Allergy/immunology Flashcards by Emily W

Resolution food allergy

Cows milk 85% by 8
Egg 70%
Peanut 20%
Fish 3%

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Venom allergic reaction risk next event anaphylactic

10%

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Drug urticaria

Last 6-12h and in 0.3%

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Percent of infants with food allergy

10%

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Anaphylaxis to egg and influenza vaccine

Do in hospital with 1/10th of dose

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Adrenaline for anaphylaxis

1;1,000 / 0.3-0.5mg

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Primary immunodeficiency presenting with recurrent sinopulm infections

CVID, XLA, transient hypogammaglobulinemia of infancy, complement def

Tx with ivig 4 weekly or subcutaneous ig weekly (300-600mg/kg/month) aim for igG 7-8g/L (doesn’t correct igA def)

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XL hypogammaglobulinaemia caused by

Present at 6-8m when maternal levels fall
Bruton kinase def with absent B cells and low immunoglobulins (all)
No LN (lymphoid hypoplasia)
No tonsils
Poor response to vaccine

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CVID clinically

Low IgG and decrease in IgA or IgM
Poor antibody response to vaccine

Ddx transient

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SCID presentation

Broad infections, FTT, persistent diarrhoea, by 3m, no thymic shadow on cxr, total lymphocytes < 2.5
Fatal by 1 year
T and B cell failure
1/50,000 (45% XL)

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XL hyper IgM syndrome presentation

40% pneumocystis jiroveci, cryptosporidium
T cell defect
CD40 ligand is the affected protein (can’t class switch)
Immunoglobulin Tx
Pcp prophylaxis
With BMT 70% survival

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CGD signs and treatment

Defect in NADPH dep oxidase pathway

Signs:
Adenopathy, HSM, gingivitis, stomitis, abscess, diarrhoea, colitis
Raised Igs (Kell sratis in XL)
Catalase positive organisms

Dx: nitroblue tetrazolium test

Tx: Cotrimox and itraconazole prophylaxis
BMT

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Leukocyte adhesion def 1 presentation

Most common with <1% normal expression CD18, delay cord, high leuks (WCC over 15)
Destructive gingivitis
Severe necrotising bacterial infections
BMT curative

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C3 action

Half life 60 microsecond, opsonisation, solubilises immune complexes, enhances killing via MAC, potential humoral response

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Which cytokines causes T cell proliferation

IL2

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Digeorge Tx for immunodeficiency

BMT, thymic transplant curative

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Selective IgA def clinically

1/700 Caucasian
Sporadic
Asymptomatic
Occ Resp and Gi infections

Anaphylaxis to blood products cos contain IgA
Assoc autoimmune disorders

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IL-1 - 6 rolls

Hot T-bone sTEAk

IL-1 HOT (fever)made by macrophages causes fever, lymphocyte proliferation
IL-2 stimulates T cells (secreted by T)
IL-3 stimulatess bone marrow (secreted by T)
IL-4 induces Th2 and stimulates IgE production
IL-5 stimulates IgA production (proliferates eosinophils) Th2
IL-6 regulates CRP

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Half life neutrophils

6 h

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Symptoms of langerhans cell histocytosis

Common symptoms of LCH in children are recurrent rash, diabetes insipidus (24%) and
bone lesions (lytic usually scalp)
Seborrhaic dermatitis

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SCID specific tests

Lymphocyte phenotype (i.e. numbers of T cells/subsets, B cells)
Lymphocyte proliferation responses (i.e. lymphocyte function)

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Which IL causes T cell proliferation

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Milk and egg allergy percent tolerate it baked

> 75%

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Will next allergic reaction be worse

It’s a myth

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Cow’s milk resolution age and percent

85% by age 8

Serum sickness reaction is a type 1-4?

Type III hypersensitivity reaction (immune complex mediated) Also retaliated to autoimmune conditions

Steven johnsons syndrome and chronic renal transplant rejection are what type of hypersensitivity reaction

Type IV delayed type when sensitised Th1 cells activat and release cytokines and bind causing increase in macrophages and cytotoxic T cells

Type 1 and 2 hypersensitivity reactions are? Which illnesses

1: immediate IgE in anaphylaxis or hay fever 2: antibody mediated in haemolytic anaemia of newborn or graves

Double row of teeth with what syndrome

Hyper IgE

Hyper IgE triad

Abscesses, increased IgE and pneumatocoele pneumonia

Immune cell important in transplant rejection

T cell (t for transplant)

If brother allergic to peanuts sibling risk

5-10%

Anaphylaxis to penicillin risk with cephalosporins

<5% (likely less than 1%)

Serum sickness triad (eg adter thymoglobulin)

Rash (urticaria) Migratory poly arthritis (joints) Fever

Half life of serum IgM

7 days

Cows milk allergy 80% outgrow by

16 Milk too allergen then egg second

IgE receptors mostly on

Mast cells (Th2 cell sends IL3/4/5/9 to mast and eosinophils

What cell produced antibodies

B cell T cell CD4 (MHC II) and CD8 (MHC I)

Mutation in NBN | Microcephalic immune def and increased cancer risk in

Nijmegen breakage syndrome

Eye telegectasia and ataxia and risk infection | Test and dx?

AFP | Ataxia telegectasia

``` Which of the following immunoglobulins fix complement when they bind to antigen? A. Only IgG. B. IgG and IgA. C. IgG, IgA and IgM. D. IgG and IgM. E. Only IgM. ```

IL-5 role

acts as a growth and differentiation factor for both B cells and eosinophils

Interleukin 1 (IL-1) is primarily produced by

Mast cells

CVID risk of what infections

Encapsulated bacteria such as S pneumoniae, S pyogenes, and H influenzae are the most common pathogens.

Moderate reaction to bee likelihood of anaphylaxis next time

10% | 30-60% if previous anaphylaxis

Food allergy afftcys what percent NZ infants

10% (5% overall)

Present with recurrent sinopulmonary infections DDx

CVID XLA THI

A type 2 helper T lymphocyte (Th2 cell) differs most from a type 1 helper T lymphocyte (Th1 cell) in which one of the following? A. Production of interleukin 3 (IL-3). B. Production of interleukin 5 (IL-5). C. Responsiveness to antigen presented by macrophages. D. Surface expression of CD4. E. Surface expression of major histocompatibility complex (MHC) class II molecules.

B All IL starting with T and F secreted by T cells (Th1 secretes IFN gamma)

``` Which one of the following major immunoglobulin classes in the human fixes the alternate complement pathway? A. IgA. B. IgD. C. IgE. D. IgG. E. IgM. ```

FcER1 receptor is on what cell

Mast cell derived from CD4 haematopoetic progenitor cell

CGD catalase positive organisms are

CGD Catalase-positive organisms: PLACESS for CATs | Pseudomonas, Listeria, Aspergillus, Candida, E-coli, S. aureus, Serratia

Interferon one and two and TNF alpha

``` Interferons: Type I (alpha and beta): o Antiviral agents mainly produced by fibroblasts and monocytes. Inhibit viral RNA and DNA production, increase expression of MHC1 leading to enhanced lysis by cytotoxic T lymphocytes. o Antiproliferative function. Type II (gamma): o Gamma interferon activates macrophage and neutrophil intracellular killing, stimulates NK cells and enhances T cell responses by increasing MHCII expression.  TNFAlpha: increases phagocyte funct ```

What cell in terminal centres predominate

B cells

Half life igG

1 month

What is in a mast cell graunule

histamine, various cytokines (such as tumour necrosis factor (TNF), IL-4) and mast cell-specific proteases (such as chymases, tryptases and carboxypeptidase A3 (CPA3) chondroitin, heparin

Measles exposure (5 days prior and after onset rash) prophylaxis for 1 year old? Pregnant woman?

Can consider MMR in infant over 6m but need a second booster 4 weeks laster immunocompromised or immune-deficient people susceptible pregnant women immune-competent infants aged under 6 months where there is no evidence of maternal immunity (presence of maternal antibody, or documentation of two MMR doses or previous history of measles infection) immune-competent children aged between 6 and 15 months, who are outside the 72-hour exposure window for MMR vaccine.

Half life IgA IgM and IgE

5-7 days M and A | IgE 3 days

Complement for chemotaxsis

C5a

What protects complement cascade from inactivation

Properdin

Initially all immature T cells (CD3) become CD4 or 8 what do these both do?

CD 4 are T helper cells which bind to MHC2 on APC and activate B cells to make immunoglobulins, activate macrophages CD8 cells are NK cells and bind MHC1-Ag and kill viral infected and tumour cells

Half life neutrophils

6 hours

Complement pathway how does it work? What does a and b do

C1-4 classical Usual cascade if known antigen C3 randomly splits on own if unknown antigen Then C5 joins C6,7,8,9 to form MAC (membrane attack complex) A parts signal allergy like response and b parts bind proteins

HPV and Hep B what type of vaccine?

Recombinant | HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.

Pneumococcus vaccine type

Conjugated

Dihydrorhodamine (DHR) flow cytometric analysis is used to evaluate

granulocyte oxidative bursts and is the test of choice for the diagnosis of chronic granulomatous disease (CGD)

12-24 month old with low albumin, protein losing enteropathy and microcytic anaemia possible cause?

Cow milk protein induced

IL 7-18 rolls?

Maturation is Key at 21st for All Party Games ``` IL-7: maturation from marrow IL-8: chemotaxsis neutrophils IL-10: decrease IL-2 IL-12: make Th1 IL-13: allergy IL-17: pro inflammatory IL-18: IFgamna production ```

Name the antigen or sending cells with MHC class two molecules?

B cells Macrophages Monocytes

SCID screening from

No detected TREC T cell receptor excision circle

STAT3 mutation in

Hyper IgE

FoxP3 affected in

IPEX

Adult range IgA IgG complements and IgM

IgM and complement 12m IgG 5y IgA adolescent

Most common complement deficiency