POPS Flashcards by Joel Glotfelty

Provides immediate but short lived protection from tetanus

Passive immunity via tetanus immune globin (human) (i.e. tetanus antitoxin)

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Provides antibodies for a longer period of time and also provides memory cells that can be quickly turned on in the future with a booster tetanus immunization

Active immunity via tetanus toxoid

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Should be given at the same time but at separate sites

Tetanus toxoid and tetanus immune globin

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Should be avoided if possible because of the risk of serious anaphylactic or serum sickness reactions

Passive immunity with a heterologous antitoxin such as equine

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Will stimulate the production of antitoxin, which will be protective

Tetanus toxoid

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Toxins that have been detoxified by moderate heat or treatment with a chemical (e.g. formaldehyde) but have intact antigenic and immunogenic properties

Toxoids

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Toxoid and toxin share

Antigenic sites

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Can be used in two different ways: 1) having the ability to induce antibody synthesis and 2) having the ability to combine with an antibody. Immunogenic refers specifically to the first property

Antigenic

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Previous passive immunization with heterologous (horse) antiserum (e.g. tetanus antitoxin [equine]) can stimulate the production of antibody to horse serum proteins. This can cause

Anaphylaxis

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Active immunization with antigens such as tetanus toxoid does not produce sensitivity to

Horse serum protein

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The lethal dose of tetanus toxin is less than the dose required to produce

Antibodies

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Recovery from tetanus does not provide any immunity to

Future infections

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Passive antibody will not give prolonged protection but will prevent

Tetanus short term

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Digest the cell wall of many bacteria and in so doing nonspecifically prevent conjunctivitis

Lysozymes in tears

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Require one to two weeks before antibody can be detected in the serum

Primary immune response

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The skin protects against many different infections and hence provides

Nonspecific immunity

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This type of immunity is present before birth and does not require prior exposure to a pathogen to provide protection; therefore, it provides

Innate immunity

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Cell-mediated and antibody-mediated are terms that apply only to

Acquired immunity

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Antibody-antigen complexes can form in the blood and be deposited in various tissues, producing pathologic changes in those tissues. More specifically, deposition of immune complexes in the renal glomeruli leads to

Glomerulonephritis

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This process produces the disease called

Serum sickness

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What is the name of the zone where if you remove all precipitate, the supernatant reacts with antigen?

Antibody excess zone

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Will not agglutinate normal RBCs

Anti-IgG

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Without washing, unbound IgG would inhibit a

Direct Coomb’s test

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IgM anti-RBCs can

Agglutinate

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Mother's serum is first added to Rh-positive RBC, the RBCs are washed and then the Coombs reagent is added

Indirect Coomb's Test

When there is so much antibody present that it coats all the antigenic sites on all the particles and there are no antigenic sites available for "bridging" antibodies we get a

Prozone

Defined as the reciprocal of the highest dilution resulting in a positive reaction

The titer

Genotype refers to the actual genes on the patient's chromosomes, whereas phenotype refers to the physical characteristics that the patient demonstrates. For example, a homozygous MM genotype appears as an

M Phenotype

Although a population of people can sometimes have more than two alleles at one locus, one genetic locus has only two possible alleles in one person. Because M and N are alleles and S and s are alleles, M and/or an N allele must always be present, and S and/or an allele also must always be

Present

Antibody to blood group antigens stimulated by ubiquitous cross-reacting antigens found on some bacteria is called

Natural antibody

People do not have natural antibody to

Rh, MN, or Ss

Rh, MN, and Ss antigens can all elicit an antibody response. This antibody is usually

IgG

Used to detect "incomplete" or nonagglutinating antibody on RBCs. In this test, antibody to human immunoglobulin is mixed with the patient's RBCs

Direct Coomb's test

The antibody isotypes able to cause complement-mediated red cell hemolysis in a test tube are those able to activate complement by the classical pathway, i.e.

IgG1, IgG3, and IgM

Of these two isotypes, however, the most efficient complement activator is

IgM

IgM is the most efficient complement activator, since a single molecule can form the duplet structure necessary for C1q binding and

C1 activation

React with configurational epitopes related to the antigen-binding site of immunoglobulin molecules

Anti-idiotypic antibodies

A multivalent antigen is required to "fire off" the

Mast cell

Thus, these can not fire off a mast cell because they are univalent

Haptens

A laboratory procedure that is designed to measure specific antibodies against given antigens (allergens).

RAST assay

Theoretically, any antibody class can be measured against any antigen, but the assay is usually used to look at IgE specific for common allergens

RAST assay

Determines how much IgE antibody there is to a specific allergen

RAST assay

Measures the in vivo activity of this antibody and is therefore susceptible to many additional complicating factors such as antihistamine therapy, blocking antibody concentrations, and number and activity of mast cells

Skin test

However, there is usually a fairly good correlation between

Skin test and RAST

In the RAST assay diagram on the next page, allergen extracts are covalently linked to insoluble polysaccharide (Sepharose) beads or cellulose discs. Patient serum is mixed with these allergen-coated beads, allowing

IgE binding

After a thorough washing of the beads, radiolabeled anti-IgE is added. After a second incubation and washing, the radioactivity of the beads is

Measured

Inhibits degranulation and histamine release. One proposed mechanism is stabilization of the mast cell membrane

Cromolyn sodium

Late in an allergic attack, it is of no value since the histamine has already been released

Cromolyn Sodium

Primarily used in upper respiratory allergies since it is administered locally by inhalation

Cromolyn Sodium

Bind to the histamine-binding sites on smooth muscle and thereby competitively inhibit the binding and subsequent pharmacological action of histamine

Anti-Histamines

Almost always produced by exposure to extrinsic allergens, whereas only about 25% of asthmatic attacks are precipitated by extrinsic allergens

Allergic Rhinitis

Ashtma affects the

Lower respiratory tract

Allergic Rhinitis affects the

Upper respiratory tract

The IgG blocking antibody, if present in adequate amounts, will be more likely to bind the allergen and thereby prevent it from reaching the

IgE antibody on the mast cell surface

The switch from IgM to IgE synthesis during the process of proliferation and differentiation of B cells induced by their recognition of a given allergen requires "help" by T helper cells with

TH2 activity

TH2 cells are characterized by their release of a specific repertoire of cytokines, which includes

IL-4, 5, and 10

Largely responsible (by unknown mechanisms) for the switch from IgM to IgE synthesis

IL-4

Promotes the proliferation of all types of helper cells

IL-2

A chemotactic factor for eosinophils

IL-5

A cytokine released by antigen-presenting cells which promotes the differentiation of helper cells with TH1 activity profile

IL-12

Has been recently shown to have the ability to induce the same effects as histamine at the bronchial level

IL-13

The IgE that produces the symptoms of allergy is already bound to mast cells before it complexes with the

Allergen

When a large dose of antigen is injected into a patient with IgG or IgM antibody to the antigen, enough anaphylatoxin can be released during complement fixation to cause anaphylaxis. This occurs via

C3a and C5a

Work by competitively blocking histamine binding sites so that when mast cells release histamine, the histamine does not bind to the receptor and hence cannot cause its effects

Antihistaminic Drugs

Whether antihistaminics block the action of histamine in lung tissue is debatable. In guinea pigs, the drugs definitely block bronchial smooth muscle contraction, but in humans this action (if it occurs) is

Not clear

Block upper airway and skin effects of histamine

Antihistaminics

There are two types of leukotriene inhibitors: those that block leukotriene receptors and those that inhibit leukotriene synthesis. Either type is mostly effective on the later stages of an

Immediate hypersensitivity reaction

Leuokotrine inhibitors have mostly been used in the treatment of

Aspirin induced asthma

Hyposensitization has two major effects: on one hand, the "allergy shots" stimulate the production of

IgG blocking antibody

Binds antigen before it can get to the IgE antibody on the mast cell

IgG blocking antigen

Associated with a decrease in the specific IgE antibody to the allergen that usually parallels the increase in IgG blocking antibody

Desensitization

Takes several months, since very small doses of antigen must be given initially to prevent induction of anaphylaxis and the shots need to be repeated with increasing doses

Hyposensitization

In respiratory allergies the ideal blocking antibody would be of the

IgA isotype

Stabilizes the mast cell membrane so that histamine release is inhibited when the allergen combines with the IgE on the mast cell membrane

Cromolyn Sodium

The drug is used locally (i.e., applied by aerosol to nasal or bronchial mucous membranes)

Cromolyn sodium

It is not readily absorbed through the GI tract and is rapidly excreted, hence parenteral administration is impractical, and local application achieves highest local concentrations

Cromolyn Sodium

Cromolyn sodium is of no value in

Anaphylaxis

Have potent anti-inflammatory effects and strongly inhibit eosinophil degranulation

Glucocorticoids

Inhibit the progression of the late phase of immediate hypersensitivity reactions (particularly asthma), preventing or reducing bronchial hyperresponsiveness

Glucocorticoids

Glucocorticoids down-regulate the synthesis of

Pro-inflammatory cytokines

Reduce expression of CAMs on the vessel wall

Glucocorticoids

The modulation of CAM expression by glucocorticoids markedly alters the trafficking of human immune system cells, particularly

Neutrophils and T lymphocytes

Down-regulate the synthesis of phospholipase A2

Glucocorticoids

Thus, glucocorticoids reduce the synthesis of

Leukotrienes, prostaglandins, and platelet activation factor

In contrast, glucocorticoids upregulate the expression of lipocortin-1, a protein which has

Anti-inflammatory effects

Glucocorticoids administered by inhalation are now recommended for the treatment of

Chronic Ashtma

Relaxes smooth muscles in the lung by stimulating the -adrenergic receptors and hence can directly reverse constriction of the bronchioles and bronchi

Epinephrine

Is usually given subcutaneously (SC); in severe cases, it can be given intravenously (IV) for faster action, or even into the heart if the patient has no immediately accessible veins

Epinephrine