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MBChB3 > Allergy In The Lung > Flashcards

Allergy In The Lung Flashcards

1
Q

What is intolerance?

A

Inability to cope with normally acceptable conditions/exposures

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2
Q

Describe the potential mechanisms of intolerance

A
  • trigger (first exposure = no reaction, but future responses decided)
  • immediate: recognition by APC + T cells, mediated by IL-4 + IL-33, response carried out by IgE and mast cells
  • delayed: recognition by APC + T cells, mediated by IL-12 + IFN gamma, response carried out by reactive T cells
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3
Q

Describe the features of allergy

A
  • clinical reaction (acute - sudden and short lived, or chronic - slow and progressive)
  • immune system intolerance (requires response to a trigger, memory, characteristic clinical features depending of which arm of the immune system activated)
  • chronic allergy leads to tissue remodelling
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4
Q

What are the differences in allergy to hypersensitivity

A
  • does not have dose dependency (only show slight changes)
  • same reaction to the trigger
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5
Q

How does an allergy affect the airways and lung parenchyma?

A

Airways:
- increases resistance to airflow
- causes wheeze/stridor (turbulence)
- measured by spirometry

Parenchyma:
- affects gas transfer and compliance
- CXR/imaging helpful

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6
Q

What are the clinical consequences of lung allergies?

A
  • medium and small airway walls are flaccid as they are not supported by cartilage
  • allergy causes the airways to collapse on expiratory phase due to narrowing
  • muco-ciliary clearance impaired causing increased sputum
  • CXR unhelpful
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7
Q

What are the pathological aspects of asthma?

A
  • inflammation
  • scabby epithelium
  • thickened BM
  • thickened smooth msucle
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8
Q

What are the physiological aspects of asthma?

A
  • yellow mucus
  • repair pathways
  • non-elastic airways
  • increased responsiveness
  • increased sensitivity
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9
Q

What are the clinical components of asthma?

A
  • cough
  • wheeze
  • hyper-reactivity
  • hyper-sensitivity
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10
Q

What is asthma?

A

Reversible airflow obstruction

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11
Q

What are physiological tests you can do for asthma?

A
  • peak flow
  • spirometry
  • plethsymography box (can be used to determine triggers)
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12
Q

What cells mediate airway inflammation in asthma?

A

Eosinophils

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13
Q

What cells are involved in asthma?

A
  • mast cells
  • lymphocytes
  • macrophages
  • epithelial cells
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14
Q

Describe the process of airway remodelling in asthma

A
  • angiogenesis
  • epithelial cell damage
  • fibrosis
  • smooth muscle hypertrophy
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15
Q

Describe the possible specifically targeted treatments for asthma

A
  • anti-IgE biological therapy (targets IgE)
  • corticosteroids (targets mast cells, macrophages and smooth muscle)
  • anti-leukotriene receptor drugs (targets macrophages and smooth muscle)
  • bronchodilators (targets smooth muscle and autonomic nerve)
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16
Q

Describe the mechanism of allergic disease in lung parenchyma

A
  • delayed immune response
  • re-exposure = intolerant systemic reaction
  • mediated by IgG and antigens forming an immune complex
  • tissue remodelling
17
Q

Describe the signs and symptoms of acute illness associated with lung parenchyma allergy

A
  • 4-6hrs after exposure
  • wheeze, cough, fever, chills, headache, myalgia, malaise, fatigue
  • can last several days
  • serum sickness
18
Q

What cells are involved in lung parenchyma allergy?

A

Neutrophils

19
Q

What are the clinical consequences of lung parenchyma disease?

A
  • thickening of septae, filling of alveolus with fluid
  • loss of O2 (hypoxaemia - normal CO2) and reduced O2 transport into bloodstream
  • air space shadowing on CXR
20
Q

What is the effect of chronic allergen exposure to lung parenchyma?

A
  • fibrosis: interstitial scarring from chronic tissue remodelling/repair pathways
  • emphysema: interstitial destruction from neutrophilic enzyme release and reduced surface area
21
Q

What is extrinsic allergic alveolitis?

A
  • acute illness = type 3 reaction (serum sickness/immune complex disease)
  • subacute illness (days-weeks) = type 4 T cell-mediated reaction (chronic dermatitis of lung)
  • chronic disease = fibrosis and emphysema
22
Q

What is the management of allergy in the lung?

A
  • avoid triggers
  • corticosteroids for inflammation (neutrophils can be responsive, cytotoxics)
  • O2 supplementation

MBChB3 (100 decks)

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