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Clinical Pathology > CP5-1 allergic diseases > Flashcards

CP5-1 allergic diseases Flashcards

1
Q

What are symptoms of rhinitis?

A

Blocked/runny/itchy nose
Sneezing
Often with eye symptoms - itching, burning, redness, watery eyes

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2
Q

What are the two types of allergic rhinitis?

A

Seasonal
Perennial

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3
Q

What causes seasonal allergic rhinitis?

A

Pollen
Moulds

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4
Q

What causes perennial allergic rhinitis?

A

House dust mite
Animal dander

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5
Q

What causes non-allergic rhinitis?

A

Vasomotor changes
Infection
Structural changes
Drugs
Hormones
Polyps

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6
Q

How is rhinitis treated?

A

With antihistamines and intranasal steroids

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7
Q

What is asthma?

A

A disease of inflammation and hypersensitivity of small airways

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8
Q

What causes asthma in childhood?

A

Aero-allergic stimuli like house dust mites

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9
Q

What type of hypersensitivity causes anaphylaxis?

A

Type I

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10
Q

What hypersensitivity reactions are caused by IgG antibodies?

A

Type II and III

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11
Q

How do IgE antibodies cause allergic reactions?

A

Binding to mast cells

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12
Q

What immunoglobulin causes the immediate symptoms of asthma?

A

IgE

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13
Q

Fill in the blank.

Damaged airways due to asthma are ____________________ to non-allergic stimuli e.g. fumes.

A

Hyper-reactive

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14
Q

What is the pathogenesis of asthma?

A

Allergen taken up by antigen presenting cell which binds to Th2 cell. IL-4 and IL-13 convert Th2 into B cells/plasma cells resulting in release of IgE. IgE binds to mast cells/basophil

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15
Q

Where do asthma drugs target in the pathway?

A

G protein-coupled receptors (GPCRs)

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16
Q

What are the three types of dermatitis?

A

Eczema
Contact
Other types

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17
Q

What are the two subtypes of eczema?

A

Atopic
Non-atopic

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18
Q

What three conditions form the atopic triad?

A

Eczema
Asthma
Hay fever

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19
Q

What are the two sub-types of contact dermatitis?

A

Allergic
Non-allergic

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20
Q

What are symptoms of eczema?

A

Intense itching
Blistering/weeping
Cracking of skin

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21
Q

What is a major trigger for atopic eczema?

A

House dust mite

22
Q

What three factors interplay with eczema?

A

Skin barrier
Pruritus/scratching
Allergy

23
Q

What is the pathway of sensitisation and memory induction?

A

Allergen binds to dendritic cell —> T cell binds to dendritic cell via MHC II molecule —> T cell differentiates into T helper 2 cell and there’s clonal expansion —> T helper 2 cells trigger memory B cells to produce IgE —> there is IgE memory B cell clonal expansion

24
Q

What is the pathway of immediate phase/type 1 reaction response?

A

IgE released by B cells binds to mast cells + allergen binds to basophils —> degranulation + release of vasoactive amines, lipid mediators, chemokines and other cytokines

25
Q

What is the pathway of late phase/allergic inflammation?

A

T helper cells:

  • activate eosinophils to release mediators, chemokines and inflammatory cytokines
  • initiates smooth muscle cells to contract and release chemokines and pro-inflammatory cytokines
  • increased adhesion of endothelial cells and inflammatory cell transmigration
  • initiates basophil entry into tissues and mast cell and basophil degranulation
  • causes atopic dermatitis by inducing keratinocyte apoptosis and activating epithelial cells to release chemokines and pro-inflammatory cytokines
  • causes allergic rhinitis and asthma by inducing increased mucus production, increased IgE production and induction of bronchial epithelial cell apoptosis.
26
Q

Which cells secrete IgE?

A

Plasma cells

27
Q

What are three specific IgE tests used?

A

Immulite 2000/Siemens
ImmunoCAP/ThermoFisher
Hytec 288 Plus/Hycor

28
Q

What are the two types of ImmunoCAP? What are each used to test?

A

Extract - tests extraction of allergens raw material

Component - sets allergen raw material after recombinant technology or purification.

29
Q

What are two skin tests used to test for allergies?

A

Skin prick test - >2mm wheal = positive
Intra-dermal

30
Q

What are all the used tests for allergies?

A

Specific IgE tests
Skin prick tests
Intra-dermal tests
Basophil activation tests
Graded challenge test

31
Q

What is a basophil activation test?

A

Patients basophil is exposed to allergen and then analysed for its response.

32
Q

How do you treat allergies?

A

By symptoms - antihistamines, steroids, adrenaline
Immunotherapy

33
Q

What allergic diseases benefit from immunotherapy?

A

Life threatening reactions to wasp and bee stings
Severe hay fever
Animal dander allergies

34
Q

What allergic disease is immunotherapy not helpful in?

A

Multiple allergies
Food allergies
Eczema
Spontaneous urticaria (aka hives)

35
Q

What is the gold standard test for allergies?

A

Graded challenge test

36
Q

What is a graded challenge test for allergies?

A

A feeding test where allergen is consumed in gradually increasing amounts to diagnose or rule out a food allergy

37
Q

What drug prevents skin prick tests from working?

A

Antihistamines

38
Q

What are the two types of immunotherapy for allergies?

A

Subcutaneous
Sublingual

39
Q

What cells does allergic-specific immunotherapy target?

A

Eosinophils and mast cells - reduces numbers and mediation release
T-cells - decreases their allergen specific proliferation, reduced number of T cells in late phase reaction, reduces number of t helper 1 and 2 cytokines in blood and T helper 2 in tissues (increased T helper 1 in tissues) + increases regulator T cells and IL-10
B-cells - reduction in allergen specific IgE and IgE facilitated antigen presentation , increase in IL-10 and blocking antibodies
Monocytes - increase IL-10 production

40
Q

What are benefits of allergen-specific immunotherapy?

A

improved quality of life
Reduction of symptoms and drug/treatment use
Decrease in response to allergen-challenge test and skin prick test
Decrease in size and number of cells in late phase reaction
Prevents progression of allergy
Prevents new sensitisation

41
Q

What are the two types of adverse food reactions?

A

Allergy
Intolerance

42
Q

What are the two sub categories of food intolerance?

A

Caused by food characteristics
Caused by host characteristics

43
Q

What are examples of food characteristics which cause intolerance?

A

Pharmacological e.g. contain caffeine
Toxin e.g. bacterial

44
Q

What are examples of host characteristics that cause food intolerances?

A

Metabolic e.g. lactase deficiency
Psychological e.g. panic disorder

45
Q

What are the three subtypes of food allergy?

A

IgE mediated
Mixed
Non-IgE mediated

46
Q

What are examples of IgE mediated food allergic reactions?

A

Anaphylaxis
Urticaria (aka hives = raised itchy skin rash)
Angioedema (sudden swelling of part of the body)
Oral allergy syndrome (itchy mouth and throat after consumption of allergen)
Acute rhinitis
Acute asthma

47
Q

What are examples of mixed food allergy reactions?

A

Atopic dermatitis
Eosinophillic esophagitis (inflammation of oesophagus)
Eosinophillic enteritis (infiltration in bowel wall)

48
Q

What are examples of non-IgE mediated food allergies?

A

Contact dermatitis
Dermatitis herpetiformis
Proctocolitis (inflammation of rectum and colon)
FPIES (food protein-induced enterocolitis syndrome - usually affecting babies)
Coeliac disease
Heiner’s syndrome (a cow milk induced pulmonary disease mainly affecting infants)

49
Q

What are the 6 major food allergens?

A

Cow’s milk
Egg
Legumes (peanut, soybean, tree nuts)
Fish
Crustaceans
Cereal grains

50
Q

What are the clinical manifestations of adverse food reactions?

A

Gastrointestinal- vomiting, diarrhoea, oral symptoms
Respiratory - rhinitis, bronchospasm
Cutaneous - urticaria, angioedema
Anaphylaxis

51
Q

What in a history will help with determining a drug allergy/what type of reaction it is?

A

Indication for the drug
Description of the reaction
Time between drug intake and symptom onset
Number of doses take before onset
Know the pharmacological effects of the drug

52
Q

If a drug allergy is suspected, how is this managed?

A

Intradermal testing
Graded challenge
Desensitisation

Clinical Pathology (65 decks)

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