ALLERGY & IMMUNOLOGY

Question 1

Anaphylaxis

1. treatment

Answer 1

1. IM epinephrine in a 1:1000 concentration, corticosteroids, antihistamines (diphenhydramine or hydroxyzine)
2. epi: alpha -1 causes vasoconstriction, beta-2 receptors dilates bronchi

Question 2

Angioedema

1. etiology
2. symptoms
3. diagnosis
4. treatment

Answer 2

1. causes:
   - minor trauma to face or hands leading to sudden swelling of face, palate, tongue and airway
   - ACE-I or
   - hereditary: C1 esterase inhibitor deficiency
2. stridor, abdominal pain, no response to steroids
3. diag:
   hereditary: low levels C2 and C4 in complement p’way
4. treatment:
   hereditary: C1 inihibitor concentrate, ecallantide (blocks bradykinin)
   Icatibant: bradykinin receptor antagonist
   androgens: danazol, stanazol increase C1 esterase levels
   FFP (acutely)

Question 3

Immunotherapy

what med must be stopped before desensitization

Answer 3

b-blockers

if pt goes into anaphylaxis then action of epinephrine will be blocked

Question 4

Primary Immunodeficiency Syndromes
presentation, diagnosis, treatment
1. Common Variable Immunodeficiency (CVID)
2. X-linked Agammaglobulinemia (Bruton’s)
3. IgA deficiency
4. Hyper IgE Syndrome

Answer 4

1. Common Variable Immunodeficiency (CVID)
   presentation
   -affects men & women, can present in adulthood
   -recurrent episodes of sinopulmonary infections (bronchitis, sinusitis, pneumonia, pharyngitis) and spruelike abdominal disorder (malabsorption, steatorrhea, diarrhea)

diag
machinery to make Igs intact, just not enough made so total IgG levels are low

treatment: infusions of IV immunoglobulins

2. X-linked Agammaglobulinemia (Bruton’s)
   presentation:
   males, recurrent sinopulmonary infections

diag:
- small lymph nodes, adenoids, spleen
- B cells and immunoglobulins are missing

treatment: infusions of intravenous immunoglobulins

3. IgA deficiency (most common)
   - lots of ppl are asymptomatic
   - may have recurrent sinopulmonary infections, spruelike malabsorption syndrome, atopic conditions
   - anaphylaxis can occur if blood received from non-deficient IgA person
4. Hyper IgE Syndrome
   presents: recurrent skin infections caused by staph
   treat infections as they arise

Question 5

Contraindications to DTaP, Hib, IPV, PCV

Answer 5

DTaP:
absolute: hx of anaphylaxis or encepholpathy
temp. contraind: moderate/severe illness
mild acute illness with or without fever not contraindication to vaccine admin.

no contraindications to admin of polio, pneumococcal or Hib vaccines