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ACAAI Review 3rd Edition > Ch. 5 Hypersensitivity Disorders > Flashcards

Ch. 5 Hypersensitivity Disorders Flashcards

1
Q

the late allergic response is characterized by what symptoms?

A

nasal congestion, mucus production

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2
Q

what percentage of chronic rhinitis patients have non-allergic triggers?

A

30-50%

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3
Q

most effective medicine for AR?

A

intranasal steroid

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4
Q

side effects of H1 antihistamines?

A

muscarinic: dry mouth, urine retention
alpha: hypotension, dizziness, reflex tachycardia
5-HT: increased appetite

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5
Q

mechanism of H1 antihistamines

A

inverse agonists, down regulating H1 receptor constitutive activity

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6
Q

unlike NARES, localized AR (entropy) is diagnostically different how?

A

Local AR responds to nasal allergen provocation testing (local specific IgE)

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7
Q

NARES has what percentage of eosinophils on nasal smear?

A

> 20%

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8
Q

Colonization of which pathogen in primary atrophic rhinitis?

A

Klebsiella ozaenae

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9
Q

Treatment of atrophic rhinitis

A

nasal irrigation and topical antibiotics

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10
Q

symptoms of atrophic rhinitis

A

nasal crusting, pain, nasal congestion, foul smell

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11
Q

What medication is ineffective in rhinitis of pregnancy?

A

intranasal corticosteroids

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12
Q

Rhinitis of pregnancy begins and ends?

A

starts 2nd trimester, resolves within 2 weeks postpartum

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13
Q

Difference between AR and infectious rhinitis

A

infection is not pruritic and limited duration

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14
Q

CSF leak characteristics

A

triggered by trauma, unilateral, rhinorrhea

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15
Q

Evaluation for CSF leak

A

check B2-transferrin in nasal secretions

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16
Q

AFRS on CT scan?

A

hyperlattenuation, heterogeneous opacification with inspissated secretions in sinuses, bony demineralization, and erosion

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17
Q

AFRS on MRI?

A

peripheral enhancement with a dark center, higher peripheral signal characteristics corresponding to inflamed mucosa, reduced central signal intensity corresponding to fungal concretions

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18
Q

Fungi associated with AFRS

A

Aspergillus, Alternaria, Curvularia, Penicillium, Fusarium, Bipolaris

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19
Q

Diagnostic criteria for AFRS

A

+SPT or sIgE to fungi, nasal polyps, characteristic CT findings, non-invasive fungal hyphae (stain with PAS or GMS) in mucin OR positive fungal culture of mucin, eosinophil mucin without invasion into sinus tissue

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20
Q

Treatment of AFRS

A

endoscopic surgery, oral corticosteroids for 3 months, topical nasal corticosteroids, and AIT

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21
Q

conjunctivitis that occurs predominantly in males, peak incidence 3-20 years old

A

vernal keratoconjunctivitis

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22
Q

conjunctivitis with equal predilection for males and females, sight threatening, peak incidence age 20-50 years

A

atopic keratoconjunctivitis

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23
Q

symptoms and signs of VKC

A 
severe photophobia, ocular itching
papillary hypertrophy (>1mm), Horner-Trantas dots
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24
Q

symptoms and signs of AKC

A

ocular pruritus with atopic dermatitis, keratoconus is a distinguishing feature, anterior sub capsular cataracts

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25
Q

Steroid administration results in what type of cataract?

A

posterior sub capsular cataracts

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26
Q

features of GPC? giant papillary conjunctivitis

A

ocular itching after lens removal, intolerance to contact lens, morning mucus discharge, tarsal papillary hypertrophy (>0.3mm) smaller than VKC

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27
Q

IgE to what bacterial toxin is produced in AD (atopic dermatitis?)

A

IgE to S. aureus toxins

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28
Q

Which chemokines are specific for AD and increase with acute symptoms?

A

CTACK, CCL27, TARC

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29
Q

what may explain the increased susceptibility of AD skin to infections?

A

decrease or absence of human B defensins and cathelicidin LL-37

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30
Q

cytokines involved in acute AD?

A

acute: IL-4, -13

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31
Q

cytokines involved in chronic AD?

A

chronic: IL-5, -12, IFNg

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32
Q

which cytokines have been shown to down regulate filaggrin expression?

A

IL-4, -13

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33
Q

expression of what protein is inversely correlated to Th2 in AD?

A

claudin-1 (CLDN1)

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34
Q

most memory T lymphocytes in AD express what ligand that binds to E-selectin?

A

CLA (cutaneous lymphocyte associated antigen)

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35
Q

the FcER1 on Langerhans cells differs from that on mast cells and basophils how?

A

lacks the beta chain

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36
Q

What organisms are AD patients susceptible to?

A

S.aureus, herpes simplex, molluscum contagiosum, Malassezia fyrfur/Pityrosporum orbiculare, Pityrosporum ovale

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37
Q

severe reaction to smallpox vaccination in patients with AD

A

eczema vaccinatum

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38
Q

atopic keratoconjunctivitis is associated what type of cataracts?

A

anterior cataracts

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39
Q

what cell type is seen in fatal asthma

A

neutrophil accumulation

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40
Q

chromosome that contains IL-4 gene cluster important for atopy/asthma development

A

chr 5q

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41
Q

sensitization to what perennial allergen by age 6 years is associated with persistent asthma by age 11

A

Alternaria

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42
Q

Samter’s triad

A

asthma, nasal polyps, aspirin sensitivity

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43
Q

definition of reversibility on spirometry

A

improvement of 12% in FEV1 (and FEF25-75 in children only); increase in PEF >20%

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44
Q

methacholine challenge is positive for hyper responsiveness if

A

PC 20 <4mg/mL

4-16 mg/mL is probably if appropriate symptoms are present

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45
Q

asthma predictive index major criteria

A

parental asthma, physician dx of AD, sensitization to aeroallergens

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46
Q

asthma predictive index minor criteria

A

sensitization to food, >4% eosinophils, wheezing apart from colds

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47
Q

the API is positive if…?

A

one major -OR- two minor criteria are met

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48
Q

asthma impairment domains

A

symptoms, functional limitation

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49
Q

asthma risk domains

A

exacerbations, lung function, medication adverse effects

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50
Q

diagnosis of exercise induced bronchospasm

A

FEV1 decrease >15% after exercise challenge test

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51
Q

asthma severity if child age 0-4 has >2 days/week symptoms, 1-2x month awakenings, >2 days/week SABA use?

A

mild persistent

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52
Q

asthma severity if child age 5-11, >2 days/week symptoms, 3-4x month awakenings, >2 days/week SABA?

A

mild persistent

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53
Q

asthma severity if child age 0-4, daily symptoms, 3-4x month nighttime awakening, daily SABA use?

A

moderate persistent

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54
Q

asthma severity if child, age 5-11, daily symptoms, >1x/week nighttime awakening, daily SABA use?

A

moderate persistent

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55
Q

start a controller in child <4 years if….

A

> 2 exacerbations in 6 months, or >4 wheezing episodes in 1 year lasting >1 day AND risk factors for persistent asthma

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56
Q

asthma severity in patient age 12 or older, <2 days/week symptoms, <2x/month awakening, <2 days/week SABA, 0-1 prednisone in 1 year

A

intermittent asthma

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57
Q

asthma severity in patient age 12+, >2 days/week symptoms, >3-4x month awakenings, >2days/week SABA

A

mild persistent

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58
Q

asthma severity in patient age 12+, daily symptoms, >1/week awakening, daily SABA use

A

moderate persistent

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59
Q

Step 1 therapy

A

SABA prn

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60
Q

Step 2 therapy? which severity to start?

A

mild persistent for all ages
low dose ICS (preferred)
montelukast (alternative for age <4 and +)
nedocromil or theophylline (also alternatives for age 5+)

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61
Q

Step 3 preferred therapy? when to start?

A

moderate persistent asthma
medium dose ICS (age 0-4)
low dose ICS + LABA (age 5+)

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62
Q

what makes food allergens allergenic?

A

10-70kd, glycosylation, heat resistant, acid stable, stable to proteases, water soluble

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63
Q

Heiner syndrome symptoms

A

recurrent pneumonia, pulm infiltrate, hemosiderosis, iron def anemia, FTT

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64
Q

diagnosis of Heiner syndrome

A

history, peripheral eosinophilia, lung biopsy, milk precipitins, and elimination diet

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65
Q

foods implicated in food-associated exercise-induced

A

celery, wheat, milk

shellfish, fish, fruit

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66
Q

fruits involved in latex fruit syndrome

A

banana, avocado, chestnut, kiwi

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67
Q

pollen-food association for timothy grass

A

swiss chard, orange

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68
Q

pollen-food association for orchard

A

cantaloupe, honeydew, watermelon, peanut, white potato, tomato

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69
Q

pollen-food association for ragweed

A

cantaloupe, honeydew, watermelon, zucchin, cucumber, banana

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70
Q

pollen-food association for mugwort

A

celery, carrot, parsley, caraway, fennel, coriander, mustard, cauliflower, cabbage, broccoli, garlic, onion

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71
Q

pollen-food association for birch

A

apple, beach, plum, pear, cherry, apricot, almond, celery, carrot, parsley, caraway, fennel, coriander, soybean, peanut, hazelnut

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72
Q

gal-alpha-1,3-gal is found in what drug?

A

cetuximab

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73
Q

LEAP study results - infants with atopic dermatitis and/or egg allergy - fed peanut starting age 4 months until 60 months.

A

86% RR in peanut allergy for infants without sensitization, 77% RR in peanut allergy for infants with sensitization (W1-4mm)

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74
Q

most common cause of anaphylaxis

A

food and drug

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75
Q

What marker has been shown to be positive correlated with the severity of anaphylaxis?

A

PAF levels

76
Q

What marker has been shown to inversely correlate with anaphylaxis severity?

A

PAF acetylhydrolase levels

77
Q

what 5 mediators positively correlate with hypotension during anaphylaxis?

A

IL-6, TNF receptor 1, tryptase, histamine, C3a

78
Q

fatality in anaphylaxis is due to?

A

circulatory collapse or respiratory failure

79
Q

what is the ratio of total/mature tryptase in mastocytosis?

A

> 20 (note:<10 is other cause)

80
Q

which mediator correlates best with symptoms of anaphylaxis?

A

histamine

81
Q

What is oversulfated chrondroitin sulfate?

A

contaminant in heparin that is cuased by activation of the contact system, contains C5a and results in hypotension, abd pain, variable angioedema, but no pruritus or urticaria

82
Q

histamine release is within 5 minutes, but levels remain elevated for how long?

A

30-60 minutes

83
Q

urinary histamine metabolites remain elevated for?

A

24 hours

84
Q

serum tryptase levels are released within 15 minutes but peak when?

A

60-90 minutes

85
Q

natural rubber latex is a cytoplasmic exudate of what tree?

A

Hevea brasiliensis

86
Q

major latex allergen in sensitized patients with spina bifida that are minor allergens in health care workers

A

Hev b 1 and Hev b 3

87
Q

major latex allergen in sensitized health care workers

A

Hev b 5, 6, 7

88
Q

most common foods associated with EIA?

A

wheat, celery

89
Q

fire ant venom contains what allergen

A

piperidine alkaloids

90
Q

major allergen in honeybee venom

A

phospholipase A2, Api m 1

91
Q

major allergen in hornet and yellow jacket

A

phospholipase A1, Ves v1 (does not cross react with honeybee)
hyaluronidase, Ves v2
antigen 5, Ves v5

92
Q

major allergen in paper wasp

A

phospholipase A1, Pol a1
hyaluronidase, Pol a2
antigen 5, Pol a 5

93
Q

mixed vespid maintenance dose

A

300ug

94
Q

single antigen venom maintenance dose

A

100ug

95
Q

what is Skeeter syndrome

A

large local reaction to mosquito bite with fever

96
Q

allergen in biting insects are found in?

A

saliva

97
Q

which biting insect has cross reactivity with cockroach on skin testing

A

asian lady beetle

98
Q

which venoms are corss-reactive

A

hornet and yellow jacket

99
Q

major allergen in ant

A

Phospholipase A2, Sol i1

Antigen 5, Sol i 3

100
Q

local heat urticaria test

A

apply water heated to 45C in a test tube on skin for 5 min

101
Q

cold urticaria test

A

ice cube test place on skin for 5 min

102
Q

cholinergic urticaria test

A

exercise for 15 mins past point of sweating or passive elevation of core body temperature by submerging patient’s arm in 42C hot water bath until core temp increases >0.7C

103
Q

solar urticaria test

A

skin exposed to UVA and UVB of varying wavelengths using a monochromatic light source

104
Q

aquagenic urticaria test

A

apply 35C water compress to upper body for 30 minutes

105
Q

delayed pressure urticaria/angioedema test

A

sling attached to 10-15lb weight is placed over arm or shoulder for 15 minutes. Patient response over next 2-24 hours.

106
Q

cold urticaria with negative ice cube test

A

cold-induced cholinergic urticaria, systemic cold urticaria, familial cold auto inflammatory syndromes, and cold-dependent dermatographism

107
Q

Schnitzler syndrome is associated with what findings?

A

IgM monoclonal paraproteinemia, nonpruritic urticaria, elevated ESR, and neutrophilic infiltrate on biopsy

108
Q

treatment of Schnitzler syndrome

A

anti-IL-1

109
Q

lab findings in hypocomplementemic urticarial vasculitis

A

low C3, C4, C1q, anti-C1q antibody, elevated ESR

110
Q

difference between work exacerbated asthma and occupational asthma

A

occupational asthma - symptoms do not occur outside of workplace. work-exacerbated asthma has asthma pre-existing with increased symptoms at work

111
Q

reactive airway dysfunction syndrome?

A

single high level exposure resulting in symptoms within 24 hours and are persistent.

112
Q

laboratory workers may take how many years to sensitize?

A

2 years

113
Q

occupational asthma in carpenters, woodworkers due to?

A

plicatic acid

114
Q

occupational asthma in nail salon workers and dental hygienists due to?

A

acrylates

115
Q

occupational asthma in body shop or auto industry or roofing/insulation or spray pain/foam coatings due to?

A

isocyanates

116
Q

occupational asthma in welder, metal/chemical workers due to?

A

platinum salts, potassium dichromate

117
Q

occupation asthma in hairdresser due to?

A

persulfate salts (ammonium persulfate)

118
Q

occupational asthma in plastic due to?

A

anhydrides

119
Q

PFT in occupational asthma

A

FEV1 reduction by 15-20% after exposure of occupation trigger; inhalation challenge is gold standard (limited availability)

120
Q

hypersensitivity pneumonitis is characterized by what T cell phenotype?

A

Th1 phenotype

predominance of CD8+ T cells

121
Q

BAL findings in HP?

A

lymphocytosis >50%

low CD4/CD8 ratio <1

122
Q

histopathology in HP

A

poorly formed, noncaseating granulomas or mononuclear infiltrate

123
Q

PFT findings in HP

A

decreased FEV1, FVC, DLCO after 4-6 hours of exposure, restrictive pattern in advance disease

124
Q

CT findings in acute HP

A

fleeting ground glass opacities

125
Q

CT findings in subacute HP

A

diffuse micro nodules, air trapping, mild fibrosis

126
Q

CT findings in chronic HP

A

ground glass opacities, emphysema, honeycombing, and parenchymal micronodules

127
Q

what bad habit is associated with decreased risk of HP

A

smoking

128
Q

antigen causing farmer’s lung

A 
thermophilic actinomycetes
(thermoactinomyces vulgarism, Saccharopolyspora rectivirgula)
129
Q

antigen causing bagassosis (moldy sugar cane)

A

thermoactinomyces sacchari

130
Q

antigen causing hot tub lung

A

mycobacterium avid complex or Cladosporium

131
Q

antigen causing basement shower lung

A

epicoccum nigrum

132
Q

antigen causing wine growers lung

A

botrytis cinerea

133
Q

antigen causing malt worker’s lung

A

Aspergillus

134
Q

antigen causing cheese worker’s lung

A

Penicillium casei

135
Q

antigen causing detergent workers lung

A

Bacillus subtilis

136
Q

chemical worker’s lung antigen

A

toluene diisocyante (TDI), diphenylmethane diisocyanate (MDI)

137
Q

plastic workers lung antigen

A

trimellitic anhydride

138
Q

epoxy resin worker’s lung antigen

A

phthalic acid

139
Q

bird fancier’s lung antigen

A

Avian proteins

140
Q

el niño lung antigen

A

Pezizia

141
Q

Saxophonists lung antigen

A

Candida albicans

142
Q

wheat weevil lung/miller’s lung antigen

A

Sitophilus

143
Q

machine operators lung antigen

A

Pseudomonas, Acinetobacter, or Mycobacter

144
Q

woodworker’s lung antigen

A

Alternaria

145
Q

humidifier fever/AC lung antigen

A

thermoactinomyces (T. vulgarism, T. saccharin, T. candidus, Klebsiella, Acanthamoeba)

146
Q

antigen in summer type HP (contaminated houses)

A

Trichosporum cutaneum (common in Japan)

147
Q

What is organic dust toxic syndrome (ODTS, pulmonary mycotoxicosis)

A

non-infectious febrile illness after exposure to dust contaminated by toxin-producingg fungi (in grain, hay, textiles); usually young patients, no prior sensitization, lack of serologic response to common fungal antigens

148
Q

What diagnosis is 50 times more common in farmers than farmer’s lung?

A

ODTS (organic dust toxic syndrome)

149
Q

ABPA occurs exclusively in which patients?

A

asthma or CF

150
Q

ABPA diagnosis in asthma?

A

+SPT to A. fumigatus, total IgE>1000ng/mL (417 IU/mL), elevated IgG and IgE to A. fumigates, central bronchiectasis, peripheral eosinophilia >1000/mm3

151
Q

ABPA diagnosis in CF?

A

+SPT A. fumigatus, total IgE >1200ng/mL (500 IU/mL), IgG or IgE to A. fumigatus, fixed chest film abnormalities, clinical deterioration not due to other causes

152
Q

what is the purpose of anti fungal therapy (itraconazole or voriconazole) in ABPA?

A

for exacerbations or if patient cannot be tapered off steroids; it decreases antigenic stimulus for bronchial inflammation, decrease sIgE to Aspergillus, and decrease dose of steroids

153
Q

what marker indicates a flare of ABPA?

A

doubling of baseline IgE

154
Q

goal of treatment of ABPA

A

prevent bronchiectasis or pulmonary fibrosis and worsening lung function

155
Q

airway inflammation in COPD is characterized by?

A

neutrophils, macrophages, and CD8+ T cells

156
Q

the emphysematous findings of COPD and alpha-antitrypsin deficiency differs how?

A

COPD is centrilobular (proximal acinar) upper lobes vs AAT is pan lobular (panacinar) lower lobes

157
Q

test for AAT in what patient?

A

young (<45 years), nonsmoker, symptoms of COPD and persistent airflow obstruction on spirometry

158
Q

when do you use ICS in COPD

A

only in moderate to severe COPD with symptoms despite bronchodilators

159
Q

what has smoking cessation been shown to do in COPD

A

returns rate of loss of function to normal (decline of 60cc/year to 30cc/year)

160
Q

What treatments in COPD decreases mortality

A

supplemental oxygen, smoking cessation, and lung volume reduction surgery

161
Q

Spirometry or PFTs in ILD

A

restriction: decrease FEV1 and FVC, normal or high FEV1/FVC, increased lung volumes, decrease DLCO

162
Q

what is the pathologic pattern in UIP (usual interstitial pneumonitis)

A

heterogeneous fibrosis prominent in the periphery, minimal inflammation

163
Q

CT findings in IPF

A

bibasilar, peripheral reticular pattern, focal honeycombing

164
Q

CT findings in NSIP

A

ground glass and fibrotic changes

165
Q

CT findings in COP

A

alveolar filling, air bronchograms mimicking acute pneumonia

166
Q

histologic features of contact dermatitis

A

lymphocytic infiltration and spongiosis

167
Q

+1 reaction in contact dermatitis?

A

erythema, edema that is palpable, occupies >50% of patch test site

168
Q

+2 reaction in contact dermatitis

A

micro vesicles and erythema that occupy at least 50% of patch test site

169
Q

+3 reaction in contact dermatitis

A

confluent vesicles or bullae, ulcerative

170
Q

how to test for nickel in products?

A

dimethylglyoxime test (pink = positive)

171
Q

allergen in stainless steel, metals?

A

potassium dichromate

172
Q

allergen in poison ivy/sumac/oak

A

uroshiol (Toxicodendron dermatitis)

173
Q

poison ivy is cross-reactive with?

A

mango peels

174
Q

the sensitizing substances in most plants are present in?

A

oleoresin

175
Q

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

A

Alstroemeria (Peruvian lily)

176
Q

allergen in fragrances

A

balsam of peru

177
Q

balsam of peru cross reacts with?

A

cinnamon and vanillin

178
Q

allergen in cosmetic that is a preservative that is the most common cause of ACD in the U.S.

A

quarternium-15

179
Q

most commonly used preservative in cosmetics, but an UNCOMMON cause of ACD

A

parabens

180
Q

most common cause of ACD in hair dressers? also seen in henna tattoos

A

paraphenylenediamine

181
Q

allergen in acrylic nails?

A

ethylacrylate

182
Q

what are the 4 major classes of sensitizing corticosteroids?

A

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

183
Q

if ACD to ethylenediamine dihydrochloride (EDTA), what you should avoid?

A

nystatin, aminophylline, meclizine, cyclizine

184
Q

if ACD to neomycin, what to avoid?

A

gentamicin, kanamycin, streptomycin, tobramycin

185
Q

What is “Baboon syndrome”

A

when patients allergic to topical antihistamines develop systemic CD after systemic administration of antihistamine- there is indurated erythema in the groin area of afflicted patients

ACAAI Review 3rd Edition (9 decks)

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