Allergy/Immunology Flashcards
Name implicated foods in oral pollen food allergy syndrome against Birch pollen.
apple, almond, carrot, celery, cherry, hazelnut, kiwi, peach, pear, plum (Stone fruits!)
Name implicated foods in oral pollen food allergy syndrome against Ragweed pollen.
banana, cucumber, melons, sunflower seeds, zucchini( Melons and cylindrical things!)
Name components of Innate immunity (4) and adaptive immunity (2).
innate- nonspecific. phagocytes/natural killer cells, skin/mucous membranes, complement system/proteins, innate lymphoid cells. adaptive - T cells and B cells. specific to antigen.
Function, cell types, and inflammatory mediators of Th1, Th2, and Th17.
Th1 - neutrophils. IFN-y, IL-2. Delayed hypersensitivity, bacterial/viral immunity. Th2 - allergy, IgE. Mast cells, eosinophils, IL4, 5, 13. Th17 - autoimmunity; IL17.
Name 3 specific entities implicated as Th2 dominant/eosinophilic entities in CRS.
AERD/asthma, AFRS, CRS w NP
Specific functions of IL4, IL5, and IL13?
IL4 - IgE. IL5- eosinophil production. IL13 - polyp formation
Shape and function of IgG, IgM, IgE, and IgA?
IgG - dimer, chronic immunity/memory. IgM - pentamer, acute response. IgE - dimer, allergy. IgA - dimer, mucous membranes. IgG crosses placenta. IgA is in breastmilk. IgE has lowest serum concentration
Which immunoglobulin crosses placenta?
IgG
Which immunoglobulin is in breastmilk?
Ig!
Which immunoglobulin has the lowest serum concentration?
IgE
IgE: found on surface of which cell types? Induced by what mediator? Inhibited by which mediator?
Basophils and mast cells. Induced by Ig4. Inhibited by IFNy [Also a fun fact: confers immunity to helminths]
Fc vs Fab: heavy chain vs light chain? binds to cell or antigen? which determines Ig class?
Fc = heavy, binds to cell, determines Ig class. Fab = light chain, binds to antigen.
IgG subclass deficiencies: which ones are a/w protein antigens? polysaccharide antigens? Which one is the most common subclass deficiency in children?
protein - 1&3. Polysaccharide = 2&4. IgG2 most common subclass def in children.
What is the immunologic derangement in CVID
CVID = quantative + qualitaive issue with IgG.
What is the immunologic derangement in Specific Polysaccharide Antibody Deficiency
SPAD = can’t produce sufficient antibodies to polysaccharide organisms.
What is the immunologic derangement in Bruton’s agammaglobulinemia
Bruton’s = issue with B cell maturation.
What is the immunologic derangement in Digeorge? What is the mnemonic CATCH-22?
DiGeorge = full syndrome, thymic aplasia. C= cardiac defects, A = atresia of the choanae, T= thymic aplasia, C = cleft palate, H = hypocalcemia. 22 = chr 22
What is the immunologic derangement in Wiskott-Aldrich?
Wiskott-Aldrich = issue with WAS protein, eczema, bleeding + recurrent infections.
Which immunologic derangement disorders cause susceptibility to encapsulated organisms?
Encapsulated organisms: SPAD, Bruton’s.
Which immunologic derangement disorders are X-linked?
X-linked: Bruton’s, Wiskott-Aldrich.
Which immunologic derangement disordershave B cell issues only? Which ones have B and T cell issues?
B cell issues: Bruton’s, SPAD. B&T issues = Wiskott Aldrich, also often CVID, DiGeorge.
Which immunologic derangement disorder is implicated in CRSsNP? Which one will have absent tonsils/adenoids? Which one is missing thymus?
CRSsNP = SPAD. Absent tonsils/adenoids: Bruton’s. Absent thymus = DiGeorge.
Name, Mechanism, and 1-2 Examples of each of the Gel-Coombs Hypersensitivity Reaction Types?
I = IgE mediated; anaphylaxis/allergy. II - cytotoxic. Antibody binds to cell and signals inflammatory cells/mediators. Ex - Hashimoto, hemolytic disease of the newborn, transfusion reactions. III= immune complex, antigen-antibody complexes deposit in tissues. Ex - SLE, glomerulonephritis. IV - delayed/cell-mediated. T cell mediated, NOT antibody. Ex- contact dermatitis
Adult and Pediatric Doses of Epinephrine?
Adult = 0.3mg 1:1,000 epi. Pediatric = 0.1mg 1:1,000 epi. More precise is 0.01mg/kg. Given IM
Effect of epinephrine on alpha, beta-1, and beta-2 receptors?
alpha = vasocontriction. beta 1 - incr cardiac contractility/rate. beta 2 - bronchodilation, inhibition of mast cell degranulation
When do histamine and tryptase levels peak after an anaphylactic reaction?
15m for histamine, normal after ~30-40. 2h for tryptase, normal after 6h.
Angioedema: mediator in allergy vs ACE?
allergy = mast cell mediated. ACE = kinin mediated.
mode of inheritance for C1 esterase deficiency? screening test for this condition?
Autosomal dominant. quantitative C4 levels (always low)
What is dupilumab and what is it used for?
dupilumab - monoclonal antibody against IL-4; used for refractory polyposis
What is Samter’s triad/AERD? What is the MOA?
asthma, nasal polyposis, ASA sensitivity. MOA is disruption of the arachidonic acid pathway leading to increase in leukotrienes
Name 3-5 benefits of aspirin rx after desensitization. Can it eliminate pre-existing polyps?
Decrease need for surgery, decrease episodes of infectious sinusitis, improve asthma control, improve sense of smell, reduce dosage of daily systemic steroids, decrease nasal congestion. Does NOT eliminate pre-existing polyps.
Early vs Late phase of allergic response: a) timing of onset after exposure? b) mediators? c) symptoms?
early: 5-15 minutes, mediated by degranulation of mast cells/histamine, rhinorrhea/watery eyes. late: 3-4h, mediated by cellular infiltration with basophils/eosinophils, nasal congestion/postnasal drip
Classification of allergic rhinitis: a) cutoff for intermittent vs persistent? b) mild vs moderate/severe?
a) intermittent = <4 days a week OR < 4 weeks. Persistent = >4 days a week AND >4 weeks. b) mild = no interference with daily life (sleep, work, etc). moderate = interference with one part of life. severe = interference with more than one part of life
Name 3-4 nonallergic causes of rhinitis.
vasomotor, hormonal, atrophic, rhinitis medicomentosa, viral, systemic disease, drug-induced
In vitro vs skin prick allergy testing: a) influenced by meds? b) cost? c) sensitivity?
a) skin prick influenced by meds, in vitro is not. b) in vitro more expensive c) skin prick more sensitive
Do oral corticosteroids affect skin test results? Do leukotriene modifiers (-lukasts) affect skin test results?
Oral corticosteroids and leukotriene modifiers do NOT affected skin test results.
Name 2-3 notable meds that affect skin test results.
Theophylline, H1&H2 blockers, TCAs, and topical steroids affect results.
Explain how to identified the skin endpoint in skin endpoint titration.
Identify the last concentration that led to progressive enlargement beyond 5mm.
What is a plateau response in skin testing and how to deal with it? What is a flash response and how to deal with it?
Plateau means it flattens out instead of getting progressively bigger — keep going until you get the progressive wheal. Flash response is a suddenly huge response compared to the previous dilution; stop testing and try again in 4-7 days.
What is modified quantitative testing?
Hybrid testing that basically has replaced skin endpoint titration (SET). You do skin prick to get a range of likely dilutions to start with — then do intradermal testing to identify the specific one (rather than sequential identification like in SET).
Assign seasonality to the following: ragweed, dust mites, grasses, trees, weed, outdoor molds, indoor molds
trees - spring. grasses - trees. weed/ragweed - fall. outdoor molds - perennial above freezing temperatures. indoor mold + dust mites - perennial.
Latex-Fruit Syndrome. Name 4 fruits overlapping with latex allergy.
ABC Kiwi. Avocado, banana, chestnut, Kiwi.
Name of the protein/allergen implicated in cat allergy?
Fel d1
Name of the protein/allergen implicated most commonly in peanut allergy?
Ara h2
What allergic rhinitis pharmacotherapy should be considered in a patient with exercise or cold-induced asthma?
Leukotriene receptor antagonists
Name 2-3 mechanisms of success for immunotherapy.
Reduce allergen-specific IgE (after initial rise). Increased Th1 levels, induction of antigen-specific IgG4. Increase IL-10 secretion - reduces mast cell/eosinophil activation + induces T cell tolerance for specific antigens.
What interleukin is implicated in inducing T cell tolerance for specific antigens in immunotherapy?
IL-10 implicated.
Name 3-4 potential treatments for vasomotor rhinitis.
ipratropium, azelastine, capsaicin, vidian neuronectomy
What oral medications can cause rhinitis medicamentosa and what is the treatment for this?
antihypertensives; change meds/cessation
