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ACAAI Review for the Allergy/Immunology Boards > Chapter 5. Hypersensitivity Disorders > Flashcards

Chapter 5. Hypersensitivity Disorders Flashcards

1
Q

What does ICD feel like, relative to ACD

A

stinging and less pruritic

almost immediate reaction

decrescendo pattern (decreases in severity between readings)

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2
Q

+++, ++, +, +/-

A

+++

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3
Q

T/F the degree of skin test sensitivity correlates well with degree of sting reaction

A

False, of course

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4
Q

What is photocontact dermatitis

What are some examples of photoallergic chemicals

What are some examples of phototoxic chemicals

A

photoallergic or phototoxic chemical that requires light-induced excitation in UV spectrum to cause dermatitis

photoallergic (requires prior sensitization) - PABA, chlorhexidine, thiourea, NSAIDs, thiazide diuretics, dapsone, sulfonylureas

phototoxic (no prior sensitization) - psoralens, furocoumarins, tar, lime, celery, parsnip, tetracyclines, amiodarone, diuretics, quinine, and NSAIDs

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5
Q

What are some examples of nonimmune-mediated adverse food reactions that are additive/toxins (not host-specific)

A

food poisoning, monosodium glutamate (MSG - numbness), sodium metabisulfite (bronchospasm)

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6
Q

Review recommendations based on skin history and results of testing

A
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7
Q

There are 2 insect allergens for ants. What are they

A

Sol i 1

Sol i 3

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8
Q

What is the protein for fish

A

Gad d 5

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9
Q

What is the species name for bumblebee

A

Bombus species

not aggressive, have subterranean or concealed nests

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10
Q

What are some examples of nonimmune-mediated adverse food reactions that are psychologic

A

food aversion, anorexia

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11
Q

There are 3 insect allergens for hornet/yellow jacket. What are they

A

Ves v 1

Ves v 2

Ves v 5

frequently cross reactive

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12
Q

Bonus round - systemic reactions from venom stings are reported in what percentage of adults and kids

How many fatal stings per year

A

3% adults

0.4-0.8% kids

40 fatal stings per year, half are in folks with no history of allergic reaction to stings

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13
Q

What are some characteristics of honeybees and their stings

A

domestic not particularly agressive, but females sting when provoked

Africanized killer bees - very agressive. tend to swarm and sting in large number

die when they sting

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14
Q

What is the protein for soy

A

Gly m 5

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15
Q

in children, what are the causes of 90% of food allergies (8)

A

cow’s milk, hen’s egg, soybean, wheat, peanut, tree nut, fish, and shellfish

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16
Q

What is the protein for egg

A

Gal d1-5

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17
Q

What cells mediate contact hypersensitivity

A

type IV hypersensitivity

mediated by CD4 and CD8 lymphocytes, stimulated by Langerhans and dermal dendritic cells

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18
Q

What are the predominant histologic features of contact dermatitis

A

lymphocytic infiltration

spongiosis

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19
Q

What is Frey’s syndrome (auriculotemporal syndrome)

A

transient, unilateral, and bilateral facial flushing or sweating after ingestion of spicy or flavored foods due to damage to the auriculotemporal nerve

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20
Q

what is the syndrome where patients exhibit symptoms of pruritis limited to the oral mucosa when eating fresh fruits and vegetables

A

pollen-food allergy syndrome

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21
Q

What are reasons to continue VIT indefinitely

A

severe initial reaction, systemic reactions to injection or sting while on shots, honeybee, (elevated tryptase)

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22
Q

What is the protein for peanut

A

Ara h 1-11

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23
Q

What percent of patients have positive serum but negative skin test to venom

A

10%

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24
Q

what medication has the alpha-gal carbohydrate group

A

galactose-alpha-1,3-galactose

this is a carbohydrate also found as part of the glycoproteins, including the chemotherapy monoclonal antibody cetuximab

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25
Q

What is the difference in presentation of normal and large local reactions to venom

A

normal = immediate, local, and transient erythema. Also edema and tenderness

large local = large surface area, peaking at 48 hours after sting. lasting one week

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26
Q

What are the major classes (3) of plant allergen

A

prolamin superfamily

cupin superfamily

PR10 protein family

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27
Q

what is “alpha-gal”

A

Galactose-alpha-1,3-galactose

urticaria, angioedema, or anaphylaxis 3-6 hours after ingesting beef, lamb, or pork. Not chicken. Associated with lone star tick.

Unlike common allergens, which are usually proteins, this is a carbohydrate

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28
Q

What is the protein for hazel nut

A

Cor a 8, 9

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29
Q

What is the protein for milk

A

Bos d4-8

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30
Q

What are paper wasps

A

subfamily Polistinae

Polistes species

nests are on eaves or window sills

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31
Q

What is Heiner’s syndrome

A

this is milk-induced pulmonary disease in infants. it is rare and not IgE-mediated

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32
Q

What are the three major families of animal food allergens

A

tropomyosin

parvalbumins/EF-hand proteins

caseins

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33
Q

What are some examples of nonimmune-mediated adverse food reactions that are pharmacologic

A

caffeine (jittery), tyramine in aged cheeses (headaches), scombroid fish poisoning (releases histamine-like chemicals)

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34
Q

What are characteristics of Vespula spp

A

yellow jackets

scavengers, aggressive, especially in the autumn when food supplies are scarce

sting for no reason at all

nests are concealed

most common cause of stings

like to hide nests in wall cavities, underground, or decaying logs

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35
Q

There are 5 major insect allergens for Honeybee. What are they

A

Api m 1

Api m 2

Api m 3

Api m7

Api m 10

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36
Q

What are the 4 etiologic categories of contact hypersensitivity

A

Allergic Contact Dermatitis

Irritant Contact Dermatitis

Photocontact Dermatitis

Contact Urticaria

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37
Q

What family of bees are yellow jackets and hornets

A

subfamily Vespinae

can sting repeatedly without losing sting apparatus

agressive

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38
Q

What are WBEs and what are they good for

A

“whole body extracts”. They are good for fire ants but terrible for flying hymenoptera (not enough venom in them)

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39
Q

what is the efficacy rate for VIT

what is a VIT maintenance dose

A

75-95% efficacy for preventing a systemic reaction

100 mcg venom (single antigen)

300 mcg venom (mixed vespids)

0.5ml of a 1:10 to 1:200 wt/vol extract given monthly (fire ant)

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40
Q

What technique is used for venom intradermals

A

concentrations between 0.001 and 0.01 micrograms/mL, increase in tenfold increments until positive or a max concentration of 1 mcg/mL is reached

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41
Q

+++, ++, +, +/-

A

+

42
Q

What percentage of patients have a positive skin test to venom but negative serologic testing

A

20%

in other words, don’t trust serum alone

43
Q

what is gustatory rhinitis

A

runny nose from spicy or hot foods

44
Q

Where do yellow jackets (vespula) hide out

A

garbage cans, around food, empty soda cans

45
Q

What is the “order” of stinging insects we care about

A

Order Hymenoptera

46
Q

What causes irritant contact dermatitis (ICD)

is previous sensitization required?

A

most prevalent form of contact dermatitis

induced by chemicals, oxidants, alkali, surfactants, solvents that directly damage the skin

previous sensitization not required

47
Q

What are Class 2 Allergens

A

these allergens are formed primarily from respiratory sensitization

sensitization to labile proteins encountered via the respiratory route, like pollens, results in IgE antibodies that recognize homologous epitopes on food proteins from plants

48
Q

What is the protein for shrimp

A

Lit v 1, Pen a 1

49
Q

+++, ++, +, +/-

A

++

50
Q

Why not keep testing venoms at concentrations > 1 mcg/mL

A

false positives due to irritant effects

51
Q

What is in fire ant venom (key fact)

A

95% piperidine alkaloids

sterile pustules within 24 hours post sting

52
Q

What are some examples of nonimmune-mediated adverse food reactions that are metabolic

A

lactose intolerance, fructose intolerance, alcohol intolerance

53
Q

How dangerous is rush venom compared to standard

A

not much higher than traditional regimens in more recent studies

54
Q

Once sensitized, how long is contact dermatitis delayed upon re-exposure

A

12-48 hours

55
Q

What family are stinging ants

A

Family Formicidae

56
Q

+++, ++, +, +/-

A

+/-

57
Q

Review the scoring system for patch test reactions

A
58
Q

Contact Urticaria

A

can be either immunologic or nonimmunologic

IgE dependent - dairy, seafood, fruits, grains, topical antibiotics, metals, preservatives, and plants

IgE independent - fragrances, arthropods, jellyfish, and coral

59
Q

what percent of children <5 have food allergy

A

6%

60
Q

What percent of the general population has food allergy

A

3.5-4%, mostly shellfish in adults

61
Q

When do you discontinue VIT

A

generally after 3-5 years

62
Q

What are some stats on VIT safety

A

during buildup, 50% of patients have large local reactions and 5-15% have systemic symptoms. The majority are mild. <5% require epi

63
Q

Allergic Contact Dermatitis (ACD)

  • what locations are typically involved
  • what is the typical pattern of positive reactions
  • itch?
A

normally on hands, generalized, face, eyelids

crescendo phenomenon where positive reactions to patch test become more marked between first and second readings

severe itch which takes 12-48 hours to develop

64
Q

What are Class 1 Food Allergens

A

primarily food that is ingested (GI sensitized).

can also invade through the skin

examples are cow’s milk protein (casein and whey), egg (ovalbumin and ovomucoid), peanut (vicilin, conglutin, and glycinin), fish (parvalbumin), shellfish (tropomyosin)

65
Q

There are 3 insect allergens for paper wasp. What are they

A

Pol a 1

Pol a 2

Pol a 5

66
Q

What is the protein for apple

A

Mal d 1,2

67
Q

Explain the practical aspects of patch testing

A

patch is placed on day 1, read and removed on day 3, and again on day 5

68
Q

What patients should definitely get venom prick testing

A

Arguably patients with history of severe anaphylaxis who may be extremely sensitive to venom

69
Q

What is the fancy/scientific name for the honeybee

A

Apis Mellifera

note the beeswax nest has numerous vertical combs

70
Q

name five of the top ten contact allergens in the United States

A

nickel, neomycin, balsam of Peru, fragrance mix, thimerosal, sodium gold thiosulfate, quaternium-15, formaldehyde, bacitracin, cobalt chloride

71
Q

What is Potassium Dichromate used in

A

stainless steel, chrome plating other metals, tanned leather

72
Q

what are chromates used in

A

textiles, leather tanners, and construction worker using wet cement

73
Q

what is Cobalt dichloride used in

A

(uncommon)

dental implants, artificial joints, engines or rockets

74
Q

what is nickel used in

A

jewely, dimethylglyoxime test of nickel-containing material (pink=positive)

75
Q

what is Toxicodendron dermatitis

what is it cross-reactive with

A

secondary to poison ivy, oak, sumac

usually develops after several encounters with plants, sometimes years after exposure

10-15% of population highly susceptible and will have systemic symptoms

cross reactive with mango peels

76
Q

Which fraction of a plant contains the sensitizing substances in ACD

A

oleoresin fraction

most of the time plants have to be crushed to release these antigenic chemicals

77
Q

What plant causes the most hand eczema in flower workers in the United States

A

Alstroemeria, also called Peruvian lily

classic dermatitis that is very itchy and affects the first three fingers and exposed areas of dorsal hands, forearms, V-region of the neck, and the face

78
Q

What is Balsam of Peru used in

A

it is used in the manufacture of pefumes, but also a flavoring agent. Has wide cross-reactivity, most prominently with cinnamon and vanillin.

79
Q

What two broad categories of preservatives are there

A

formaldehyde donors (high prevalence of positive patch tests to these, and most fabrics contain these)

nonformaldehyde donors

80
Q

What preservative is the most frequent cause of ACD in the US

A

Quaternium-15

formaldehyde donor

81
Q

What type of products are second only to skin care products as the most common cause of cosmetic allergy

A

hair products

82
Q

cocamidopropyl betaine

A

important allergen that is in shampoos, eye/face cleaners, bath prodcuts

83
Q

paraphenylenediamine (know this)

A

most common cause of contact hypersensitivity in hair dressers

84
Q

glycerol thioglycolate

A

found in permanent wave hair products

85
Q

ethylacrylate

A

has been demonstrated to detect a higher number of acrylate-allergic patients.

acrylics are in nail products

86
Q

what type of contact dermatitis do sunblocks/sunscreens cause

A

photoallergic ACD

87
Q

topical corticosteroids

  • what are most common screening agents in patch testing
  • how are they classified
A

can cause ACD

test them 7 days after application

  • budesoinde and tixocortol pivalate 1%
  • Group A hydrocortisone type
  • Group B triamcinolone type
  • Group C betamethasone type
  • Group D hydrocortisone-17-butyrate type
88
Q

epoxy resin

A

when cured is nonsensitizing

ACD occurs to uncured resin or to hardener

89
Q

colophony

A

type of resin made from pine trees. appears in cosmetics, topical meds, and industrial products. may cross-react with Balsam of Peru

90
Q

what kind of products have ethylenediamine dihydrochloride

A

topical creams, aminophylline, generic nystatin

EDTA does not appear to cross react

91
Q

paraphenylenediamine

A

benzene derivative and common, epidemic with henna tattoos. this is what people with allergies to henna tattoos are actually reacting to

92
Q

topical antibiotics (resin)

A

common and iatrogenic with risk of anaphylaxis that can be delayed

neomycin is crossreactive with bacitracin

93
Q

what is systemic contact dermatitis (SCD)

A

generalized ACD rash from systemic administration of a drug, chemical, or food to which the patient previously experienced ACD

for example, patients who had ACD to topical benadryl can get SCD when given IV benadryl

baboon syndrome - indurated erythema that appears in the groin of afflicted patients

94
Q

What are symptoms of EoE

A

GERD. intermittent vomiting, abdominal pain, dysphagia, food impaction, irritability, food avoidance, insomnia

95
Q

What is required for definite diagnosis of EoE

A

15 eosinophils/hpf

96
Q

T/F Most children who are unable to consume nonbaked forms of eggs and milk are able to tolerate baked egg and milk

A

True

97
Q

which type of Th response is expected for hypersensitivity pneumonitis (Th1, Th2, or Th3?) Which type of cell is expected

A

note that chronic HP switches to Th2 type

98
Q

review the presentation of acute, subacute, and chronic HP

A
99
Q

review important HP associations

A
100
Q

T/F - cigarette smoking is protective for HP

A

True for acute.

somehow the smoking inactivates the macrophages in lungs.

However, smoking can worsen chronic disease

101
Q

review lab findings in HP

what kind of PFT findings would you expect

A

restrictive

over time, with progressive chronic disease, can become obstructive

102
Q

review differential of HP

pay attention especially to organic dust toxic syndrome

A

ACAAI Review for the Allergy/Immunology Boards (11 decks)

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