Immunology Flashcards
Features to include when counselling about nasal spray technique?
Aim to get good coating throughout nasal passage
Hold spray in left hand when spraying into right nostril and vice versa
Aim to spray slightly outward (away from nasal septum)
Do not sniff at same time as spraying as this sends mist into back of throat
Patient should not taste spray at back of throat.
Features of Cow’s Milk Protein Allergy?
First 3 months of life, usually in formula fed infants and those with atopic FH.
IgE and non-IgE mediated.
Regurgitation and vomiting after feeds Diarrhoea, bloating, wind Urticaria, atopic eczema Colic symptoms - irritability, crying Rarely angioedema and anaphylaxis may occur
Diagnosis of Cow’s milk protein allergy?
Clinical
Skin prick/patch testing
Total IgE and specific IgE (RAST) for cow’s milk protein
Management of Cow’s milk protein allergy?
Breast feeding mother should avoid milk or milk products.
If severe refer to paediatrics
If formula fed:
First line - extensive hydrolysed formula (eHF) for infants with mild-moderate symptoms
Second line - Amino-acid based formula (AAF) in infants with severe CMPA or if no response to eHF.
If breast-fed:
Continue breastfeeding
Eliminate cow’s milk protein from maternal diet
Use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months.
Features of anaphylaxis?
Urticaria Itching Swelling around lips, tongue, eyes Wheeze Stridor Shortness of breath Tachycardia Lightheadedness Abdominal pain Collapse.
Features of X-linked Agammaglobulinaemia (Bruton’s disease)
Commonest primary antibody deficiency
Failure of B-cell development and Ig production
Presentation - severe bacterial infection, often from around 3-6 months.
Common variable immunodeficiency features?
Deficiency in IgG and IgA, with or without IgM def.
Leads to recurrent respiratory tract infections, leading to chronic lung disease over time.
Prone to immune disorder - non-hodgkins lymphoma.
Manage with regular immunoglobulin infusions and treating infections and complications as they arise.
Selective IgA deficiency features
Most common Ig deficiency.
Common in caucasians.
IgG and IgM levels normal.
IgA present in secretions of mucous membranes and protects against opportunistic infections.
Mild immunodeficiency and patients often asymptomatic and never diagnosed.
Tendency to recurrent mucous membrane infections - eg lower respiratory tract infections and autoimmune conditions.
Features of SCID?
Defective T and B cells.
First few months of life
Persistent diarrhoea
Failure to thrive
Opportunistic infections that are more frequent or severe than in healthy children (eg severe and later fatal chickenpox, Pneumocystis jiroveci pneumonia and CMV).
Becoming increasingly unwell after live vaccinations - BCG, MMR, nasal flu vaccine.
Omen syndrome - mutation in recombination-activating gene (RAG) and other genes responsible for T and B cell mutation
Causes of SCID?
50% caused by mutation in common gamma chain on X chromosome (X-linked) that codes for receptors for interleukin on T and B cells
JAC3 gene mutations
Mutations leading to adenosine deaminase deficiency.
Management of SCID?
Condition fatal unless treated.
Management should be in specialist immunology centre.
Treat underlying infections, preventing new infection.
BMT.
Features of Chronic Granulomatous Disease?
Usually X-linked
Phagocytic cells fail to produce oxidative burst required for phagocytosis.
Repeated bacterial/fungal infections involving the skin, lymph nodes, lungs, liver and bones.
Granulomas and abscesses form in these sites.
Diagnosis confirmed with NBT test.
Management of Primary immunodeficiency?
Antibiotic prophylaxis - cotrimoxazole for pneumocystis pneumonia
Aggressive IV antibiotic therapy for infection
IVIG for severe antibody deficiency
BMT can be curative, but high mortality rate
Gene therapy
Live vaccines are contraindicated in primary immunodeficiency.
Causes of secondary immunodeficiency?
Chemotherapy, high-dose corticosteroids, organ transplants.
HIV.
When to use skin prick test?
If allergen suspected.
