Allergy Immunoligy Flashcards
What is the role of beta blockers in allergy?
“Beta-blockers should be stopped in patients with a history of anaphylaxis if possible. Beta-blockers amplify anaphylaxis and make it more difficult to treat.”
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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What is vocal cord dysfunction (VCD) and what is its significance?
“Patients with VCD present with hoarseness, coughing, dyspnea, and loud inspiratory wheezing/stridor, along with other symptoms mentioned above. Pulmonary function testing indicates airway obstruction due to an extrathoracic component. It appears that paradoxical inspiratory vocal cord adduction causes airflow restriction at the level of the larynx, thereby resulting in a flattened inspiratory loop on flow-volume diagram”
Name the three foods that latex has an allergic cross-reactivity with.
“Symptoms of oral allergy syndrome can include oral pruritus with or without angioedema of the lips, tongue, palate, and posterior oropharynx. Cross-reactivity has been reported between:
Ragweed antigens and the gourd family and banana.
Birch pollen allergy may result in sensitivity to apple, carrots, parsnips, celery, hazelnuts, and potatoes.
Latex-fruit cross-reactivity may occur with banana, avocado, passion fruit, kiwi, and chestnut, but not celery”
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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What is the medication regimen for contrast dye allergy?
“The appropriate premedication regimen for contrast dye allergy includes (1) diphenhydramine 50 mg IM/PO 1 hour before procedure and (2) prednisone 50 mg PO 13 hours, 7 hours, and 1 hour before procedure.”
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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What are the most common foods involved in food allergy?
“Studies have shown that eight foods account for 93% of reactions, and these foods are, in order of frequency, egg, peanuts, milk, soy, tree nuts, fish, crustacean, and wheat”
“Although these food allergies may be outgrown, sensitivity to peanut, tree nuts, fish, and crustacean tend to be lifelong”
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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Which vaccination is contraindicated in patients allergic to egg?
Influenza vaccine. “As of 2012 the CDC suggests vaccinating egg allergic patients as long their reaction was hives only”
Also, MMR used to have an egg contraindication because it is derived from chicken, but no longer.
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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What is hereditary angioedema and how is it diagnosed?
“hereditary angioedema (HAE), or C1-esterase inhibitor deficiency. This entity is clinically characterized by recurrent episodes of angioedema involving any part of the body. Thus, it can present with laryngeal angioedema (the major cause of death) or recurrent abdominal pain (generally with a normal white count and “always” without peritoneal signs). Urticaria is not a feature of this disorder. HAE is caused by a C1-esterase inhibitor deficiency, which allows an overexuberant activation of the complement cascade. For this reason, patients with C1-esterase inhibitor deficiency have chronically low levels of C2 and C4. They may have normal levels of C1-esterase inhibitor but have a nonfunctional allele.”
“C4 levels should be low if the patient has C1-esterase inhibitor deficiency. Of course, you will also check a C1-esterase inhibitor level keeping in mind that the nonfunctional allele may give a false negative test (e.g., the presence of a nonfunctional C1-esterase inhibitor).”
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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What is the patient education that you need to give patients with hereditary angioedema?
“Most attacks are precipitated by trauma (often head and upper airway trauma), medical procedures (dental and oral surgery in particular), emotional stress, infections, menstruation, or the use of medications, especially oral contraceptives “and ACE inhibitors. Interestingly, H. pylori infection has been associated with HAE, and H. pylori eradication reduces the frequency of angioedema attacks.”
Excerpt From: Mark Graber & Jason Wilbur. Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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What is the treatment for hereditary angioedema?
Primarily patient education.
Emergency epinephrine and antihistamines have not generally been effective, as HAE is not allergic in nature. Prophylactic treatment in the form of attenuated androgens (danazol) is available. Attenuated androgens appear to work by up-regulating the synthetic capability of hepatic cells that make C1-esterase inhibitor, thus raising the C4 level and reducing the number and severity of acute exacerbations.
“Treatment of acute episodes of HAE includes FFP that contains C1-esterase inhibitor, the C1-esterase inhibitor replacement protein products, and bradykinin/kallikrein inhibitors Additionally, these three options could be used as prophylactic treatment in short-term situations, such as prior to surgery in a high-risk patient. However, FFP would not be a long-term preventive measure.
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What are the chances that a biologic sibling of a patient with hereditary angioedema also has the disease?
It is about 50%.“HAE is transmitted in an autosomal-dominant fashion with incomplete penetrance, which may be why the patient’s sister is less symptomatic. New mutations do arise and cause a minority of cases.”
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
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What is the typical treatment for someone exhibiting a allergic reaction to shellfish?
Antihistamines and steroids.
What is the most common presentation of a patient with immunoglobulin a deficiency?
“IgA deficiency is present in approximately 1 in 700 Caucasians in the United States and is the second most common immunodeficiency described. Most of these patients are asymptomatic, but some IgA-deficient patients may present with an increased rate of respiratory tract infections”
It is important to work up patients with immunoglobulin a deficiency because they often have other accompanying immunodeficiency syndrome’s.
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.
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Which type of immunodeficiency syndrome is most often associated with a anaphylactic reaction to IVIG?
“Patients with IgA deficiency have preformed IgG or IgE antibodies against IgA, and thus may develop an anaphylactic reaction in response to IVIG”
“Not all patients with IgA deficiency will develop anaphylaxis, but the risk is high enough to be prepared and to reduce the risk by using IgA-depleted IVIG and giving the IVIG slowly”
Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.
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