Lung Immunology

Question 1

Which areas the following disorders associated with: allergic rhinitis, asthma, allergic alveolitis

Answer 1

Upper airways - allergic rhinitis
Bronchi - asthma
Alveoli - allergic alveolitis

Question 2

What is hypersensitivity and what are the two types

Answer 2

Exaggerated response
Immunological (allergy)
Non-immunological

Question 3

Define allergy

Answer 3

Exaggerated immunological response to a foreign substance (allergen) which is either inhaled, swallowed, injected or comes in contact with the skin or eye

Question 4

What are the two types of immunological hypersensitivity responses and give examples

Answer 4

IgE-mediated e.g. hay fever, eczema, asthma

Non-IgE-mediated allergic diseases e.g. Farmer’s lung

Question 5

What are the 3 types of non-immunological hypersensitivity responses and give examples

Answer 5

Intolerance e.g. food
Enzyme deficiency e.g. lactase DH deficiency
Pharmacological e.g. aspiring hypersensitivity

Question 6

What induces a Th1 response and what does it involve

Answer 6

Viruses, bacteria, fungi

Th17, NK cells, cytotoxic T cells, IgM, IgA, IgG

Question 7

What induces a Th2 response and what does it involve

Answer 7

Helminths and ectoparasites

IgE, IgG1 antibody epithelial barriers, innate lymphoid cells, eosinophils, mast cells, basophils, macrophages

Question 8

Explain the process of Th2 response

Answer 8

1. Sensitisation process
2. Exposure
3. Dendritic cells takes antigen to interleukins (IL-4, IL-5) or Th0,
4. Tfh and Th2 activation
5. B cells differentiate, eosinophil and basophil generation
6. IgE production

Question 9

Define atopy

Answer 9

hereditary predisposition to produce IgE antibodies against common environmental allergens

Question 10

What are allergic reactions in atopic subjects characterised by

Answer 10

Infiltration of Th2 cells
Eosinophils

May be asymptomatic

Question 11

What is allergic march

Answer 11

common progression of atopic diseases from a topic dermatitis to allergic asthma

Question 12

Give some examples of atopic diseases

Answer 12

Allergic rhinitis
Asthma
Atopic eczema

Question 13

Describe the epidemiology of rhino-conjunctivitis

Answer 13

Up to 25% of the population
Highest prevalence in the UK
Mostly seen in the summer
June - grass pollen, weeds, fungals

Question 14

What are some common causes of perennial allergic rhinitis and asthma

Answer 14

House dust mites
Cats
Dogs
Cockroaches
Horses

Question 15

What are the symptoms of asthma

Answer 15

Cough 
Shortness of breath
Wheezing
Tightness
Secretions

Question 16

What are the classifications of asthma

Answer 16

Intermittent - mild, allergy important
Persistent - manageable, allergy sometimes important
Chronic/sever - uncontrolled

Question 17

What are the types of asthma based on endotype/phenotype

Answer 17

Allergic
Neutrophilic
Exercise induced

Question 18

Describe extrinsic allergic alveolitis

Answer 18

Small allergenic particles (<5) penetrate to the distal airways and alveoli
Induce antigen/antibody complexes, complement, chemotactic factors, neutrophils, macrophages, fibroblasts

Question 19

What is the treatment for allergy

Answer 19

Allergen avoidance
Anti-allergic medication 
Immunotherapy
Intra-nasal steroid 
Oral or local non-sedative H1-blocker

Question 20

What is allergen-injection immunotherapy

Answer 20

Hypersensitisation or desensitisation

Subcutaneous or sublingual

Question 21

What are the advantages and disadvantages of allergen-injection immunotherapy

Answer 21

Effective
Produces long lasting immunity

Occasional severe allergic reaction
Time consuming
Standardisation problems

Question 22

What proportion of the population does asthma affect

Answer 22

8-12%