Lec 09: Prevention Immunotherapy and Immunomodulators

Question 1

T/F

Allergies are curable and preventable through immunotherapy and immunomodulation.

Answer 1

F

Allergies are not curable as of now.

Question 2

Allergy results from the interplay of what three general factors?

Answer 2

genetic factors
environmental factors
age-related factors

Question 3

This is the process or condition wherein environmental factors affect the expression of genes.

Answer 3

epigenetics / epigenetic changes

Question 4

True of immune regulation EXCEPT

A. Th2 is protective in utero and essential for fetal integrity
B. Excessive Th2 activation leads to autoimmunity.
C. Th1 sends regulatory signals to prevent the action of Th2.
D. Treg cells regulate both Th1 and Th2 responses.
E. NOTA

Answer 4

B

excess Th1 - autoimmunity
excess Th2 - allergy / hypersensitivity

Question 5

These cytokines are secreted by Treg cells to regulate Th1 and Th2 activation.

Answer 5

IL-10 and TGF-B

Question 6

IL-10 and TGF-B are also known as what type of cytokines?

Answer 6

tolerogenic cytokines

They allow for the development of immune tolerance (e.g. oral tolerance for food).

Question 7

Non-atopics produce this type of immunoglobulin in response to allergens or environmental stimuli.

Answer 7

IgG

Question 8

If both of your parents have no history of atopy, what is the probability of you being atopic?

A. O%
B. <1%
C. 1-10%
D. 5-15%
E. 10-20%

Answer 8

D

5-15%

Epigenetics (i.e. environmental effects) play a role in the development of atopy.

Question 9

T/F

Increase in cases of allegy is likely due to genetic drift.

Answer 9

F

It is more likely due to environmental changes.

Question 10

The following are included in a pro-allergic lifestyle EXCEPT

A. hygiene
B. infections
C. caloric restriction
D. sedentary living
E. NOTA

Answer 10

C

Obesity rather than caloric restriction is pro-allergic.

Other factors include

climate change
pollution and tobacco smoke
early feeding
stress

Question 11

The following cytokines are predominantly secreted by Th1 cells EXCEPT

A. IL-2
B. IL-5
C. IL-12
D. IFN-y
E. NOTA

Answer 11

B

IL-5 is secreted by Th2 together with IL-4, and IL-13

Th1 secretes IL-2, IL-12, and IFN-y

Question 12

T/F

Immune regulation is affected pre- and postnatally.

Answer 12

T

Question 13

IgE can be produced as early as how many weeks in utero?

Answer 13

16 weeks

Question 14

A balanced Th1/Th2 immunity should be developed by what age?

Answer 14

5 years

Question 15

Which T line matures slower in atopic individuals?

A. Th1
B. Th2
C. Treg
D. Tcyt
E. B & C only

Answer 15

A. Th1

Th1 maturation is late, therefore there is excess Th2 activity predisposing the individual to atopic diseases.

Question 16

At what level must the immune response cascade be blocked for it to be the most ideal primary prevention strategy?

Answer 16

blocking the antigen from binding to the antigen-presenting cells

Question 17

Theoretically, how do you achieve the solution in the previous question?

Answer 17

by putting the child in a sterile plastic bubble :D

Question 18

Interrupting the allergic march falls to what level of prevention?

A. primary
B. secondary
C. tertiary
D. active management
E. B or C

Answer 18

B

Tertiary is more of preventing serious complications such as COPD in the case of asthma.

Question 19

This is immunologic unresponsiveness to antigen induced by prior exposure to the same antigen.

Answer 19

immune tolerance

Question 20

Promotion of oral tolerance falls to what level of prevention.

A. primary
B. secondary
C. tertiary
D. active management
E. NOTA

Answer 20

A

Question 21

Treatment with antihistamine for 18 months of an infant with atopic dermatitis to prevent asthma later in life falls under what level of prevention?

A. primary
B. secondary
C. tertiary
D. active management
E. NOTA

Answer 21

B

This interrupts the atopic march.

Question 22

Enumerate the three mechanisms by which immunologic tolerance develops.

Answer 22

T cell anergy
T cell apoptosis
anti-inflammatory cytokine production

Question 23

This is the best time to manipulate the diet of an infant since the gut is pliable and the immune system is neither too young nor too mature.

Answer 23

4-6 months (window of tolerance)

Question 24

T/F

Bigger antigens elicit greater immune response.

Answer 24

T

That’s why milk products for infants are extensively hydrolyzed.

Question 25

Why is the window of tolerance only up to 6 months?

Answer 25

The child might have been exposed already (through non-oral routes) to allerges, therefore the patients is already sensitized and pro-allergic. It is too late already.