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ACAAI BOARD REVIEW BOOK > Ch. 5 Hypersensitivity Disorder > Flashcards

Ch. 5 Hypersensitivity Disorder Flashcards

1
Q

what is the cause of idiopathic atrophic rhinitis in a young/middle age female in a developing country near the equator?

A

Klebsiella ozaenae

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2
Q

name key drugs for medication induced rhinitis

A

B blockers, alpha agonists, phosphodiesterases (i.e. sildenafil), OCPs, ACE-I, gabapentin, risperidone, amitryptiline, ASA/NSAIDs (AERD)

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3
Q

what happens to eNO in Allergic rhinitis? Sinusitis?

A

increases; decreases

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4
Q

if worried about CSF leak, what should you check?

A

B2 transferrin in nasal secretions

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5
Q

what are in Charcot-Leyden crystals?

A

eosinophil degranulation products

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6
Q

what is the size of papillary hypertrophy in vernal keratoconjunctivitis? What are other features of VKC?

A

> 1mm; Horner Trantas dots, photophobia, itching, shield ulcers; sight-threatening; male predominance (age 3-20); treatment with high dose pulse topical corticosteroids; topical calcineurin inhibitors, antihistamine drops +/- antibiotics

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7
Q

what are key clinical features of atopic keratoconjunctiivits?

A

ocular pruritis with atopic dermatitis; sight-threatening; punctate keratitis (visualized with dye), corneal infiltrates, keratoconus, anterior subcapsular cataracts

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8
Q

what is the % of eos in nasal smear in NARES

A

20

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9
Q

what is the size of papilary hypertrophy in Giant papillary conjunctivitis?

A

> 0.3 mm (smaller than VKC)

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10
Q

what are 3 key chemokines that have been implicated in active atopic dermatitis?

A

CTACK, CCL27, TARC

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11
Q

what cytokines are involved in acute AD?

A

IL4, 13

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12
Q

what cytokines are involved in chronic AD

A

IL5, IL12, IFNgamma

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13
Q

what is unique about the FCeRI of Langerhan’s cells?

A

lack the beta chain

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14
Q

what is associated with anterior cataracts? posterior?

A

anterior=atopic kc; posterior=prednisone

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15
Q

name 3 antimicrobial peptides? and what cells produce them?

A

H-B defensin (2 & 3) and human cathelicidin (LL-37); secreted by keratinocytes

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16
Q

what is the blackbox warning on topical tacrolimus

A

long term use may cause increased risk for infections (osteomyelitis and bullous impetigo; lymphoma and skin malignancy

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17
Q

an accumulation of what cell type in the airway is a hallmark of fatal asthma?

A

neutrophil

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18
Q

what type of collagen composes reticular basement membrane?

A

collagen type III

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19
Q

what is CD14

A

co receptor for TLR

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20
Q

what is a diagnostic methacholine challenge

A

PC20 <4mg/mL; 4-16 mg/mL is suggestive of diagnosis

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21
Q

what are major and minor criteria for Asthma Predictive Index

A

Major: parental asthma, physician diagnosed atopic dermatitis, aeroallergen sensitization; minor: eos>4%, food allergy, wheezing apart from colds. Need one major or two minor to be positive.

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22
Q

what is auriculotemporal syndrome (aka Frey’s sydnrome)

A

transient, unilatera and/or bilateral facial flushing or sweating after ingestion of spicy or flavored foods; non-immune mediated; may be due to damage to auriculotemporal nerve

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23
Q

what are the protein allergens for milk?

A

Bos d4-8; casein and whey

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24
Q

what are the protein allergens for egg?

A

Gal d1-5; ovalbumin and ovamucoid

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25
Q

what are the protein allergens for shrimp?

A

lit v1, Pen a 1; tropomyosin

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26
Q

what is the protein allergen for fish

A

Gad d 5; parvalbumin

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27
Q

what are the protein allergens for peanut?

A

ara h 1-11; vicilin, conglutinin, glycinin

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28
Q

what are the protein allergens for soy?

A

Gly m 5

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29
Q

what are the protein allergens for hazelnut?

A

Cor a 8,9

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30
Q

what are the protein allergens for apple?

A

Mal d1,2

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31
Q

what is Heiner’s syndrome?

A

Food hypersensitivity pulmonary syndrome; usually to cow’s milk; recurrent pneumonia, pulmonary infiltrates, hemosiderosis, Fe deficiency anemia and FTT; peripheral eosinophilia, milk precipitans, lung biopsy; tx: elimination diet

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32
Q

common foods implicated in food-dependent-exercise-induced anaphylaxis

A

celery, wheat (omega-5-gliadin), shellfish, fruit, milk and fish

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33
Q

what foods/allergens cross react with birch?

A

apple, plum, peach, pear, cherry, apricot, almond (Rosaceae); celery, carot, parsely, caraway, fennel, corriander (Apiaceae); soybean, peanut (Fabaceae); hazelnut (betulaceae)

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34
Q

what foods/allergens cross react with ragweed?

A

cantaloupe, honeydew, watermelon, zucchini, cucumber (cucurbitaceae); banana (musaceae)

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35
Q

what foods/allergens cross react with mugwort?

A

celery, carot, parsely, caraway, fennel, corriander (Apiaceae); mustard, cauliflower, cabbage, broccoli (brassicaceae), garlic, onion (lilaceae)

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36
Q

what foods/allergens cross react with orchard grass?

A

cantaloupe, honeydew, watermelon (cucurbitaceae); peanut (fabaceae); white potato, tomato (solanaceae)

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37
Q

what foods/allergens cross react with timothy grass?

A

swiss chard (amaranthaceae), orange

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38
Q

what fruits cause latex fruit syndrome

A

banana, avocado, chestnut, kiwi

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39
Q

what is the allergen that causes delayed anaphylaxis (3-6 hours) after ingestion of red meat, lamb or pork?

A

galactose a 1,3 galactos (aka alpha-gal); lonestar tick; will also cause anaphylaxis to cetuximab (chemo)

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40
Q

what cytokines have been correlated with hypotension during anaphylaxis?

A

IL-6, TNF receptor1, mast cell tryptase, histamine, C3a

41
Q

patients with spina bifida may have higher risk of anaphylaxis to latex? what allergens are commonly identified?

A

Hev b 1 and 3; these allergens are less common in healthcare workers

42
Q

what latex allergens do healthcare workers react most frequently?

A

Hev b 5,6 7

43
Q

fire ant venom contains this unique protein?

A

2-6, disubstituted piperdines (95%)

44
Q

Honeybee relevant allergens

A

Apis mellifera; Phospholipase A2 (Api m 1) is most important; minor allergens include hyaluronidase, acid phosphatase, mellitin, CUB serine protease, icarapin

45
Q

Hornet/yellow jacket key allergen

A

Vespinae family -> Vespula spp (yellow jacket) & Dolichovesupula arenaria and D. maculata (yellow and white faced hornet); key allergen is antigen 5 (Dol m 5); also phospholipase A1, hyaluronidase

46
Q

paper wasp name and key allergen

A

Polistes ssp; phospholipase A1 (pol a 1); hyaluronidase (pol a 2); antigen 5 (pol a 5)

47
Q

Honeybee characteristics; key facts (guess what I’m thinking)

A

usually not aggressive; stingers are left in skin after sting and kills bee; females can sting; although they do not sting often, reactions tend to be more severe

48
Q

yellow jacket characteristics (nest, stinging,etc)

A

nests are layers of masticated wood, usually in the ground or in stumps; very aggressive, especially in fall; most common culprit in North America; usually the cause of stings while mowing, around garbage cans, soda/food, etc; can sting multiple times

49
Q

hornets characteristics(nest, stinging,etc)

A

aerial nests, but otherwise similar in structure to yellow jackets; sting multiple times; vibration can set off their stinging behavior

50
Q

paper wasp characteristics (nest, stinging, etc)

A

nests are single layer of open cells (i.e. classic comb appearance) found in eaves of windows or around homes; narrow wasp waist and dangling legs when flying; less aggressive than yellow jackets and hornets, but can sting repeatedly without losing stinger; common culprit in Gulf coast

51
Q

what is PLAID syndrome?

A

Phospholipase Cy2 asociated antibody deficiency and immune dysregulation; cold-urticaria during infancy; negative ice cube test, but positive evaporative cooling; often have associated Ab deficiency

52
Q

what are the cold urticaria syndromes that have negative ice cube test?

A

cold-induced cholinergic urticaria (i.e. exercise in cold air), systemic cold urticaria, familial cold autoinflammatory syndromes (FCAS) and cold-dependent dermatographism

53
Q

what is Schnitzler syndrome?

A

IgM monocolonal paraproteinemia, nonpruritic urticaria, elevated ESR, and neutrophilic infiltrate on biopsy; treated with IL-1

54
Q

what cell type might be found on urticarial biopsies of the autoinflammatory syndromes?

A

neutrophils

55
Q

western red cedar mill workers, carpenters, woodworkers

A

plicatic acid; also important to know that plicatic acid activates complement

56
Q

body shop, spray paint, foam insulation, roofing, auto industry

A

isocyonates (TDI is tolouene diisocyonate); 10% of exposed will get occupational asthma; bad prognosis despite removal of exposure; can induce reactions both immunologic and non-immunologic mechanisms

57
Q

nail salon, dental hygienist, adhesive manufactorer

A

acrylates

58
Q

metal/chemical workers, welders

A

platinum salts (less common, but 25% of exposed will get occupational asthma); smoking is a unique risk factor

59
Q

hairdressers

A

persulfate/ammonium salts (hair bleach)

60
Q

what are common high molecular weight sensitizers in occupational asthma?

A

animal proteins (rodent urine);25% of exposed will be sensitized within 2 years; flours in cereal makers, seafood handlers, bakers, textile workers

61
Q

hospital workers, professional cleaners

A

formaldehyde, quarternary ammonium products

62
Q

what is the CD4:CD8 ratio in acute hypersensitivity pneumonitis?

A

low <1; also CD8 lymphocytosis observed in COPD; CD4 lymphocytosis observed in granulomatous lung disease…TB, sarcoid, beryliosis

63
Q

Farmer’s lung

A

thermophillic actinomyteces; most common historically; exposure to moldy hay, grain, compost, silage, etc. needs to be distinguished from organic dust toxic syndrome

64
Q

humidifier/AC lung

A

thermoactinomyces

65
Q

hot tub lung

A

contaminated water with MAC (mac avium complex) or Cladosporium

66
Q

bird fancier’s lung/pigeon breeders lung

A

avian proteins from feathers, droppings, etc; common cause of HP

67
Q

detergent workers lung

A

B. subtilis

68
Q

woodworkers lung

A

moldy wood; Alternaria

69
Q

True or False: Smoking cigarettes increases one’s risk for hypersensitivity pneumonitis

A

False- cig smoking is associated with decrease risk of HP

70
Q

bagassosis

A

thermoactinmyces sacchari; moldy sugar cane

71
Q

basement shower lung

A

epicoccum

72
Q

malt workers lung

A

aspergillus; malt, tobacco, soy

73
Q

cheese workers lung

A

penicillium; exposure to moldy cheese

74
Q

machine operator lung

A

pseudomonas, acinetobacter or mycobacter; contaminated metal working fluid

75
Q

winegrower’s lung

A

Botrytis cinerea; mold on grapes

76
Q

el nino lung

A

Pizezia; exposure to mushrooms after a heavy rainfall

77
Q

saxophonist lung

A

Candida albicans

78
Q

epoxy resin worker’s lung

A

Phtallic acid; exposure to heated epoxy resin

79
Q

wheat weevil; miller’s lung

A

Sitophilus; exposure to contaminated flour

80
Q

plastic worker’s lung

A

trimllitic anhydride

81
Q

what PFT pattern would be appreciated in HP after inhalation/exposure?

A

decreased FEV1 and FVC and DLCO after 4-6 hours; restrictive pattern observed in chronic exposure

82
Q

what is organic dust toxic syndrome?

A

non-infectious febrile illness that occurs after exposure to dust contaminated by toxin-producing fungi (often in grain or textiles); occurs in young patients; 30-50 x more common than HP; contracted during summer and complete recovery; no prior sensitization; no serologic response found to common fungal antigens

83
Q

byssinosis

A

dust inhalation of cotton, flax or hemp; leads to bronchoconstriction that improves with time

84
Q

how can total IgE help you in the management of ABPA

A

a rise (doubling) may indicate a flare of disease; treatment goal of reducing IgE by 35%; follow monthly

85
Q

what are the GOLD criteria

A

GOLD 0- symptoms, but normal spiro=at risk; GOLD 1 - FEV1>80 %pred= mild;j GOLD 2 FEV1 50-80%pred= moderate; GOLD 3 FEV1 30-50% pred= severe; GOLD 4 FEV1<30% pred or <50% with chronic respiratory failure = very severe

86
Q

what are the key cells that mediate airway inflammation in COPD

A

macrophages, neutrophils (release proteases) and CD8 T cells

87
Q

what emphysema pattern would you see with alpha1antitrypsin deficiency

A

panlobular (panacinar) including lower lobe emphysema: think about A1AT deficiency in <45 with persistent airflow obstruction and no smoking history; bad phenotypes=ZZ and MZ; MM is normal

88
Q

what is considered normal lung function losss (mL/year) ? in smokers?

A

loss of 30 mL/year is normal; doubled in smokers; smoking cessation leads to near normal lung function loss

89
Q

what has been shown to reduce mortality in COPD

A

smoking cessation and oxygen therapy; lung reduction therapy?

90
Q

what is the name of the test that detects presence of nickel for patients with ACD?

A

dimethylglyoxime test (turns pink if nickel is present)

91
Q

Chromates are found in what (and can cause ACD)?

A

Cement (wet), textile, leather tanners

92
Q

potassium dicrhomate is found in what?

A

stainless steel, chrome plating; tanned leathers

93
Q

what causes poison ivy (aka Toxicodendron dermatitis)

A

type IV hypersensitivity to uroshiol; cross-reactive with mangoes

94
Q

what is the most common cause of hand eczema in flower workers in US?

A

Peruvian lilly; Alstroemeria; first 3 fingers and dorsum of hand and forearm and v of neck

95
Q

what is a common fragrance implicated in ACD?

A

Balsam of Peru (cross reactive with cinnamon and vanillin)

96
Q

what is the most common formaldehyde releasing preservative that causes ACD?

A

Quaternium-15; although parabens are commonly used as preservative in cosmetics, they are an uncommon cause of ACD

97
Q

what is the most common cause of ACD in hairdressers?

A

PPD (paraphenylediamine); can also be in henna tattoos

98
Q

what are the 4 major classes of sensitizing corticosteroids?

A

Group A: hydrocortisone; Group B: triamcinolone: Group C: betamethasone; Group D hydrocortisone-17-butyrate

99
Q

what is baboon syndrome?

A

a form of systemic allergic contact dermatitis; i.e. generalized ACD rash systemic administration of a drug, such as benadryl; get classic induration and erythema of groin region; can occur with systemic or intra-articular steroid injections after topical sensitization

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