat
- vanco red man (pretreat)
- opiod
- radiocontrast media
nasal polyps… do what?
screen for CF!
epi dose for anaphylaxis
1:1000
IM 0.01 mg/kg up to 0.3ML q15 min
abdominal pain, painful swelling at sites of trauma?
Dx
Test
Tx
hereditary angioedema
autosomal dominant, C1 inhibitor defect.
Complement C4 is best screening test
Tx w/ anabolic steroid (danazol) or newer C1INH prep for attack
serum triptase used to confirm what?
anaphylaxis to insect
what is urticaria pigmentosa
tx?
cutaneous mastocytosis
tx w/ H1/H2 blockade
red/brown macules that urticate when stroked, need bx? vasculitis
chronic urticaria def
cause?
lasts > 6 wks
90% idiopathic
joint and kidney involved, with one giant urticaria and target lesions 1 week after exposure?
serum sickness
hives with exercise?
cholinergic urticaria
Dx w/ recurrent bacterial infx at 4-6 mos, paucity of lymphoid tissue
Tx?
Risk of what major bug/dz
X linked agammaglobulinemia
Risk of meningoenceph w/ enteroviral
Tx w/ IVIG
most common immunoglobulin deficiency?
IgA def
inheritance of hyper IgM?
Sx
x-linked
recurrent abscesses, high IgE levels, dental anomalies
Hyper IgE syndrome
hallmark of phagocyte def?
Test?
Tx?
abnormal neutrophils very high levels, adenopathy, staph infx (catalase producers), lots of ulcers and recurrent infx of many types.
Abnormal NBT test
Tx w/ interferon gamma
syndrome with recurrent staph infx, large granules in WBC, may have partial albinism and periph neuropathy
Chediak-Higashi syndrome
recurrent infx w/o pus, delayed umbilical cord separation?
leukocyte adhesion def
No abscess formation b/c no pus
recurrent staph, abscesses, fungal infx, osteomyelitis with aspergillus, Serratia
CGD def! phagocyte def
% of asthma with resolution by adulthood
60%
TReatment of serum sickness?
oral steroids
interstitial nephritis and antibiotics is caused by what?
methicillin
recurrent neisseria meningitis
Dx and test?
Complement def C6-C9: check CH50
pollen food oral allergy syndrome, what foods?
Ragweed vs Tree polon
Ragweed: watermelon, melons, banana
Tree pollen: apple, pear, cherry, plum
FRESH ONLY
tx of chronic allergic rhinitis w/ lots of congestion?
intranasal steroids for congestion
pyoderma gangrenosum in what disease
IBD
defect in X-linked agammaglobulinemia
Tx
Bruton’s tyrosine kinase gene (no B cells / Immunoglobulin)
Tx: IVIG, broad spectrum Abx
TReatment for T cell deficiencies?
Stem cell or bone marrow trp to reconstitute
Treatment of SCID
ADA def, so replace with bovine ADA
Tx of Digeorge immunodef?
Thymic transplant
patient with recurrent bronchospasm and bronchiectasis with transient wandering pulm infiltrates
Dx?
Lab test?
allergic bronchopulmonary aspergillosis (NEED dx of chronic asthma for this)
Has high Total serum IgE or IgG
latex food allergy cross reaction, which foods?
ABCs: avocado, banana, chestnut, Kiwi (cross of banana / papaya)
recurr infx, eczema, bleeding?
Wiskott Aldrich Sydrome, X linked
Top 5 food allergies?
milk, eggs, soy, wheat, peanuts
most important predictor of asthma, eczema, allergic rhinitis?
Breast feeding does what?
parental hx: 50% if 1, 75% if two.
bf delays onset, but risk is same at age 2y
diagnosis of allergic rhinitis?
What is the major DDX?
snot eos
Also found in NARES: non-allergic rhinitis with eosinophilia syndrome: but Skin test and serum IgE levels neg/normal
Treatment and Medication for allergic rhinitis?
Treatment: Immunotherapy
Medication: nasal steroids
what to do during immunotherapy if local skin reaction occurs?
wait 15-30, continue if no systemic rxn
def: rhinitis medicamentosa and vasomotor rhinitis
medicamentosa: rebound to adrenergic nasal drops
vasomotor: drainage but no trigger / infx agent
recurrent rhinorrhea in child less than 3y?
URI! Pollen needs lots of exposure over years, not seen before 3y
treatment of chronic urticaria?
fexofenadine
type of reaction of contrast media?
Tx?
osmolality, hypertonicity rxn triggering mast cell degranulation/basophils. NOT IgE! Prevent w/ pretreatment (benadryl/steroids)
Treatment of child with life threatening rxn to bee sting?
allergist! Venom immunotherapy (98% effective for future rxns)
IgE mediated reaction is what type?
Anaphylactic, A Type 1
Ab mediated type of allergic rxn?
Type 2: Ab = B reaction
Type three allergic reaction is what?
Immune Complex / Arthus rxn
Type 4 allergic rxn is what?
Delayed hypersens: skin test PPD / Poison ivy
sneezing, wheezing, squeezing (tight chest), teary eyes.
Dx?
Ragweed Respiratory rxn
Drugs that may interfere with skin testing for allergies?
Antihistamine / drugs with these effects like TCAs / imipramine
RAST vs skin testing
skin testing in vivo, risk of anaphylaxis, but more sensitive and cheaper.
RAST in vitro, not impacted by antihistamine tx and no anaphylaxis risk
Rule that reassurance is okay with frequent infx?
about 1/month, self limited GI and resp WITHOUT growth/FTT and without RECURRENT infx of one type.
recurrent pyogenic infx. Think what immunodef?
B cell Ab dysfunction
Chronic recurrent candida infx? Type of immunodef?
T cell dysfunction
No lymphoid tissue and recurrent infx/
SCID
key component in adaptive immunity?
Antigen presenting cells
ataxia, discolored conjunctivae, frequent sinus infx?
Dx and lab test / prognosis?
Ataxia telangiectasia
Incr AFP/risk for ca
Elevated T cell count, decreased lymphoid tissue, recurrent encapsulated pyogenic bacteria: strep pneumo, pseudomonas, H flu
Bruton’s x-linked aggamaglobulinemia: Bcells affected so no plasma cells
Recurrent ear infx, pna then sinusitis in older kid?
Dx, dx test / confirmation, Tx, Prognosis?
Bruton’s X linked agammaglobulinemia XLA
Check immunoglobulin levels, then if low check B and T cell subsets.
Tx w/ IVIG
Risk for bronchiectasis and CLD
most common primary immunodef?
Associated with what?
Prognosis / Risk
Tx?
CVID
assoc w/ autoimmune dz too. Hi risk of lymphoma/EBV related
Tx w/ IVIG
transmission of most complement def? exception?
autosomal recessive except X-linked properdin def
Best treatment for DiGeorge?
thymic transplantation for prevention of infx
Absence of CD40 ligand causes what?
Risk for what dz?
Tx?
X-linked hyper IgM syndrome: disrupts B cell differentiation (Can’t change IgM –> IgG
High risk of PCP w/o HIV
Tx w/ Ig replacement (IVIG) and bactrim for PCP prophylaxis
HyperE syndrome? Also called Sx? Infx Assoc features Tx
Job Syndrome: Three Es: Eos, eczema, elevated IgE
Infx w/ S aureus, chronic thrush
Assoc w/ fractures, abnormal faces
Tx w/ Abx and steroids
Lab Diagnosis of SCID
complete absence of T cell function, B cells may be normal
Flurometric analysis of T, B, and NK cell subsets
Severe infx, dermatitis, diarrhea, FTT in first few months of life, DX? A specific type?
Tx
SCID, may be ADA deficiency
BMT
situation in which 6 mo has lots of infections and lab has severely low IgG, slightly low IgA, and normal IgM.
Transient hypogammaglobulinemia of infancy due to decreased helper T cell function
S. aureus abscesses and serratia marcescens UTIs, think of what immuno def? Tx?
Phagocyte issue: CGT
Tx: Abx, interferon gamma
Dx w/ high WBC > 20,000and infx w/ perirectal abscess, indolent skin infx, omphalitis but NO PUS, delayed wound healing
LAD: leukocyte adhesion def
Tx for LAD?
BMT can be curative
Zidovudine type of drug
nucleoside analog
nevirapine type of drug
reverse transcriptase inhib
indinavir type of drug
protease inhib
normal NBT test?
turns blue: good neutrophil ACTIVITY
what test for ability of cells to migrate in LAD?
Rebuck Skin Window
consider this dx if Ab levels are high in the first year but dysfunctional, and then later on are low?
HIV in infant
