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Clinical Pathology > Core Immunology - Allergic Diseases (11) > Flashcards

Core Immunology - Allergic Diseases (11) Flashcards

1
Q

Allergy

A

Undesirable, damaging and sometimes fatal reaction produced by immune system, directed against innocuous antigens in a pre-sensitised (immune host)

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2
Q

Immunopathological classification

A

Coombs and Gel 1963 - IV types, extended classification - type V

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3
Q

Type 2 allergy

A

Cytotoxic

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4
Q

Type 2 immunopathogenesis

A

IgG/IgM Ab response against self/foreign antigen at cell surface - complement activation/phagocytosis/ADCC

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5
Q

Type 2 clinical features

A

Onset minutes to hours, cell lysis and necrosis

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6
Q

Type 2 common antigens

A

Penicillin

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7
Q

Type 2 associated diseases

A

Erythroblastosis fetalis, Goodpasture’s nephritis

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8
Q

Type 3 allergy

A

Immune complex

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9
Q

Type 3 immunopathology

A

IgG/IgM Ab against soluble antigen (immune complex deposition)

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10
Q

Type 3 clinical features

A

Onset 3-8 hours, vasculitis

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11
Q

Type 3 cause

A

Serum sickness

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12
Q

Type 3 associated diseases

A

SLE

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13
Q

Inhaled >

A

Farmer’s lung, alveolar/capillary interface

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14
Q

Type IV allergy

A

Delayed

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15
Q

Type IV clinical features

A

Delayed onset 48-72 hours, erythema induration

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16
Q

Type IV common antigen

A

Metals - nickel (tuberculin reaction)

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17
Q

Type IV associated diseases

A

Contact dermatitis

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18
Q

Immune response to parasitic disease

A

Increased IgE, specific to pathogen (cross-reactive), tissue inflammation (eosinophilia, mastocytosis, basophil infiltration), presence of CD4+ T cells secreting (IL4, IL5, IL13)

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19
Q

Hygiene hypothesis

A

Microbes stimulation is protective, increase asthma after anti-parasitic treatment, prevention of autoimmunity, pro-biotics in pregnancy (Th1 Th2 deviation)

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20
Q

Genetic influence on allergic immune response - polygenic disease, cytokine gene cluster (IL3,5,9,13), IL12R, IL4R, FC3RI, IFNy, TNF, Not sufficient for disease, only suscepibility

A

??

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21
Q

4 groups of susceptibility genes for allergic disease

A
  1. Sensing the environment
  2. Barrier function
  3. Regulation of (atopic) inflammation
  4. Tissue response genes
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22
Q

Allergens

A

Antigens that initiate an IgE-mediated response, first encounter results in innate and IgM response

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23
Q

Conventional immune response

A

Allergen requires processing, presentation to T cells, cytokine release > delineation of T-helper subsets into different types

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24
Q

IgE production

A

Th2 cell stimulates B cell with IL-4, stimulates B cell proliferation > IgE release

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25
Q

Type 1 allergy

A

Fc receptor for IgE on mast cell > degranulation > vasoactive amines > smooth muscle, blood vessel mucous gland, platelets, sensory nerve endings > eosinophil

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26
Q

Primary mediators released from degranulation (initial response)

A

Histamine, proteases, chemotactic factors

27
Q

Secondary mediators (late-phase response)

A

Membrane phospholipid > Arachidonic acid > leukotrienes and prostaglandin

28
Q

Role of Th2

A

Multiple cytokine release - innate inflammatory response (IL-4 and IL-13), drive for Ig production

29
Q

Th1 cells produce

A

IFN and TNF

30
Q

Role of Th1

A

Activation and apoptosis of keratinocytes, bronchial epithelial cells and pulmonary smooth muscle (activation of mast cells and basophils > histamine)

31
Q

Atopic triad

A

Asthma, rhinitis, eczema

32
Q

Allergic rhinitis

A

Nasal congestion (oedema, mucus, nasal polyps)

33
Q

Asthma

A

Airway inflammation (oedema, mucus)

34
Q

Rhinitis allergic

A

Perennial/seasonal (allergic/non-allergic)

35
Q

Rhinitis symptoms

A

Blocked nose, runny nose (eye symptoms)

36
Q

Antigens for Rhinitis

A

House dust mite, animal danders

37
Q

Rhinitis treatment

A

Antihistamines and nasal steroids

38
Q

Early phase response/acute allergic symptoms

A

Mucus hypersecretion, increase of vascular permeability (oedema), vasodilation, C-sensory nerve stimulation)

39
Q

Late phase response/chronic allergic inflammation

A

Sneezing, nasal itching, rhinorrhea, nasal obstruction, occular symptoms, nasal hyperresponsiveness

40
Q

What is asthma?

A

Disease of inflammation and hyper-reactivity of small airways

41
Q

Asthma in childhood

A

Aero-allergic stimuli (house dust mite)

42
Q

Asthma immediate symptoms are mediated by what

A

IgE

43
Q

Asthma damage to airways due to

A

Late phase response (infiltration of eosniphil, lymphocyte, Th, basophil), hyper-reactive to non-allergic stimulis (fumes)

44
Q

Pathogenesis of asthma

A

Allergen > APC > Th2 > IL-5/IL-4/13 > eosinophil/mast cell basophil > histamine, leukotrienes, prostaglandins, cytokines > allergic asthma

45
Q

Contact dermatitis

A

Allergic/non-allergic

46
Q

Atopic dermatitis clinically

A

Intense itching, blistering/weeping, cracking of skin

47
Q

Major trigger in atopic dermatitis

A

House dust mite

48
Q

Treatment for atopic dermatitis

A

Topical steroids and moisturisers

49
Q

How do you get pruritus?

A

Th2 - IL-31 > pruritus/scratch

50
Q

Anaphylaxis

A

Acute, life-threatening, IgE mediated systemic hypersensitivity reaction

51
Q

Diagnosis of allergy

A
  • Specific IgE (>0.35)
  • Skin prick test (>3mm)
  • Intra-dermal test
  • Oral challenge test (gold standard)
  • Basophil activation test
  • Component resolved diagnostics
52
Q

Basophil activation test

A

When IgE, upregulate expression of markers (CD63, CD203c, CD300a) > activated

53
Q

Advantages of specific IgE

A

Safe

54
Q

Disadvantages of specific IgE

A

False negatives and positives

55
Q

Advantages of skin prick test

A

Quick, patient satisfaction

56
Q

Disadvantages of skin prick

A

False negatives and positives, antihistamines, slight risk

57
Q

Treatment

A

Antihistamines, steroids, adrenaline, immunotherapy (subcutaneous/sublingual)

58
Q

Indications for treatment

A

Life threatening reactions to wasp, bee sting, severe hay fever, animal dander allergy

59
Q

Not helpful for treatment

A

Multiple allergies, food allergy, allergic rashes (eczema, urticaria)

60
Q

Major food allergens

A

Cow’s milk, egg, legumes (peanut, soybean, tree nuts), fish, crustaceans/molluscs, cereal grains

61
Q

Adverse food reactions - GI clinical

A

Vomiting, diarrhoea, oral symptoms

62
Q

Adverse food reactions - resp clinical

A

Rhinitis and bronchospasm (anaphylaxis)

63
Q

Adverse food reactions - cutaneous

A

Urticaria, angioedema, role of food in atopic dermatitis unclear

Clinical Pathology (60 decks)

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