Allergy

Question 1

Anaphylaxis, type and etiology?

Answer 1

Type 1
IgE to mast cells
Degranulation
Vasodilation

Question 2

Anaphylaxis, presentation

Answer 2

Low BP
Fast or slow HR
Hives, prurits
angiodema
headache, vomiting
diarrhea, SOB, cough

Question 3

Autoimmune hemolytic anemia, type and etiology?

Answer 3

Type 2, cytotoxic
IgG bind to RBCs, leading to premature destruction,
-1/2 cases idiopathic

Question 4

Autoimmune hemolyic anemia, presentation?

Answer 4

Symptoms - non specific, may have general symptoms of anemia -fatigue etc.

• jaundice or splenomegaly
• reticulocytes in peripheral blood smear

Question 5

Poststreptococcal glomerulonephritis, type and etiology?

Answer 5

Type 3, Immune complex mediated

• prior infection of beta hemolytic strep
• immune complexes form and get stuck in glomeruli

Question 6

Contact Dermatitis, type?

Answer 6

Type 4, Delayed Hype reaction

Question 7

PSGN background info?

Answer 7

History of pharyngitis summer

-or impetigo in winter

Question 8

Contact dermatitis, etiology?

Answer 8

Phase 1- sensitization
Phase 2- Allergic response after preexposure.
May take months or years to see response

Question 9

Contact dermatitis, symtoms?

Answer 9

Primary= intense pruritis
Pain with excoriation, risk of secondary infection
-transient erythema, vesiculation, swelling with bullae

Question 10

Serum sickness, type and etiology?

Answer 10

Type 3, ICF
admin of nonhuman protein leads to AB response
- ICF deposits in small vessels/tissues = vasculitis and tissue injury
Ex. antitoxins and antivenims

Question 11

Vasculitis, type and etiology?

Answer 11

Type 3, ICF

Immune complexes get stuck in vessel walls.

Question 12

Three types of vasculitis?

Answer 12

Small- Henochschonlein purpurn

Medium - Kawasaki disease

Large vessel - Giant cell(temporal) arteritis

Question 13

Symptoms of vasculitis?

Answer 13

Regardless of size, systemic inflammation:

• fever, night sweats
• fatigue, anorexia, weight loss
• arthralgias, arthritis

SMall= thick palpable purpura

Question 14

Transplant rejection, type and etiology?

Answer 14

Type 4, delayed

Graft destruction caused by T cell-mediated to allograft histocompatibility antignes

Question 15

Transplant rejection, symptoms

Answer 15

Broad: fevers, chills, malaise, arthralgias

Question 16

Anaphylaxis vs. anaphylactoid?

Answer 16

Anaphylaxis = IgE dependent

Anaphylactoid = IgE independent

• no sensitization required
• can occur on first exposure
• not predicted by skin test

Question 17

Urticaria

Answer 17

Hives
Swelling of upper dermis
rasied blebs (wheals) with circuscribed edges (red halo)
Itching (pruritis)

Question 18

Angioedema -acquired

Answer 18

swelling of the deep dermis
characterized by pain or burning not pruritus
-typically affects the face

Question 19

Angioedema - hereditary

Answer 19

deficiency of complement inhibitors

leads to recurrent potentially life threatening attacks facial, laryngeal and GI swelling

Question 20

Urticaria and angiodema pathphys, and Treatment?

Answer 20

-Type 1 hypersensitivity, degranulation of mast cells
Histamine binds to H1 and H2, causing aterial dilation, venous constriction, increased capillary permeability

Treatment: ovar H1 antihistamine

Question 21

Atopic diseases

Answer 21

• allergic rhinitis
• atopic dermatitis
• allergic asthma
• allergic gastroenteropathy

Question 22

Food allergy vs. food intolerance?

Answer 22

allergy = specific immune response
-potentially life threatening
intolerance = associated with digestion
- not life threatening

Question 23

Most common food allergies?

Answer 23

IgE associated:

• milk, eggs, peanut, soy, wheat, tree nuts, fish, shellfish
• asthma and urticaria not likely to be caused by food allergies

Question 24

exanthematous/

morbilliform

Answer 24

Etiology: commonly penicillin family

S&S: “rash all over,” widespread symmetric, erythematous macules and papules on the trunk and extremities, pruritus, mild, fever
-First exposure rash after 7-10 days
Most common of all cutaneous drug eruptions (90%)

• Stop medication, resolves a few days to a week after the medication is stopped, can continue medication if not too severe and meds can’t be substituted, resolves without sequelae
• Treat: topical steriods and oral antihistamines

Question 25

Fixed Drug Eruption Etiology

Answer 25

``` commonly: phenolphthalein tetracyclines metronidazole sulfonamides NSAIDS salicylates ```

Question 26

Fixed drug eruption S&S

Answer 26

erythematous patch with central bulla, same location with re-exposure - often affects acral areas - 30 min to 8hrs from exposure - healed lesions dark brown or purple

Question 27

Fixed drug eruption Diag work up and management

Answer 27

stop meds, should resolve days to weeks - non eroded lesions can use topical steriod - eroded lesions can use antimicrobial ointment - if widespread and generalized refer to derm

Question 28

Drug related eosinophilia w/ systemic symptoms DIHS or DRESS Etiology

Answer 28

``` Etiology: Sulfa drugs penicilin minocycline, metronidzole isoniazid phenytoin diclocfenac meloxicam abacavir ```

Question 29

Drug related eosinophilia w/ systemic S&S and PE findings DIHS or DRESS

Answer 29

Fever, malaise, start typically 3rd wk, (1-12wks) Patient is sick looking with rash! Facial edema, diffuse erythematous macules and plaques, Trunk and extremities. Organ involvement CBC, LFT, BUN, creatinine Elevated WBC, AST, Atypical lymphocytes consult derm and stop meds if not severe can use topical steroids and systemic antihistamines

Question 30

Steven-Johnson syndrome | Toxic Epidermal necrolysis etiology

Answer 30

``` Sulfa antibotics, sulfasalazine Allopurinol Tetracyclines, Thiacetrazone Anticonvulsants (carbamezapine, phenbarbital, phentoin, lamotrigine NSAIDS, Nevirapine ```

Question 31

Steven-Johnson syndrome | Toxic Epidermal necrolysis S&S

Answer 31

Painful sloughing rash. Flaccid blisters that spread with pressure. 8 weeks after exposure. - Fever, headaches, malaise before lesions 1-3 days preceding lesions -Initial lesions irregular red to purpuric macules. Could have mucous membrane involvement - Erythematous erosions, open skin, begin as flaccid blisters - if 30% BSA = toxic epidermal necrolysis - punch tissue biopsy, if 25-30% BSA = burn unit - discontinue all non life sustaining meds. If skin is dusky gray , necrosis is likely

Question 32

Manifestations of IgE: eyes

Answer 32

Swelling of conjunctiva

Question 33

Manifestations of IgE: skin

Answer 33

Uriticaria (hives) Pruritis (itching) flushing

Question 34

Manifestations of IgE: Respiratory tract

Answer 34

``` SOB wheezes/stridor hoarseness pain with swallowing cough ```

Question 35

Manifestations of IgE: Heart

Answer 35

fast or slow HR | Low BP

Question 36

Manifestations of IgE: GI tract

Answer 36

``` crampy/ abdominal pain diarrhea vomiting rhinorrhea swelling of lips and tongue and throat pelvic pain loss of bladder control ```

Question 37

Manifestations of IgE: Neuro

Answer 37

``` lightheadedness loss of consciousness confusion headache anxiety ```