Occupational Allergy and Asthma 2022 Flashcards
1
Q
- A 32-year-old pharmaceutical laboratory technician presents with recent onset of shortness of breath and wheezing while at work.
Which of the following high molecular weight agents is likely to be responsible for his symptoms?
A. Aldehydes
B. Carmine dye
C. Papain
D. Toluene diisocyanate
A
- C, Papain, p. 942, Table 56.1.
Reference Table 56.1 Principal Agents Causing Immunologic Occupational Asthma.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
2
Q
2. What Low Molecular Weight substance can induce an IgE-mediated immune response in occupational asthma? A. Barley B. Latex C. Platinum salts D. Seafood
A
- C, Platinum salts, p. 942.
Although High Molecular Weight (HMW) agents (proteinaceous products such as animal proteins and flour) act as complete antigens and induce the production of specific IgE antibodies, some Low Molecular Weight (LMW) occupational agents (including platinum salts and trimellitic anhydride as well as other acid anhydrides) can also induce specific IgE antibodies. This is probably by acting as haptens and binding with proteins to form functional antigens.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
3
Q
- A 48-year-old man who has recently started working in the plastics industry develops a cough, shortness of breath, chest tightness, and wheezing. He is diagnosed with occupational asthma secondary to diisocyanate exposure.
How long after cessation of exposure would a reduction in subepithelial fibrosis be most likely to occur?
A. From 4 to 21 weeks
B. From 5 to 21 months
C. From 4 to 5 years
D. From 3 to 4 months
A
- B, 5 to 21 months, p. 942.
“Removal from exposure for a period ranging from 5 to 21 months in subjects with
diisocyanate-induced asthma was associated with a reduction in subepithelial fibrosis, but persistence of inflammatory cell infiltration of the airways was noted”.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
4
Q
4. What is the most important environmental risk factor for the development of occupational asthma? A. Atopy B. Genetic susceptibility C. Level of exposure D. Smoking
A
- C, Level of exposure, p. 944.
The intensity of exposure to sensitizing agents is currently the most characterized and the most important environmental risk factor for the development of occupational asthma.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
5
Q
5. What is the gold standard test for the diagnosis of occupational asthma? A. Exhaled nitric oxide B. Serial peak expiratory flow C. Specific inhalation challenge D. Sputum cell counts
A
- C, Specific inhalation challenge, p. 946.
Specific inhalation challenge (SIC) tests are the reference test in investigation of occupational asthma.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
6
Q
- A patient with suspected occupational asthma is scheduled for induced sputum collection as part of his diagnostic evaluation. His work schedule is Monday through Friday, 7 am to 3 pm.
What is the best time to collect the sputum?
A. Just before going to work on Monday morning
B. Just before going to work on Tuesday morning
C. Just before leaving work on Monday evening
D. After a week of absence from work
A
- B, Just before going to work on Tuesday morning.
The correct answer is B as the best time frame of collection is 7-24 hours after exposure.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
7
Q
7. Which etiological agent is most likely responsible for occupational asthma in bakers? A. Aldehydes B. Dust mite C. Fungal amylase D. Latex
A
- C, Fungal amylase, p. 950.
Bakers and pastry makers are exposed to a variety of potentially sensitizing agents including:
• flour from cereals (wheat, rye and barley) and other sources (ie, soy, lupine, and
buckwheat)
• enzymes used to improve the baking process (ie, fungal amylase, cellulase, and
xylosidase)
• egg proteins
• other ingredients (eg, sunflower seeds, soy lecithin).
Dust mite is incorrect as it is an occasional cause but not a common cause in bakers.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
8
Q
8. What are the main allergens responsible for latex allergy in healthcare workers? A. Hev b5 and Hev b 6.01/6.02 B. Hev b3 and Hev b 6.01/6.02 C. Hev b 1 and Hev b3 D. Hev b5 and Hev b8
A
- A, Hev b5 and Hev b6.01/6.02, p. 951.
Fifteen natural rubber latex allergens have been characterized at the molecular level. The use of recombinant or highly purified natural proteins revealed that health care workers are sensitized predominantly to Hev b5 and Hev b 6.01/6.02, whereas Hev b1 and Hev b 3 are the major allergens for patients with spina bifida indicating that the pattern of Ig E reactivity is dependent on the route of sensitization.
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
9
Q
9. What is the most common low molecular weight agent responsible for occupational asthma in most of the world? A. Nickel B. Red cedar C. Polyisocyanates D. Aldehydes
A
- C, Polyisocyanates, p. 951.
Polyisocyanates are the most common cause of occupational asthma in many parts of the world. Diisocyanates are used in the automobile industry in the production of foam rubber cushions and finish coating
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
10
Q
10. How much must an agent weigh to be considered a high molecular weight protein? A. > 10kDa B. > 20kDa C. > 100kDa D. > 200kDa
A
- A, >10kDa, p. 940.
High molecular weight protein of molecular mass >10 kDa
Chapter 56: Occupational Allergy and Asthma
Middleton’s Allergy Principles and Practice, 9th Edition
