Hypersensitivities

Question 1

Type 1

Answer 1

• IgE mediated Disorders
• Anaphylaxis
• Degranulation of mast cells and basophils

Question 2

Mediators of allergic rxns:

Answer 2

Histamine
Complement
ACh
Leukotrienes and prostoglandins
Kinins
Eosinophils

Question 3

2 subgroups of IgE mediated allergy

Answer 3

Atopy (rhinitis) and Anaphylaxis

Question 4

Percentages of urticaria and angioedema in Type 1.

Answer 4

50% of the time there is both
40% of the time there is only urticaria
10% of the time only engioedema

Question 5

Urticaria

Answer 5

Immune-mediated eruption of well-circumscribed wheals on an erythematous base
Snake-like (serpiginous)
May persist for 12-24 hrs, but most resolve sooner than this.

Question 6

Idiopathic chronic urticaria is thought to be caused by an _________ _______.

Answer 6

Autoimmune process

Question 7

Dermatographism

Answer 7

Gently stroking of the skin produces immediate wheal and flare response.

Question 8

Pressure urticaria

Answer 8

Pressure to skin at right angle results in red swelling after about 4 hours.

Question 9

Cold urticaria

Answer 9

Eruptions within minutes following application of cold

Question 10

Cholinergic Urticaria

Answer 10

Punctate hives triggered by exercise or hot shower

Question 11

Aquagenic urticaria

Answer 11

hives after contact with water

Question 12

Solar urticaria

Answer 12

Hives developing after exposure to light

Question 13

Substances that may aggravate urticaria and angioedema

Answer 13

ASA, NSAIDS, ETOH, ACE inhibitors, certain foods

Question 14

Often times Thyroid issues and H. Pylori are associated with?

Answer 14

Chronic urticaria and angioedema

Get thyroid panel, sed rate and H. Pylori

Question 15

Anaphylactiod Reaction

Answer 15

Responses are clinically indistinguishable from anaphylaxis but are not IgE mediated.
-First-time exposure of contrast dye

Question 16

Anaphylaxis presentation

Answer 16

Resp. tract involvement in 50%
Hypotensive shock in 30%
-third-spacing of 50% of up to blood volume

Question 17

Chronic urticaria mgmt

Answer 17

Education, it will generally go away within a year.

Question 18

Type 1 hypersensitivity examples.

Answer 18

Anaplylaxis
Angioedema
Bronchospasm
Urticaria
Allergic rhinitis

Question 19

Type II

Answer 19

Antibody-dependent cytotoxicity

Question 20

Type II Mechanism

Answer 20

• Either IgG or IgM is made against normal self antigens.
• either a failure of immune tolerance, or a foreign antigen resembling a molecule on host cells enters and antibodies are made, which cross-react.

Question 21

At a cellular level, type II leads to…

Answer 21

Opsonization of host cells
Activation of classical complement
Antibody-dependent cellular toxicity (ADCC)
-destruction of host cells

Question 22

Examples of Type II diseases

Answer 22

1. AB and Rh blood group rxns
2. Idiopathic thrombocytopenia purpura
3. Hashimoto’s thyroiditis, graves disease
4. Myasthenia gravis
5. Goodpasture’s syndrome
6. MS
7. Interstitial nephritis

Question 23

Hemolytic transfusion rxn triad

Answer 23

Fever/chills, back pain, burning at transfusion site.

Question 24

Type III

Answer 24

Immune complex disease

Antigen-antibody complexes form and travel throughout the body and are deposited into tissues, causing inflammation.

Question 25

Favorite sites of Type III deposition

Answer 25

Glomeruli, joints, skin, heart, serosal surfaces, small blood vessels. Tissue death and inflammation occur wherever the complexes are deposited.

Question 26

Types of Type III diseases

Answer 26

- Glomerulonephritis - Rheumatoid Arthritis - Systemic Lupus Erythamatous

Question 27

Rheumatoid arthritis is generally ______?

Answer 27

Symmetric. as opposed to osteoarthritis

Question 28

Type IV

Answer 28

Delayed, cell mediated hypersensitivity | Initiated by activated T-lymphocytes

Question 29

Type 1 Type IV

Answer 29

Mediated by CD4 T cells, release cytokines and leukocytes that promote inflammation.

Question 30

Type 2 Type IV

Answer 30

Mediated by CD8 T cells that directly kill tissue cells

Question 31

Types of Type IV diseases

Answer 31

- Contact dermatitis - Temopral arteritis - Celiac Sprue - Graft vs. host - Type I DM

Question 32

T or F: Food and drug reactions usually cause chronic urticaria.

Answer 32

False. Food and drug reactions usually do NOT cause chronic urticaria, but can cause fleeting urticaria and angioedema.

Question 33

T or F: The key to managing angioedema and urticaria is a thorough physical examination.

Answer 33

False: The key to managing urticaria and angioedema is a thorough history. Identify triggers.

Question 34

What is the most common adverse blood transfusion reaction?

Answer 34

Febrile non-hemolytic transfusion reaction. These are unpleasant, but have no lasting effects.