Ch. 5 Hypersensitivity Disorder Flashcards
what is the cause of idiopathic atrophic rhinitis in a young/middle age female in a developing country near the equator?
Klebsiella ozaenae
name key drugs for medication induced rhinitis
B blockers, alpha agonists, phosphodiesterases (i.e. sildenafil), OCPs, ACE-I, gabapentin, risperidone, amitryptiline, ASA/NSAIDs (AERD)
what happens to eNO in Allergic rhinitis? Sinusitis?
increases; decreases
if worried about CSF leak, what should you check?
B2 transferrin in nasal secretions
what are in Charcot-Leyden crystals?
eosinophil degranulation products
what is the size of papillary hypertrophy in vernal keratoconjunctivitis? What are other features of VKC?
> 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
what are key clinical features of atopic keratoconjunctiivits?
ocular pruritis with atopic dermatitis; sight-threatening; punctate keratitis (visualized with dye), corneal infiltrates, keratoconus, anterior subcapsular cataracts
what is the % of eos in nasal smear in NARES
20
what is the size of papilary hypertrophy in Giant papillary conjunctivitis?
> 0.3 mm (smaller than VKC)
what are 3 key chemokines that have been implicated in active atopic dermatitis?
CTACK, CCL27, TARC
what cytokines are involved in acute AD?
IL4, 13
what cytokines are involved in chronic AD
IL5, IL12, IFNgamma
what is unique about the FCeRI of Langerhan’s cells?
lack the beta chain
what is associated with anterior cataracts? posterior?
anterior=atopic kc; posterior=prednisone
name 3 antimicrobial peptides? and what cells produce them?
H-B defensin (2 & 3) and human cathelicidin (LL-37); secreted by keratinocytes
what is the blackbox warning on topical tacrolimus
long term use may cause increased risk for infections (osteomyelitis and bullous impetigo; lymphoma and skin malignancy
an accumulation of what cell type in the airway is a hallmark of fatal asthma?
neutrophil
what type of collagen composes reticular basement membrane?
collagen type III
what is CD14
co receptor for TLR
what is a diagnostic methacholine challenge
PC20 <4mg/mL; 4-16 mg/mL is suggestive of diagnosis
what are major and minor criteria for Asthma Predictive Index
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.
what is auriculotemporal syndrome (aka Frey’s sydnrome)
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
what are the protein allergens for milk?
Bos d4-8; casein and whey
what are the protein allergens for egg?
Gal d1-5; ovalbumin and ovamucoid
what are the protein allergens for shrimp?
lit v1, Pen a 1; tropomyosin
what is the protein allergen for fish
Gad d 5; parvalbumin
what are the protein allergens for peanut?
ara h 1-11; vicilin, conglutinin, glycinin
what are the protein allergens for soy?
Gly m 5
what are the protein allergens for hazelnut?
Cor a 8,9
what are the protein allergens for apple?
Mal d1,2
what is Heiner’s syndrome?
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
common foods implicated in food-dependent-exercise-induced anaphylaxis
celery, wheat (omega-5-gliadin), shellfish, fruit, milk and fish
what foods/allergens cross react with birch?
apple, plum, peach, pear, cherry, apricot, almond (Rosaceae); celery, carot, parsely, caraway, fennel, corriander (Apiaceae); soybean, peanut (Fabaceae); hazelnut (betulaceae)
what foods/allergens cross react with ragweed?
cantaloupe, honeydew, watermelon, zucchini, cucumber (cucurbitaceae); banana (musaceae)
what foods/allergens cross react with mugwort?
celery, carot, parsely, caraway, fennel, corriander (Apiaceae); mustard, cauliflower, cabbage, broccoli (brassicaceae), garlic, onion (lilaceae)
what foods/allergens cross react with orchard grass?
cantaloupe, honeydew, watermelon (cucurbitaceae); peanut (fabaceae); white potato, tomato (solanaceae)
what foods/allergens cross react with timothy grass?
swiss chard (amaranthaceae), orange
what fruits cause latex fruit syndrome
banana, avocado, chestnut, kiwi
what is the allergen that causes delayed anaphylaxis (3-6 hours) after ingestion of red meat, lamb or pork?
galactose a 1,3 galactos (aka alpha-gal); lonestar tick; will also cause anaphylaxis to cetuximab (chemo)
what cytokines have been correlated with hypotension during anaphylaxis?
IL-6, TNF receptor1, mast cell tryptase, histamine, C3a
patients with spina bifida may have higher risk of anaphylaxis to latex? what allergens are commonly identified?
Hev b 1 and 3; these allergens are less common in healthcare workers
what latex allergens do healthcare workers react most frequently?
Hev b 5,6 7
fire ant venom contains this unique protein?
2-6, disubstituted piperdines (95%)
Honeybee relevant allergens
Apis mellifera; Phospholipase A2 (Api m 1) is most important; minor allergens include hyaluronidase, acid phosphatase, mellitin, CUB serine protease, icarapin
Hornet/yellow jacket key allergen
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
paper wasp name and key allergen
Polistes ssp; phospholipase A1 (pol a 1); hyaluronidase (pol a 2); antigen 5 (pol a 5)
Honeybee characteristics; key facts (guess what I’m thinking)
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
yellow jacket characteristics (nest, stinging,etc)
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
hornets characteristics(nest, stinging,etc)
aerial nests, but otherwise similar in structure to yellow jackets; sting multiple times; vibration can set off their stinging behavior
paper wasp characteristics (nest, stinging, etc)
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
what is PLAID syndrome?
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
what are the cold urticaria syndromes that have negative ice cube test?
cold-induced cholinergic urticaria (i.e. exercise in cold air), systemic cold urticaria, familial cold autoinflammatory syndromes (FCAS) and cold-dependent dermatographism
what is Schnitzler syndrome?
IgM monocolonal paraproteinemia, nonpruritic urticaria, elevated ESR, and neutrophilic infiltrate on biopsy; treated with IL-1
what cell type might be found on urticarial biopsies of the autoinflammatory syndromes?
neutrophils
western red cedar mill workers, carpenters, woodworkers
plicatic acid; also important to know that plicatic acid activates complement
body shop, spray paint, foam insulation, roofing, auto industry
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
nail salon, dental hygienist, adhesive manufactorer
acrylates
metal/chemical workers, welders
platinum salts (less common, but 25% of exposed will get occupational asthma); smoking is a unique risk factor
hairdressers
persulfate/ammonium salts (hair bleach)
what are common high molecular weight sensitizers in occupational asthma?
animal proteins (rodent urine);25% of exposed will be sensitized within 2 years; flours in cereal makers, seafood handlers, bakers, textile workers
hospital workers, professional cleaners
formaldehyde, quarternary ammonium products
what is the CD4:CD8 ratio in acute hypersensitivity pneumonitis?
low <1; also CD8 lymphocytosis observed in COPD; CD4 lymphocytosis observed in granulomatous lung disease…TB, sarcoid, beryliosis
Farmer’s lung
thermophillic actinomyteces; most common historically; exposure to moldy hay, grain, compost, silage, etc. needs to be distinguished from organic dust toxic syndrome
humidifier/AC lung
thermoactinomyces
hot tub lung
contaminated water with MAC (mac avium complex) or Cladosporium
bird fancier’s lung/pigeon breeders lung
avian proteins from feathers, droppings, etc; common cause of HP
detergent workers lung
B. subtilis
woodworkers lung
moldy wood; Alternaria
True or False: Smoking cigarettes increases one’s risk for hypersensitivity pneumonitis
False- cig smoking is associated with decrease risk of HP
bagassosis
thermoactinmyces sacchari; moldy sugar cane
basement shower lung
epicoccum
malt workers lung
aspergillus; malt, tobacco, soy
cheese workers lung
penicillium; exposure to moldy cheese
machine operator lung
pseudomonas, acinetobacter or mycobacter; contaminated metal working fluid
winegrower’s lung
Botrytis cinerea; mold on grapes
el nino lung
Pizezia; exposure to mushrooms after a heavy rainfall
saxophonist lung
Candida albicans
epoxy resin worker’s lung
Phtallic acid; exposure to heated epoxy resin
wheat weevil; miller’s lung
Sitophilus; exposure to contaminated flour
plastic worker’s lung
trimllitic anhydride
what PFT pattern would be appreciated in HP after inhalation/exposure?
decreased FEV1 and FVC and DLCO after 4-6 hours; restrictive pattern observed in chronic exposure
what is organic dust toxic syndrome?
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
byssinosis
dust inhalation of cotton, flax or hemp; leads to bronchoconstriction that improves with time
how can total IgE help you in the management of ABPA
a rise (doubling) may indicate a flare of disease; treatment goal of reducing IgE by 35%; follow monthly
what are the GOLD criteria
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
what are the key cells that mediate airway inflammation in COPD
macrophages, neutrophils (release proteases) and CD8 T cells
what emphysema pattern would you see with alpha1antitrypsin deficiency
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
what is considered normal lung function losss (mL/year) ? in smokers?
loss of 30 mL/year is normal; doubled in smokers; smoking cessation leads to near normal lung function loss
what has been shown to reduce mortality in COPD
smoking cessation and oxygen therapy; lung reduction therapy?
what is the name of the test that detects presence of nickel for patients with ACD?
dimethylglyoxime test (turns pink if nickel is present)
Chromates are found in what (and can cause ACD)?
Cement (wet), textile, leather tanners
potassium dicrhomate is found in what?
stainless steel, chrome plating; tanned leathers
what causes poison ivy (aka Toxicodendron dermatitis)
type IV hypersensitivity to uroshiol; cross-reactive with mangoes
what is the most common cause of hand eczema in flower workers in US?
Peruvian lilly; Alstroemeria; first 3 fingers and dorsum of hand and forearm and v of neck
what is a common fragrance implicated in ACD?
Balsam of Peru (cross reactive with cinnamon and vanillin)
what is the most common formaldehyde releasing preservative that causes ACD?
Quaternium-15; although parabens are commonly used as preservative in cosmetics, they are an uncommon cause of ACD
what is the most common cause of ACD in hairdressers?
PPD (paraphenylediamine); can also be in henna tattoos
what are the 4 major classes of sensitizing corticosteroids?
Group A: hydrocortisone; Group B: triamcinolone: Group C: betamethasone; Group D hydrocortisone-17-butyrate
what is baboon syndrome?
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
