Allergy & Immunology Flashcards
Tx of anaphylaxis
IM Epi, corticosteriods and H1 blocker(diphenhydramine, or hydroxyzine)
Angioedema
sx?
sudden swelling of the face, palate, tongue and airway in association with minor trauma to the face, hands or ingestion of ACEi. +/- stridor, ab pain and lack of response to steroids
- *NO URTICARIA OR PRURITIS!
- may be hereditary due to C1 esterase inhibitor deficiency
dx of angioedema?
low levels of C2, C4 and C1.
tx of angioedema
epinephrine then Icatibant(bradykinin B2 antagonist), androgens(danazol, stanazol), Fresh frozen plasma
Urticaria
sx? tx?
sudden swelling of the superficial skin layers ccaused by: insects, medication, pressure, cold, vibration.
tx: antihistamines or LT antagonist
man with neurosyphillis who is allergic to PCN and has a hx of essential tremor tx with propanolol. tx?
stop propanolol and desensitize to PCN. if you dnt stop propranolol can worsen anaphylaxis and interfear with epi administration in the event of anaphylaxis
sx of Allergic Rhinitis
recurrent episodes of nasal itching, stuffiness, rhinorrhea, paroxysms of sneezing, eye itching and dermatitis. Inflammed boddy nasal mucosa, pale turbins and +/- nasal polyps
tx of allergic rhinits?
avoid!, intranasal steroids, antihistamines, nasal saline wash/spray
CVID
sx?
Impaired maturation of B cells = have b cell but they dnt make Ig!
- recurrent sinopulmonary infection
- sprue-like malabsorption
- GIARDIASIS
- older patient(teens+)
- often linked with AI disorders
- enlarged lymph nodes, adenoids and spleen
- decreased all Ig! (especially IgA & IgG
- normal Tcells, normal B cell #s
Tx of CVID
abx for infections + IVIG infusions
XL agammaglobulinemia/Bruton’s
absent B-cells due to them not maturing past proB.
- normal T cells
- NO Bcells = small/absent lymph, adenoids and spleen
- male children(XLR) with recurrent sinopulmonary infections
tx of Brutons agamm?
IVIG & ppx abx
IgA Deficiency
sx? tx?
- recurrent sinopulmonary infections
- spruelike malabsorption syndrome
- increased incidence of ATOPIC conditions
- anaphylaxis when recieving blood donations
- recurrent GI infections
tx: tx infections as they arise
how do you prevent anaphylaxis with pt who have IgA deficiency
washed pack RBCs on transfusion
Hyper IgE syndrome
sx? tx?
recurrent SKIN INFECTIONS caused by STAPHYLOCOCCUS
tx: ppx w/Docloxacillin or Cephalexin
SCID sx? tx? cause?
ADA mutation resulting in low B/T cells
- everythigns gone = get AIDs like infections
tx: abx + BONE MARROW TRANSPLANT
Wiskott-Aldrich Syndrome
inheritance + sx?
XLR, WAITER Wiskott Aldrich IgE/A increased Thrombocytopenia Eczema Recurrent infections
Chronic Granulomatous Disease
sx?
- def NADPH = cant make oxide to kill shit = make granulomas instead
- extensive inflammatory rxn w/purulent material that just dnt heal, increase risk of Aphthous ulcer & infalmmation of the nares. Granulomatous formation that may obstruct GU/GI tract, increased infections with catalast + organims
CGD are at an increased risk of infections with what bugs? name them!
catalase + = SPACE-LMN = Staph A, Pseudomonas, Aspergillus, Candida, Ecoli, Listeria, Mycobaterium, Nocardia
dx of CGD
negative Nitroblue tetrazolium or Dihydrorhodamine test = doesnt turn paper blue = no superoxide made = neutrophils are messed up due to CGD
Pt experiences angioedema after a surgical or dental procedure. What can be given as prophylaxis for the next procedure?
Any of the following: antifibrinolytics(tranexamic acid), androgens(danaxol, stanozolol), infusion of C1 inhibitor
Mutation associated with Hyper-IgM syndrome? sx?
CD40 ligand, increase sinopulmonary infections - increased IgM and low levels of all other Ig w/normal # lymphocytes
DiGeorge Syndrome
sx? tx?
CATCH22: Cardiac defects, Abnormal faces, Thymic dysplasia(no Tcells or Low T cells), Cleft Palate, Hypocalcemia, 22q11 deletion mutation
TX: bone marrow transplant and IVIG for ab deficiency, ppx against PCP(bactrim)
Ataxia-telangiectasia
mutation/inheritance? sx? tx? what are these patients at an increased risk of?
Mutation: AR mut in ATM - DNA repair defect = dsDNA breaks
SX: progressive cerebellar ataxia & oculocutaneous telangiectasis, increased risk of CANCER = non hodgkin lymphoma, leukemia, gastric carcinoma
TX:may need IVIG
Severe Combined Immunodeficiency(SCID)
mutation? sx? tx?
Mutation: XLR mutation causing defect in ADA & JAK causing SEVERE lack of T & B cells = “bubble boy disease”
SX: severe frequent bacterial infections, chronic candidiasis & other opportunistic organisms
TX: bone marrow or stem cell transplant, IVIG & PCP ppx
