allergy/immuno Flashcards
anaphylaxis
acute systemic IgE mediated reaction
what does anaphylaxis effect?
vascular tone and bronchial reactivity
mechanism of of anaphylaxis
antigen binding to IgE on the surface of mast cells and basophils results int eh release of potent mediators that affect vascular tone and bronchial activity
what are the cardiovascular symptoms relating to anaphylaxis?
ranges from mild hypotension to shock
what is the treatment for acture respiratory and cardiovascular complications of anaphylaxis?
epinephrine
this is an IgE mediated inflammatory response int he nasal mucosa to inhaled antigens
allergic rhinitis
pathophysiology behind allergic rhinitis
mast cells degranulate and release histamine, leukotrienes, kinins, and prostaglandins
these are dark circles under the eyes caused by VENOUS CONGESTION
allergic shinders
these are creases under the eyes as a result of CHRONIC EDEMA
Dennie’s lines
what is the lab eval of allergic rhinitis?
total IgE concentration may be elevated, allergen skin testing
what is critical to do before an allergy skin test?
discontinue antihistamines 4-7 days before skin testing
how can you differentiate allergic rhinitis from other disorders
more than 10% eosinophils suggests allergic rhinitis
more POLYMORPHIC LEUKOCYTES SUGGESTS AN INFECTION CAUSE
what is the most effective class of drugs for controlling rhinitis symptoms?
intranasal steroids
what are the 2 benefits of intranassal steroids
minimal systemic absorption, and the hypothalamic pituitary adrenal axis is not affected at recommended doses
diphenhydramine is a ____ generation antihistamine that may cause _____ and can impair academic performance
first generation antihistamine
sedation
cetirizine, fexofenadine, loratidine are all what class of drugs
second generation antihistamines that are safer and better tolerated
how does cromolyn sodium work?
prevents max cell degranulation
these relieve vasoconstriction and relieve nasal congestion but can cause insomnia, nervousness and rebound rhinitis?
decongestants (pseudoephedrine)
repeated injections of allergens with time lead to ?
better tolerance of the allergen by the patient
chronic inflamm dermatitis
atopic dermatitis (eczema)
characteristics of eczema
dry skin and lichenification
when is atopic dermatitis worse?
in extremes of temperature
is atopic dermatitis familial?
yes
acute or chronic? erythema, weeping and crusting and secondary staph aureus, hsv infection?
ACUTE
acute or chronic? lichenification, dry scaly skin and pigmentary changes?
chronic
truncal and facial area, scalp and EXTENSOR SURFACES are affected
infantile form of atopic dermatitis
FLexural serfeces, lichenifcation ?
early childhood form of atopic dermatitis
what are the 4 major criteria of eczema?
pruritus
personal/familial history of atopy
typical morphologic distribution
relapsing or chronic dermatitis
management of eczema
avoid known triggers
low to medium potency corticosteroid cream except on face
antihisamines
baths
this is an igE mediated response to food antigens?
food allergy
what are most allergic reactions caused by?
egg, milk, peanut, soy wheat and fish
true or false, exclusive breastfeeding for 6 months may decrease food allergies and atopic dermatitis in the infant?
true
what are the 2 tests for food allergies?
skin tests and radioallergosorbent tests
what its he definitive test for food allergy?
double blind placebo controlled food challenge test
what can local skin reactions be treated with for insect bites?
cold compresses, analgesics and antihistamines
diffuse urticartia tx
antihistamines and systemic steroids
this is a circumscribes, raised vanishing areas of edema that are always pruritic? they are are also symmetric and migratory
urticaria
these 2 groups of ppl are at higher risk for acute urticaria due to latex allergy
MYELOMENINGOCELE
health care workers
this is urticaria that last >6 months
chronic urticaria
what is chronic urticaria usually associated with?
malignancy and rheumatologic disease
those with chronic urticaria generally have an Ig___ antibody to the Ig____ receptor
IgG antibody to the IgE receptor
these are common drugs that cause drug allergies
penicillin, sulfonamides, cephalosporins, aspirin and other non steroidal antiinflam drugs and narcotics
phagocytic cells, nK cells, toll-like receptors, mannose binding protein and alternative complement pathway are all what type of response?
innate response ( first defense)
T cells, B cells and immunoglobulin molecules are all what type of response?
adaptive responses
serum igA concentrations
IgA deficiency ( most common deficiency)
a patient comes in with recurrent sinusitis, pneumonia, otitis media and bronchitis along w/ chronic diarrhea and foul smelling fatty droplet diarrhea w/ SLE and JVA will most likely have what?
igA deficiency
how is igA deficiency diagnosed?
quantitative measurement of serum immunoglobulin
true or false IVIG is indicated in IgA deficiency?
false, IVIG is not indicated b/c IgA cannot be replaces, IVIG is not indicated because it contains almost all IgG
normal numbers of B and T cells but variable degrees of T - cell dysfunction?
common variable immunodeficiency w/ HYPOGAMMAGLOBULINEMIA
a fully immunized boy comes in but his titers still show low antibodies? what does he most probably have?
diminished antibody function due to common variable immunodeficiency
3 treatments for common variable immunodeficiency?
monthly IVIG replacement
aggressive management of infections w/ antibiotics
chronic diarrhea management w/ nutritional support
deficiency of the common gamma chain of receptor for cytokines IL 2,4,7,9 and 15?
x linked SCID
caused by T- cell ontogeny defect and adenosine deaminiase def?
Autosomal recessive SCID
what 2 opportunistic organisms will cause infection within the first few months of life in a baby w/ SCIDS?
candida and pneumocystis carinii
how will a patient w/ acids present in CBC? flow cytometry? ogg? t cell response?
- perisient lymphopenia
treatments for SCIDS
- supportive care
- blood prudcts be irradiated to prevent draft vs. host disease
- monthly IVIG replacement
- TMPSMX prophylaxis for P. Carinii
combined immunodeficiency, cerebellar ataxia, oculocutaneous telangiectasias, and predisposition to malignancy?
mutation of a gene on the long arm of CHROMOSOME 11
ataxia telangiectasia
true or false? most patients diagnosed w/ ataxia telangiectasia will need wheel chair assistance by early adolescence?
true
what are most patients w/ ataxia telengectasia deficient in?
IgE and IgA
what should those w/ ataxia telangiectasia avoid?
avoid ionizing radiation which exacerbates DNA breakage and repair thus increasing risk for malignancy
cardiac defects, abnormal facies, thymic hypoplasia, cleft palate and hypocalcemia?
digeorges syndrome
what chromosome is involved w/ digeorges syndrome?
22q11
x linked disoder characterized by combined immunodeficiency, eczema, congenital thrombocytopenia w/ small platelets?
wiskott aldrich syndrome
what gene product is lost in wiskott aldrich syndrome?
t - cell receptor signaling and cyto skeletal organization
what will those w/ wiskott aldrich syndrome generally present w/
- infection w/ encapsulated organism such as h. influenza and s. pneumo
- thromboycytopenia w/ small defective platelets ( frequent bleeding episodes)
- eczema
those with wiskott aldrich syndrome will have decreased Ig_____
IgM
what is the therapy of choice for wiskott aldriche syndrome?
HLA matched bone transplantation
what will cure the thromboycytopenia in wiskott aldrich?
splenectomy
severe hypogammaglobulinemia w/ a paucity of mature B cels in peripheral blood w/ normal t- cell number and function?
Brutons Agammaglobulinemia
this gene is critical to normal B-cell ontogeny and mutations lead to a block in the development from Pre-b Cellt o B cell?
BTK
what is preserved in britons a gammaglobulinemia?
t - cells are present and cell mediated functions are preserved, IVIG replacement to prevent infection
defective NADPH results in what?
chronic granulomatous disease
does chronic grandulomatous disease affect catalase positive or negative bacteria?
catalase positive
what are 3 disorders of granulocytes?
CGD, schwachman diamond syndrome, chediak higashi sydrome
what is characteristic of CGD?
abscess formation
what is the diagnostic test for CGD?
nitroblue tetrazolium test
what 3 things are given prophylactically to CGD patients?
TMP SMX, itraconazole for aspergillus, interferon gamma
patients with disease present with recurrent soft tissue infection, chronic diarrhea and failure to thrive
schachman diamond syndrome
patients with those infections generally have s. aureus infections, neutropenia, thrombocytopenia, and partial albinism
chediak higashi syndrome
composed of plasma proteins and cellular receptors functioning in an integrated series to prevent infection
complement systom
how can you differentiate between early component deficiency vs. late component?
early - autoimmune
late - increased meningococcal and gonococcal infections
this type of complement deficiency will cause heretarary angioedema and episodic swelling ov arious body parts including hands and feet and bowel
C1 esterase deficiency
how can you diagnose complementt system disorders
CH50
management of complement deficiency
- tx bacterial infect
- manage autoimmune disease
- fibrinolysis inhibitiors and attenuated androgens (DANAZOL) for hereditary angioedema
