Allergy & Immunology 2% Flashcards
Hypersensitivity rxns
Type I: Immediate, IgE
Type II: Cytotoxic, IgG/M
Type III Immune complex IgG, M
Type IV: Cell Medidiated
Type I Hypersensitivity
Immediate, IgE
Weed, pollen, dust, grass, mold cat or Dog progeins (atopic), hives, utricaria, peanuts, shellfish, bee stings, drugs
Tyope II - Cytotoxic
Antibody mediated (no ab/ag complexes)
Hemolytic rxn, goodpastrure’s
hyperacute graft rejection
Type III Immune complex IgG/M
Serum sickness, SLE, Post Strep Glomerulonephritis, PAN, RA, Arthus rxn, hypersensitive Pneumonitis
Type IV Cell medicated
PPD, Poison Ivy, Nicketl, Type I DM, acute and chronic graft rejection, Latex
IgE
Type I
Cytotoxic cell mediated (Ab nwsuRWS XTRIRIZUX EZB(
Type II
Immune complex mediated
Type III
Cell mediated/delayed
Type IV
ABPA
Type I (mold)
Hyperseitivity pneumonitis
Type III
Rh incompatibility
Type II
ABO incomaptiblity
Type II
Arthus rxn
Type III (Immune complex dep mediated)
Serum Sickness
Type III
SLE, PAN, RA, Hep B
Type III (Hep C low complement)
PPD, Poison Ivy, Nickel, Latex
Type IV
Hyperacute graft rejection
Type II
Acute or chronic graft rejection
Type IV
Allergic Rhinitis/Urticaria
Type I
Wheal and flare
Type I
Pt with sore throat - hematuria _-> Pre-renal azotemia
Antigen-ab rxn (type III)
Pt receiving IV abx for endocarditis - pt c/o arthralgias - mechanism of arthralgia is….
immune complex depeostion - serum complement low
RAST (radioallergosorbent test
measures IgE in serum (quantitiative immunoglobulins)
Skin testing (pin prick test)
more specific and sensitive
Pt with rhinitis, occular itching exacerbated by pollen best test?
Pin Prick test
Can you do skin testing if pt on anti-histamine
No - reduces sensitivity for 7 days
Nursing student started using latex glove for first time and pw hives - best test to confirm?
RAST for allergy to latex
Can yo give allergy injections to ABPA?
NO!! will make it worse
Can you give allergy injections to prevent contrast dye rxn or hypersensivity pneumonitis
No not IgE mediated….
How can you dx ABPA
Serum IgE level
Effetive immunotherapy causes increas in what ab type
IgG
What med will you NOT use during immunotherapy
BB - will interfere with epi tx
Pt on BB - receives immunotx and gets anaphylactic rxn - in addition to epi what else to give?
glucagon to reverse BB effect
Pt has allergy to ASA 0 what NSAID can you use?
Salicylate
Best way to reduce rxn in pt allergic to radiocontrast media
Diphenyhydramine, steroids, lower osmolar radiocontrast
HLA I ag
most tissues EXCEPT RBCs
presented to T8 cells
responsible for TRANSPLANT rejection and destroying tumor cells
HLA II ag
B cells, macrophages, langerhan cells, dendritic cells - presented to T4 helper cells - > responsible for cell mediated immunity
Pt gets utricaria when exposed to COLD
cold cryoglobulin - IgE mediated
All the following are T cell mediated
Nickel Poison IVY PPD Cosmetics/hair dyes (NOT NSAIDS)
Which anti inflamm drug contraindicated with sulfa allergy
Celecoxib (has sulfa)
Pt with latex allergy while using condoms
polyurethane condoms
Pt after seeing needle or blood - becomes anxious, pale diaphoretic and passes out BP 80/60, HR 40 dx?
Vasovagal syncope
Pt post IWMI gets TPA - 30min later HR 35, BP 70/40 wtd?
atropine to inc vagal tone
Pt gets utricaria when exposed to heat or hot shower
Cholinergic utricaria
You suspect allergic rhinitis wtd?
nasal secretions - smear for eosinophils
What is effetive in any type of rhinits including perennial allergic rhinitis?
Nasal glucocorticoids
Cromolyn on good with allergic rhinitis
Pt stung by bee pw broncospasm, utricaria, flusing BP 94/60 HR 100 IVF started wtd?
SQ Epinephrine
Whic of follwing would benefit from immunotx?
Bee keeper
not ABPA, not hypersensitiveity pneumonits
Pt with wasp sting, local wheal, burnign sensation wtd?
cool compress, antihitamine, topical calamine, elevate for local rxn
Young man was picking apples and was stung by bee - next day presents to you with large wheal on R arm - itch wtd?
reassurethat this is normal rxn to insect bite
Bee stings on face, neck throat ->
swelling lips, tongue largngeal edema
Bee sting to other parts of body
local rxn
Immune defiicenices
dec'd ab (immunoglobulins MM AIDS Asplenia ALL/CLL CVID All inc'd risk for capsulated bugs - S pneumo, H flu, Meningiococcus
B cells -> plasma cells -> Ab’s (HLA II)
MOst common Immunoglobulin def
IgA def
Does IVIG help in IgA deficieny?
No - causes anaphylaxis
IN IGA nephropathy what is complement level?
Normal
Pt with severe IgA deficiency which is contraindicated
IVIG - anaphylaxis
HAV vacc, HBV vacc, FFP, plts all ok
32yo Pt with recurrent sinusitis for 5 years - nasal endoscopic surgery done couple years ago now pw facial pain and xray shows total opacification of maxillary sinuses
Immunoglobulin titers
Pt with recurrent bronchitis x 25 years - when he takes TMP-SMZ infxn resolves CXR normal wtd?
Immunoglobulin titers
Neutropenia
Bacterial: Pseudomonas, corynebacterium jeikeium
Fungal: andida, aspergillus (halo sign), Mucor
Tx: INc’d count with G=-CSF and tx infection
Phagocytic deficit
Staph aureus, Gram neg, fungal, nocardia
Able to INGEST , but UNABLE to DIGEST - recurrent infections, fhx for recurrent infexns, NBT abnormal failure to produce O2 super radicals
dx: Chronic granulomatous dz, NADPH oxidase deficiency
Tx: Interferon gamma and abx
Chronic mucocutaneous candidiasis
Candidiasis of skin and MM
severe, recurrent thrush, onychomyosis, vaginitis, chronic skin lesions
maylook hyperkeratotic, crusted on face, scalp, hands
Solitary furuncle infection 4x in past 5 years - easily tx with incision and drainage
DX: Nasal colonization with staph (under finger nails)
Can eradicate with mupirocin ointment and rifampin
Complement C1 esterase inhibitor deficiency
Hereditary angioedema
responds to FFP
no response to Epi
Type I hereditary angioedema
dec’d C4, dec’d C1 inhibitor (total)
Type II hereditary angioedema
Dec’d C4, NORMAL C1 inhibitor total but dec’d C1 inhibitor fxn
Acquired Angioedema
all decreased (C4, C1q, C1 inhib total and fxn)
ACEi induced angioedmea
All normal (C4, C1q, C1 inhib total and fxn)
Pt after pillow fight or after camping with non-pitting facial edema - no itching - similar sx before - most likely dx?
C1 esterase inhib deficiency - if don’t know why welling - r/o C1 esterase inhibitor deficiency
Teen pw swelling arm, no erythema or itching what to expect
Low C4, CH50
screen for C1 esterase inhibitor deficiency
Pt post excercise deelops swelling of arms, no hx of trauma, father died at early age wtd?
check C2, C4
Pt hiking in shenandoah mtns pw facial swelling no itching no erythema wtd?
C1 esterase inhibitor activity level
Best management for pt with facila swelling ,laryngeal edema and h/o C1 esterase inhibitor deficiency
FFP (NOT EPI)
Long term tx: Danazol -> stimulates release of C1 esterase inhibitor
SLE
Complement dec’d (C3 more than C4)
IgA nephropathy
Complement normal
Post strep GN
complement dec’d (C3 only dec’d)
Wegeners
complement normal
Churg Strauss
COmplement normal
PAN
Complement normal
Cryoglobulinemia
complement dec’d (C4 more than C3)
Goodpasture’s
complement normal
Membranoproliferative nephritis
Complement dec’d
Pt h/o meningiococcemia and gonorrhea what test to order?
CH50
if dec’d check C5-9
Pt with SLE, CH50 undectectable - what complement component def suspect?
C3
Pt with recurrent infections in skin, sinusitis, PNA now with liver abscess - Immunoglobulins normal, CH50 low which complement likely deficient?
C3
Major opsonin of complement system responsible for defense against encapsulated bacteria
