IMMUNOLOGY Flashcards by Jananee Myooran

Types of vasculitis?

LARGE
- GCA: granuloma assoc
- Takayasu: granuloma assoc

MED
- Kawasaki
- PAN
- Thromboangiitis obliterans

Small
- Paucity: Granuloma- EGPA, GPA, Non granuloma- MPA
- Immune complexes: Cryoglobin, HSP, CTD, malignancy
- Other: Behcets

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Most specific signs for GCA?

Limb claudication
Jaw claudication

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Treatment for GCA/PMR?

Steroids
Tocilizumab if can’t tolerate steroids
Aspirin reduces mortality

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Takayasu arteritis classic px?

Female
Young
Women
Aorta/Abdominal aorta/ BP

Biopsy: granulomas

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PAN presentation and classic associations?

Renovascular HTN
Mononeuritis multiplex

NO; pulm haemorrhage, GN

Assoc: hep B/C

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PAN treatment?

Treat cause!!!!!
If no cause: steroids and immunopression

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How to differentiate MPO/GPA/EGPA?

MPA: no upper airway, granulomatous
GPA: granulomas, upper airway
EGPA: sinusitis, asthma, eosinophilia, granulomas, MPO +, assoc mononeuritic multiplex

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Treatment MPA/GPA?

Ritux/cyclo/steroid induction

Ritux maintenance

NO PLASMA EXCHANGE

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Significance of ANCA titres in monitoring vasculitis?

Unclear of significance of titre
- if still (+): poor prognosis

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HSP (IgA vasculitis) classic hx and sign?

Hx: gastro/resp infection preceding
OE: leukocytoclastic rash over buttocks, LL

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Cryoglobulinemia associations and type?

I: MM
II: hep B/C, Sjogrens
III: AI inflammation e.g. RF

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Cryoglobulinemia key feature on blood tests?

Low complement

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Cryoglobulinemia treatment?

Steroids
Plasma exchange
Treat cause

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Behcets treatment?

Topical
Steroids
Inflix if refractory

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Cogan’s Syndrome treatment?

Vesibulo-auditory
Keratitis
Aortitis

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Which drugs can cause vasculitis?

Same drugs that can cause SLE
- HCT, BB, ACEI
- Hydralazine
- Isoniazid
- Phenytoin, CMZ
- Minocycline
- PTU
- TNF alpha inhibitors
- Statins
- Lithium/ chloperamazine
- Procainamide

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Live vaccines?

MOBY JVH

MMR
Oral typhoid
BCG
Yellow fever
Japanese encephalitis
Varicella
Herpes Zoster

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Pregnancy vaccines?

Before
- MMR
- Hep B
- Pneumococcal
- Varicella

During
- inactive influenza
- whooping cough

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Vaccinations for asplenia?

Protect Me I’m Immunocompromised = ENCAPSULATED ORGANISMS
- Pneumococcal (conjugated then polysaccharide)
- Meningococcal
- Influenza
- Hemophilus Influenzae

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Management of an asplenic patient?

Amoxicillin 250mg daily / phenocymethylpenicillin 250mg BD
Sick: Amoxi 2g STAT –> delabel/ densesitise OR cefuroxime 500mg

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Egg vaccines?

Q fever
Yellow fever

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Difference between conjugated and polysaccharide vaccines?

Conjugate: more immunogenic, covers less serotypes
Unconjugated:

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How is a T cell primed to fight?

APC presents to CD4+
Costimulatory molecules B7 and CD28 activates cell
Differentiates into Th classes

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What is each Th class associated with?

Th1
- IGN-gamma
- macrophages
- intracellular pathogens
- inflammation

Th2
- IL4,5,13
- Eosinophils
- Parasites
- allergy

Th7
- IL 17, 22
- neutrophils
- extracellular
- AI

Tfh
- IL21
- B cells
- extracellular
- AI

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Role of immunotherapy in allergy?

YES - bee/wasp - allergic rhinitis NO - large local reactions

Effect of immunotherapy in allergy?

Changes TH2 --> TH1 and IgG Reduces risk of severe reaction

Hypersensitivity type I: mediator and examples?

MEDIATOR - IgE - Sensitisation changes to Th2; next time allergen encountered, antigen binds on IgE (on mast cells), cross links and activates --> mediator production EXAMPLES - Anaphylaxis - Urticaria - Angioedema - Asthma - Rhinitis - Allergic oncjunctivities - Bee venom - Penicillin/contrast - Pollen - Latex

Hypersensitivity type II: mediator and examples?

MEDIATOR - IgG --> MAC EXAMPLES - hemolytic anemia - transfusion reactions - HITTS - RF - Good pastures

Hypersensitivity type III: mediator and examples?

MEDIATOR - antibody/antigen complex EXAMPLES - GN - Vasculitis - RF - MPGN - IgA nephropathy - SLE - *SOMETIMES VENOM*

Hypersensitivity type IV: mediator and examples?

MEDIATOR - T cell --> Th1 EXAMPLES - SJS - TENS - TB skin test - contact dermatitis - DM - interstitial nephritis - DILI - Scabies - Erythema multiforme

How long does tryptase remain elevated for?

5 hours

New treatment options for: - Allergic rhinitis - Atopic dermatitis

Allergic rhinitis: Omalizumab, Immunotherapy Atopic dermatitis: Topical dupilumimab

Key features and diagnosis for mammalian meat allergy?

Pork/beef/lamb; takes time to manifest IgE to alpha-gal

Key features and diagnosis for wheat dependent exercised induced anaphylaxis?

Wheat --> exercise --> 1-4 hours later symptoms IgE to omega gliadin

Features of systemic mastocytosis + diagnosis?

Features - recurrent anaphylaxis - symptoms from organs infiltration - typical symptoms: urticaria, flushing, pruritus - causes: venom, drugs, exercise Diagnosis - KIT mutation - biopsy --> mast cells - serum tryp persistently > 20 - CD 25 on mast cells

HAE testing results? C4, C1 quan, C1 func, C1q - Type 1 - Type 2 - Type 3 - Acquired

Type 1: all low, C1q normal Type 2: C4, C1 func low, C1q normal Type 3: all normal --> FX11 def? Acquired: All low, C1q low

HAE treatment?

Icatibant: Bradykinin receptor competitive antagonist

Cross reactivity between penicillin and cephalosporins?

Cross reactivity between penicillin and carbapenems?

Which drugs share same R1 side chains?

Amoxicillin, Ampicillin, cephalic, cefaclor

If a drug is reacting to amoxicillin and other beta lactase, what is it reacting to?

beta lactam ring

If a drug is reacting to amoxicillin and amp/cephalex/ cefaclor, what is it reacting to?

R1 side chain

What hypersensitivity drug reaction can sulphonamides cause?

type IV

What causes allergy in sulphonamide?

Arylamine group

Cut offs for skin detachment in SJS/TEN?

SJS < 10% TEN > 30%

Key signs for SJS/TENS

Nikolsky: skin peels Lutz: fluctuates

B cell immunodeficiency most likely to cause?

Encapsulated Sinopulmonary GI

T cell immunodeficiency most likely to cause?

Viral Fungal MOST SEVERE

TLR deficiency 3/4/5 causes:

3: Legionella 4: sepsis gram - 5: herpes simplex encephalitis

Early classical pathway deficiency causes:

AI diseases - SLE

Late complement pathway deficiency causes

encapsulated organisms

HLH diagnosis + tx

CD25 Elevated CXCL9 Hyperlipidemia Fever Splenomegaly Elev ferritin Low fibrinogen No NK cell activity TX: etoposide, T cell therapies

How does COVID infect a cell?

Spike protein interacts with ACE2/ TMPRSS2 to facilitate fusion with membrane --> virus uptake

Paxclovid MoA

Nirmatrelevir + ritonavir - ritonavir boosts norma - nirmatrelevir anti protease

Remdes MoA

Inhibits RNA polymerase --> halts replication

Molnupirivir MoA

incorporate into RNA --> halts replication

Baracitinib MoA

JAK 12 inhibitor

Toclizumab MoA

IL 6 inhibitor

Evusheld MoA

antispike antibodies

Pfizer and Moderna - describe vaccine type and MoA

mRNA - mRNA code for spike polyprotein delivered to host cells ○ Synthesises viral protein ○ Expressed on cell surface does NOT go to blood - Immune system reacts to spike protein

Novovax - describe vaccine type and MoA

protein subunit - Contains compounds that BEST stimulate immune system

AZ - describe vaccine type and MoA

Viral vector - Packages DNA into virus vector --> carries into host cells ○ Uses adenovirus vector from monkeys --> DOES NOT CAUSE RESPONSE FROM IMMUNE SYSTEM ○ Released into cytoplasm Host enzymes transcribe mRNA --> spike proteins --> expressed on cell

Which hypersensitivities mainly cause drug allergies?

IgE T cell mediated

Cross reactivity percentage with carbapenems when you have an allergy to penicillin?

Most common drug related causes of IgE hypersensivity?

NSAIDs penicillin Contrasts Cephalopthin

Purpose of skin testing in drug allergies? Which drugs?

Limited group of IgE mediated Available for: penicillin G and V, amoxicillin, ampicillin, cefaclor

Common causes of SJS/TENS?

Bactrim Cephalosporins 1+2 Penicillins Anticonvulsants esp CMZ if HLAB*1501 NSAIDs esp oxicam Allopurinol

Immunotherapy indications + CI?

Allergic rhinitis Bee/wasp anaphylaxis CI - asthma - pregnancy

Mechanism of immunotherapy?

Th2 --> Th1 Promotes IL10 and TGF-beta; inhibits IL4/5/13 Changes IgE --> IgG

Sarcoidosis implicates which cell type as part of the inflammatory process?

T cell ylmphocytes