Allergy & Immunology Flashcards by juhee lee

[Allergy/HS]

Acute Type 1 hypersensitivity?
- Different name: __
- Mediators: __
- Cells involved: __
- Timing: __

Type 1 - acute
Name: Immediate, acute HS
Mediators: Allergen specific Immunoglobulin E (IgE) mediated
Cells: Mast cells and basophils
Timing: Minutes to an hour

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[Allergy/HS]

Late phase Type 1 hypersensitivity?
- Different name: __
- Mediators: __
- Cells involved: __
- Timing: __

Name: Immediate, late phase HS
Mediators: IgE
Cells: Eosinophils and basophils
Timing: 2 - 12 hours after the immediate reaction, Can last hours to days

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[Allergy/HS]

Type 2 hypersensitivity?
- Different name
- Mediators
- Cells involved

Name: Cytotoxic HS
Mediators: IgG, rarely IgM
Cells: Phagocytes

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[Allergy/HS]

Type 3 hypersensitivity?
- Different name
- Mediators
- Cells involved

Name: Immune complex mediated HS
Mediators: IgG or IgA immune complex precipitation
Cells: Phagocytes

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[Allergy/HS]

Type 4 hypersensitivity?
- Different name
- Mediators
- Cells involved

Name: Delayed or cell mediated
Mediators: T-Cells
Cells: T-cells and phagocytes

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[Allergy/HS]

Examples of Type 1 hypersensitivity? (3)

A
F
U

Allergic conjunctivitis, allergic rhinitis, and allergic asthma
Foods (e.g., peanuts, tree nuts), insect stings, latex allergy
Urticaria (angioedema and anaphylaxis when severe)

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[Allergy/HS]

Examples of drugs of Type 1 hypersensitivity? (2)

Penicillin
Chemotherapies

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[Allergy/HS]

Function?
H1 receptor: __
H2 receptor: __

H1: Wheal and flare reaction, bronchoconstriction, and pruritus

H2: Increased gastric acid secretion
(Eg. H2 blocker, Ranitidine, Zantac)

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[Allergy/HS]

Examples of Type 2 hypersensitivity? (3)
Target cell receptors and disease

Platelets - immune thrombocytopenia
RBCs - Autoimmune hemolytic anemia
WBCs - Leukopenia

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[Allergy/HS]

Examples of Type 2 hypersensitivity? (3)
Target fixed-tissue antigen and disease

Basement membrane component in kidney and lungs - Goodpasture syndrome
ACh receptor on muscle cells - Myasthenia gravis
Thyroid hormone receptor - Graves disease

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[Allergy/HS]

2 types of type 3 hypersensitivity?

Serum sickness
Arthus reaction

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[Allergy/HS]

Mechanism?
Serum sickness reaction vs Arthus reaction (type 3 hypersensitivity)?

Amount of antigen: __
Immunization status: __
Presentation: __

Serum sickness
Amount of antigen: Large
Immunization status: Non-immunized
Presentation: Necrotic vasculitis

Arthus reaction
Amount of antigen: Small
Immunization status: Hyperimmunized
Presentation: 4-6 hours of vaccination, painful induration and sterile abscess

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[Allergy/HS]

Examples of type 3 hypersensitivity autoimmune diseases? (4)

Systemic lupus erythematosus
Rheumatoid arthritis
Pernicious anemia
IgA vasculitis

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[Allergy/HS]

Examples of type 4 hypersensitivity? (4)

Allergic contact dermatitis (Poison ivy, Nickel)
Granulomatous disease (Crohn disease, Sarcoidosis)
Allograft rejection
Graft-versus-host disease

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[Allergy/Anaphylaxis]

Anaphylaxis diagnosis criteria? (3)

Any 1 of the following 3 criteria:
1. Sudden onset with involvement of the skin or lmucosal tissue and either (2): __
2. >=2 of the following occur suddnely after exposure to a likely allergen (3): __
3. __ after exposure to a known allergen

Any 1 of the following 3 criteria:
1. Sudden onset with involvement of the skin or lmucosal tissue and either:
i) Sudden respiratory symptoms or
ii) Hypotension
2. >=2 of the following occur suddnely after exposure to a likely allergen
i) Skin or mucosal tissue involvement (hives, rash, swelling)
ii) Respiratory symptoms (wheezing, cough, chest tightness)
iii) Hypotension
iv) GI symptoms
3. Hypotension after exposure to a known allergen

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[Allergy/Anaphylaxis]

Common anaphylaxis allergens? (5)

F
I
B
A
R

Foods (MNEWS: milk, nuts, wheat, eggs, seafood)
Insulin
Blood products
Antibiotics (Penicillin), NSAIDs,
Radioactive dye

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[Allergy/Anaphylaxis]

Treatment of anaphylaxis? (3)

Epinephrine 1st line, IM
IV dephenhydramine and cimetidine (relieves hives not swelling or shock)
+/- Steroid for late phase

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[Allergy/Anaphylaxis]

Epinephrine dose for anaphylaxis?

IM dose __ mg/kg, max __ mg in 1:__ epinephrine

IM dose 0.01 mg/kg, max 0.5 mg in 1:1000 epinephrine

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[Allergy/Urticaria]

Duration for acute vs chronic urticaria?

Acute urticaria < __ weeks
Chronic urticaria > __ weeks

Acute urticaria < 6 weeks
Chronic urticaria > 6 weeks

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[Allergy/Urticaria]

Common triggers for acute urticaria? (4)

D
I
F
I

Drugs (penicillin, cephalosporins)
Infection, viral
Foods
Insect bites

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[Allergy/Urticaria]

Test for immediate pressure urticaria?

Dermatographism

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[Allergy/Urticaria]

Proposed mechanism for chronic urticaria?

Autoimmune etiologies

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[Allergy/Urticaria]

Treatment for chronic urticaria? (3)

H2 antihistamins, non-sedating 2nd Generation: loratadine (claritin), cetirizine (zyrtec)
Immunosuppressive: Omalizumab, cyclosporine
Steroid

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[Allergy/Urticaria]

Causes other than autoimmune for chronic urticaria? (4)

Cold: Acquired cold urticaria, familial cold urticaria
Heat: Cholinergic urticaria
Pressure: Immediate pressure urticaria, delayed pressure urticaria
Insect bite: Papular urticaria

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# [Allergy/Urticaria] Diagnosis? Autosomal dominant After cold exposure, urticaria, myalgias, fever and joint pain

Familial cold urticaria

# [Allergy/Urticaria] Diagnosis? Hives lasting > 24 hours, fixed Ecchymosis, hyperpigmentation, and purpura Elevated ESR, ANA positive, hypocomplementemia Leukocytoclastic vasculitis in skin biopsy

Urticarial vasculitis

# [Allergy/Urticaria] Diagnosis? Treatment? Trigger: After insect bites, especially fleas Sx: Papules in group with central punctum

Papular urticaria - Treatment: 2nd gen antihistamines: loratadine (Claritin), cetrizine (Zyrtec) Topical glucocorticoids

# [Allergy/Urticaria] Diagnosis? Diagnostic test? Infants with reddish-brown macular lesions

Urticaria pigmentosa (mastocytosis) - Test: Diagnosed by formation of wheal on gentle stroking

# [Allergy/Urticaria] Two types of isolated angioedema without urticaria?

1. ACE inhibitor induced angioedema 2. Hereditary angioedema

# [Allergy/ARC] Physical findings of allergic rhinoconjunctivitis? (6)

1. Nasal polyps 2. Allergic shiners (dark circles under the eyes) 3. Nasal crease (due to nasal salute) 4. Dennie-Morgan lines (folds below the eyes due to edema) 5. Enlarged tonsils and adenoids 6. Cobblestoning in oropharynx

# [Allergy/ARC] Most common environmental seasonal triggers? Spring: __ Summer: __ Fall: __ Year-around: __

Spring: Tree pollens Summer: Grass pollens Fall: Weeds Year-around: Mold

# [Allergy/AR] Treatment for allergic rhinitis (3)

1. Intranasal spray 2. 2nd gen antihistamines: cetirizine (zyrtec), loratadine (claritin) 3. Montelukast (singulair)

# [Allergy/Food] Vaccine administration needs to be _monitored_ with egg allergy (2)?

1. Influenza 2. Yellow fever

# [Allergy/Food] Contraindication/indication of influenza vaccine with egg allergy? (3) Only hives: __ Systemic or anaphylaxis: __ Severe reaction to influenza vaccine: __

Only hives: can receive Systemic or anaphylaxis: can receive under medical supervision Severe reaction to influenza vaccine: can’t receive

# [Allergy/Food] Examples of non-IgE mediated food allergy? (3)

1. Eosinophilic esophagitis 2. Protein-induced proctitis/proctocolitis 3. Food protein-induced enterocolitis syndrome (FPIES)

# [Allergy/Food/PIP, FPIES] Protein-induced proctitis/proctocolitis vs Food protein-induced enterocolitis syndrome Streaks of blood in stools in infants otherwise well: __ Protracted vomiting, diarrhea, abdominal distention, lethargy, hypotension in infants: __

**Protein-induced proctitis/proctocolitis** Streaks of blood in stools in infants otherwise well **Food protein-induced enterocolitis syndrome** Protracted vomiting, diarrhea, abdominal distention, lethargy, hypotension in infants

# [Allergy/Food] Fruits with cross reactivity to latex allergy? (PeeKaBoo PACT)

**P**apaya, **K**iwi, **B**anana **P**otato, **A**vocado, **C**hestnut, **T**omato (PeeKaBoo PACT)

# [Allergy/Latex] High risks for developing latex allergy (2)?

1. Spina bifida, congenital urologic problems 2. Multiple surgeries at early age

# [Allergy/Drug] Antibiotics of choice with penicillin allergy?

2nd and 3rd generation cephalosporine

# [Allergy/Drug] Diagnosis? Management? Flushing, erythema itching after Vancomycin

Vancomycin flushing syndrome - Management: Lowering infusion rate with antihistamines

# [Allergy/Drug] Diagnosis? Common triggering medication? Treatment? 'String of pearls signs': rings of blisters

Linear IgA dermatosis - Trigger: Vancomycin, most common - Treatment: Dapson

# [Allergy/Drug] Diagnosis? Common triggering medication? Well-circumscribed, re-appearing lesions with the same trigger,

Fixed drug eruption - Trigger: TMP/SMX, tetracyclines, quinolones Antiseizure meds, pseudoephedrine

# [Allergy/Drug] Distinctions between Stevens-Johnson syndrome and toxic epidermal necrolysis? SJS < __% body surface area (BSA) TEN > __ % BSA

SJS < _10_ % body surface area (BSA) TEN > _10_ % BSA

# [Allergy/Drug] Diagnosis? Treatment? Urticaria, edema, arthralgia, GI: nausea/vomiting Children 1-3 weeks after antibiotics Eosinophilia, Proteinuria, Elevated ESR, decreased C3, C4

Serum-sickness like reactions - Tx: Supportive care, discontinuing offending drug

# [Allergy/Drug/SS] Difference between serum sickness and serum sickness like reactions?

Serum-sickness: usually adults, with monoclonal antibodies Serum-sickness _like reactions_: children after antibiotics

# [Allergy/eczema] Treatment options for atopic dermatitis? (3)

1. Moisturizers 2. Topical corticosteroid, topical calcineurin inhibitor, crisaborole ointment 3. Wet wraps

# [Imm/ID] Which immunodeficiency? Sinopulmonary infections after maternal antibodies depleted Common organisms: Encapsulated bacteria: NHS and P (Neisseria, Haemophilus, Staph or Strep, Pseudomonas) (No IgG or IgM) Virus: Enterovirus (no IgA) Protozoa: Giardia (no IgA or IgE)

B-cell deficiency

# [Imm/ID] Which immunodeficiency? Intracellular organisms and opportunistic infections Common organisms: Intracellular bacteria: Salmonella, Syphilis Mycobacteria: tuberculosis, Mycobacteria avium complex Virus: CMV, Herpes, VZV, EBV, hepatitis, HPV, Molluscum Fungi: Candida, Aspergillus, Coccidioidomycosis, Cryptococcus, Histoplasmosis Protozoa: Pneumocystis, toxoplasmosis, cryptosporidiosis,

T-cell deficiency

# [Imm/ID] Which immunodeficiency? Sx: Skin and organ abscesses Common organism: SNS (**S**. aureus, **N**ocardia, **S**erratia)

Phagocytic disorder

# [Imm/ID] Which immunodeficiency? Sx: recurrent severe infections like cellulitis, arthritis, meningitis, osteomyelitis, sepsis Common organisms: Bacteria: pyogenic bacteria, mycobacteria Virus: Herpes

Toll-like receptor defects

# [Imm/ID] Which immunodeficiency? Sx: overwhelming sepsis Common organism: Neisseria meningitis S. pneumoniae

Complement deficiency

# [Imm/ID/B-cell] Test for B-cell deficiency? Quantitative (2): __ Qualitative (1): __

Quantitative - Flow cytometry for CD 19+ cells - Immunoglobulines Qualitative - Response to vaccines

# [Imm/ID/T-cell] Test for T-cell deficiency? Quantitative (2): __ Qualitative (2): __

Quantitative - Flow cytometry for CD3+ , CD4+ and CD8+ cells - CBC Qualitative - Delayed-type hypersensitivity - Lymphocyte proliferation to mitogens and antigens

# [Imm/ID/Phago] Test for phagocyte deficiency? Quantitative (1): __ Qualitative (1): __

Quantitative - CBC Qualitative - Neutrophil oxidation (DHR: DiHyroRhodamine oxidation)

# [Imm/ID/Comp] Test for complement defects? Quantitative (1): __ Qualitative (1): __

Quantitative - C3, C4, CH50, AH50, C1 esterase inhibitor Qualitative - C1 esterase inhibitor function

# [Imm/ID] Which immunodeficiency? Mechanism? Age: Between 6 months to 2 years old Sx: Recurrent bacterial infections (AOM), GI infection (persistent diarrhea), FTT PE: absence or small lymph nodes Lab: low or no B-cell on flow cytometry, low in all Igs

X-linked Agammaglobulinemia (XLA) Mechanism: BTK gene (B cell development) defect -> Arrest in pre-B cell stage

# [Imm/ID] Which more commonly seen? Common variable immunodeficiency (CVID) vs X-linked Agammaglobulinemia (XLA) Sarcoid-like disease with noncaseating granulomas Immune thrombocytopenia Pernicious anemia, hemolytic anemia Amyloidosis

Common variable immunodeficiency (CVID)

# [Imm/ID] Which immunodeficiency and its mechanism? Age: early infancy or early childhood Sx: Recurrent and severe bacterial infections pneumonia and Opportunistic infections (PJP), chronic diarrhea with cryptosporodium PE: Mouth ulcers, periodontal disease, HSM, LAD

Hyper IgM syndrome Mechanism: X-linked and AR, CD40L gene defect on T cells -> Defect in T cell-B cell signaling -> can't switch IgM to other class Ig

# [Imm/ID] Which immune disorder? Age: childhood, <10 years old Sx: Fulminant infectious mononucleosis, HLH, lymphoma, aplastic anemia PE: HSM, LAD

X-linked lymphoproliferative disease (Duncan syndrome)

# [Imm/Basic] Time line for Lowest Ig in infancy and time for reach adult level?

Lowest at 2-3 months Adult level at 3-4 years

# [Imm/ID] Nezelof syndrome Inheritance: __ Immune dysfunction: __

Autosomal recessive Varying degree of T-cell dysfunction

# [Imm/SCID] Two common forms of severe combined immunodeficiency (SCID)?

1. X-linked IL-2 receptor γ (IL-2Rγ) defect (X-linked SCID) 2. AR adenosine deaminase (ADA) deficiency

# [Imm/ID/WAS] Classic triad of Wiskott-Aldrich Syndrome? E X I T

**E**czema **X**-linked **I**mmunodeficiency **T**hrombocytopenia Newborn with prolonged bleeding after circumcision, eczema, small platelets

# [Imm/ID] Which immunodeficiency? Mechanism? Sx: Delayed umbilical cord separation, omphalitis, and severe gingitvitis

Leukocyte adhesion deficiency (LAD) type 1 Mechanism: CD18 gene defect, phagocyte chemotaxis disorder

# [Imm/ID] Which immunodeficiency? Common cause of skin infection? Abscess without redness, heat (cold abscess), eczema, dysmorphic fase, delayed dental exfoliation

Hyper IgE syndrome (Job syndrome) S. aureus

# [Imm/ID] Which immunodeficiency? Mechanism? Peripheral smear finding? Partial oculocutaneous albinism, progressive neurologic deterioration, cutaneous, sinopulmonary infections

Chediak-Higashi syndrome Mechanism: Impaired lysosome degranulation PBS: Giant granules in neutrophils

# [Imm/ID] Which immunodeficiency? Diagnostic test? Serious skin, perirectal infection, liver abscess, and osteomyelitis with S. aureus, Norcadia, Serretia

Chronic granulomatous disease Test: DHR (dihydrorhodamine) oxidation

# [Imm/ID] Which immunodeficiency? Pyogenic, encapsulated bacterial infection and SLE

Early complement deficiency (C1, C2, or C4 deficiency, C3 deficiency)

# [Imm/ID] Which immunodeficiency? Severe Neisseria infection

Terminal complement deficiency (C5-9 MAC deficiency)

# [Imm/ID/Comp] What CH50 measures and meaning?

CH50 measures total complement hemolytic activity Normal test means all C1-9 present

# [Imm/ID] Which immunodeficiency and screening/diagnostic test? Sudden abdominal pain and extremity swelling

Hereditary angioedema Screening: - low C4 Diagnose: - decreased C1-INH level (C1 inhibitor defect)

# [Imm/ID] Screening test for immunodeficiency? Humoral: __ Cellular: __ Complement: __

Humoral: IgG levels Cellular: flow cytometry with lymphocyte substes Complement: CH50

# [Imm/ID] Newborn screening suspected of primary immunodeficiency, what’s the next step? (3)

1. Prophylactic antibiotics (TMP-SMX) 2. CBC and flow cytometry 3. Urgent referral to allergy/immunology