Immunology and allergy handbook Flashcards
What is the clinical criteria of anaphylaxis?
Any one of the 3
What is management of anaphylaxis?
What is management workflow for anaphylaxis patients?
How to assess in anaphylaxis for unidentified triggers/ allergens
What is gell and coombs classification of hypersensitivity reactions?
- Type I: IgE-mediated
- Type II: Antibody-mediated (Cytotoxic) 3. Type III: Immune complex-mediated
- Type IV: Cell-mediated
Useful to differentiate into immediate vs non-immediate/delayed (from history) to guide investigation and management
What is the presentation of immediate type hypersensitivity
What is management
What is the presentation of delayed/non immediate type hypersensitivity
What is management
Indications for Immunology & Allergy evaluation
No alternative drug available and consideration for desensitization
Uncertain diagnosis or culprit drugs
Anticipated need for use of index or similar drugs in future & identify suitable alternatives (e.g. antibiotics / NSAIDs & aspirin)
Are most penicillin allergies true allergies
What is the cross reactivity with other B lactams
What is angioedema?
Non-pitting transient subcutaneous or submucosal swelling
Exclude airway obstruction, systemic involvement and anaphylaxis first (for acute management, see section on Anaphylaxis)
Not all cases with angioedema are allergic reactions
Differentiate into bradykinin or histamine-mediated (or others)
What is cause of histamine mediated angioedema
Clinical features
management
What is cause of bradykinin mediated angioedema
Clinical features
management
What is the JM foundation 10 warning signs of immunodeficiency in adults?
- > 2 ear infections in one year
- > 2 sinus infections in one year in the absence of allergies
- 1 pneumonia per year for more than one year
- Chronic diarrhoea with weight loss
- Repeat viral infections (colds, herpes, warts, condyloma)
- Recurrent need for intravenous antibiotics to clear infections 7. Recurrent, deep abscesses of the skin or internal organs
- Persistent thrush or fungal infection on skin or elsewhere
- Infection with normally harmless tuberculosis-like bacteria 10. Family history of a primary immunodeficiency
What is initial evluation in suspicion of immunodeficiency?
Exclude common causes of secondary immunodeficiency (e.g.
diabetes mellitus, HIV infection, protein-losing states, chronic kidney disease, malignancies, chemotherapy or immunosuppression)
Assess if disproportionately frequent or severe infections
Assess if any unusual microorganisms or sites of infection
Check immunization history and any adverse reactions
Chart family tree and enquire about possible consanguinity
Documentation of past infections and identification of phenotypes
Consider Immunology & Allergy referral for workup and follow-up
What are 1st line screening tests for immunodeficiency?
What are 2nd line tests for susicion of immunodeficiency?
What to be cautious of when working up a suspected immunodeficient patient?
What are examples of combined immunodeficiences?
What clinical features?
What therapies?
e.g. Severe combined immunodeficiency, Hyper IgE syndrome, CD40L deficiency, Wiskott Aldrich syndrome, ataxia-telangiectasia
Clinical features: Recurrent bacterial, viral and fungal infections, esp. opportunistic intracellular pathogens ±syndromic features
Therapies: Prophylactic antimicrobials, Ig replacement, HSCT
What are examples of antibody deficiencies?
What clinical features?
What therapies?
e.g. Agammaglobulinaemia, common variable immunodeficiency, B-cell depleting therapies, multiple myeloma, chronic lymphocytic leukaemia
Clinical features: Recurrent/chronic sinopulmonary and GI infections, esp. encapsulated bacteria
Therapies: Ig replacement, prophylactic antimicrobials
What are examples of diseases of immune dysregulation?
What clinical features?
What therapies?
e.g. Autoimmune lymphoproliferative syndrome, haemophagocytic lymphohisocytosis, polyglandular autoimmune syndrome type 1
Clinical features: Non-malignant lymphoadenopathy/splenomegaly,
autoimmunity, autoimmune cytopenias and haemophagocytosis
Therapies: immunomodulation, HSCT
What are examples of phagocytic defects?
What clinical features?
What therapies?
e.g. Chronic granulomatous disease, leukocyte adhesion deficiency,
Clinical features: Recurrent invasive skin and soft tissue infections/abscesses, esp. catalase-positive organisms and fungi
Therapies: prophylactic antimicrobials, interferon-γ, G-CSF, HSCT
What are examples of defects in intrinsic and innate immunity?
What clinical features?
What therapies?
e.g. Mendelian Susceptibility to mycobacterial disease, chronic mucocutaneous candidiasis, STAT1 Gain-of-Function defect
Clinical features: Recurrent and severe mycobacterial, salmonella, viral/fungal infections, chronic mucocutaneous candidiasis
Therapies: prophylactic antimicrobials, immunomodulation, HSCT
What are examples of autoinflammatory disorders?
What clinical features?
What therapies?
e.g. Familial Mediterranean Fever, periodic fever syndromes
Clinical features: Periodic/recurrent fevers and systemic inflammation (without infectious or autoimmune cause)
Therapies: immunomodulation
What are examples of complement deficiencies?
What clinical features?
What therapies?
e.g. early and terminal complement deficiencies, hereditary angioedema
Clinical features: Recurrent pyogenic infections, disseminated Neisserial infections, recurrent angioedema without urticaria
Therapies: vaccinations, prophylactic antibiotics, C1 esterase inhibitor replacement
