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Allergy and asthma Flashcards

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1
Q

where do all immune cells come from?

A

hematopoietic stem cells

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2
Q

which cytokines act on naive CD4 T cells to turn them into T regulatory cells?

A

IL-2

TGF-beta

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3
Q

which cytokines act on naive CD4 T cells to turn them into Th1

A

IL-12

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4
Q

which cytokines act on naive CD4 T cells to turn them into Th2

A

IL-4

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5
Q

which cytokines act on naive CD4 T cells to turn them into Th17

A 
TGF beta
IL-6
IL-21
IL-23
IL-1beta
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6
Q

which cytokines are produced by T reg cells

A 
TGF-beta
IL-10
IL-35
STAT6
FOXP3
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7
Q

which cytokines are produced by Th1 cells?

A

IFN-gamma
LT alpha
STAT4
T-bet

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8
Q

Which cytokines are produced by Th2 cells?

A 
IL-4
IL-5
IL-13
STAT6
GATA3
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9
Q

Which cytokines are produced by Th17 cells?

A 
IL-17A
IL-17F
IL-22
IL-21
CCL20
STAT3
ROR gamma T
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10
Q

what do T reg cells do?

A

suppresses tumour immunity
promotes immune tolerance
maintains lymphocyte homeostasis

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11
Q

what do Th1 cells do?

A

promotes tumour immunity
intracellular pathogens
drives autoimmunity

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12
Q

what do Th2 cells do?

A

extracellular pathogens
allergy
asthma
produce IgE

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13
Q

what do Th17 cells do?

A

controversial tumour immunity
breaks immune tolerance
extracellular bacteria
autoimmunity

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14
Q

T cell balance

A

equal numbers of Th1 and 2 cells

inhibit each other

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15
Q

autoimmune diseases

A

more Th1 cells than Th2

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16
Q

atopy

A

more Th2 cells than Th1

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17
Q

T reg cells

A

maintain the balance between Th1 and 2 cell populations by realsing IL-10 and TGF-beta

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18
Q

what is IgE used for?

A

kills helminths and parasites by activation eosinophils

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19
Q

what happens in initial sensitisation?

A 
allergen presented to DC cells which recognise them as foreign and so presents them on MHC 2 of DCs to naive T cells which makes them become Th2 cells which activates naive B cells that produce IgM and then they are class switched through DNA splicing so they produce IgE.
Clonal expansion - memory cells
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20
Q

IgE receptor

A

FCepsilonRI receptor which allows IgE to bind to cells

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21
Q

where are IgE receptors?

A

mast cells - tissue
basophils - blood
B lymphocytes - lesser extend

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22
Q

what cytokines cause class switching?

A

IL-4 and 5

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23
Q

how do B cells class switch?

A

DNA splicing

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24
Q

re-exposure to allergen

A

allergen/ antigen binds to IgE, has to cross link - bind to 2 IgE molecules and causes degranulation of the mast cell

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25
mast cell mediators
biogenic amines lipid mediators cytokines enzymes
26
biogenic amines released by mast cell
histamines
27
lipid mediators released by mast cells
Prostaglandins - PGD2 | leukotrienes - LTC4
28
cytokines released by mast cells
TNF alpha or beta
29
Enzymes released by mast cells
exogenous tryptase
30
what do histamines do?
vasodilation and vascular leak
31
what do lipid mediators do?
bronchoconstriction | intestinal hypermotility
32
what do cytokines do?
inflammation
33
what do enzymes do?
tissue damage
34
phases of allergy
immediate and late
35
late phase
recruit Th17 cells which produces IL-17 and IL-22 which causes activation of eosinophils and recruitment of basophils
36
what do eosinophils do?
release mediators, chemokines and proinflammatory cytokines | increased inflammatory cells migration and activation
37
what do basophils do?
have their own IgE molecules
38
how long does it take for inflammatory cells to be recruited?
6 hours after exposure
39
eosinophils
elevated/ recruited in lungs and blood of asthmatics | allergy and parasitic infections
40
what activates eosinophils?
activated by cytokines
41
what do eosinophils release?
release toxins, leukotrienes and cytokines
42
what do eosinophils cause?
activation causes bronchial hyperactivity - wheezing
43
smooth muscle cell activation and hyperactivity
can also be caused by IFN gamma and TNF from Th1 cells when they are recruited due to imbalanced immune system
44
What do Il-4,13 and CCL5 do?
cause increased endothelial-cell adhesion and inflammatory cell transmigration so even if allergen is removed inflammatory process will continue
45
why does an allergy cause eczema?
atopic dermatitis Th1 cells produced IFN gamma, TNF and CD95L which induces keratinocyte apoptosis and release of chemokines and proinflammatory cytokines
46
chronic allergic reaction
persistent inflammation prolonged or repetitive exposure to antigens characterised by large numbers of innate and adaptive immune cells substantial changes in the extracellular matrix and alterations in the number, phenotype and function of structural cells in the affected tissues
47
fibroblasts
implicated in normal healing process and scar formation deposit extracellular matrix cause thickening of basement membrane
48
fibroblasts in lungs
tryptase affects fibroblasts in lungs but this can cause increase in extracellular matrix and thickening of basement membrane, further narrowing the airways
49
what happens in severe chronic asthma?
``` vasodilation hyperplasia and mucus hypersecretion leukocyte infiltration eosinophilia hypertrophy of smooth muscle collagen deposition partial occlusion of bronchial lumen by mucus plug thickening of basement membrane oedema desquamation/ degradation of epithelium ```
50
what are the 2 types of asthma?
type 2 inflammation | non-type 2 inflammation
51
non type/ Th 2 inflammation
caused by smoking irritants pollutants infections
52
what happens in non Th2 inflammation
similar reaction but call in Th1 cells quicker and recruit neutrophils
53
clinical presentations of allergy
anything presented via dendritic cell can be perceived as non self or pathogenic antigens which can then trigger an IgE mediated reaction. This can be anything
54
causes of IgE mediated reactions?
``` drug hormones genetics systemic illness food allergies stress ```
55
common drugs that cause IgE mediated reaction?
``` antibiotics NSAIDs - second most common allergy biologicals contrast agents blood ```
56
what infections cause hives IgE mediated reaction?
infections - Hepatitis, EBV, herpes chronic parasites cutaneous fungal infections
57
what foods cause allergies/ IgE mediated reaction?
``` peanuts tree nuts milk eggs wheat soy fish shellfish sesame ```
58
IgE mediated symptoms
``` sneezing runny nose nasal congestion discomfort in mouth swelling of lipd itching hives reddening loss of consciousness lethargy blue-white lips/ nails itchy eyes redness of eyes swelling of eyelids raspy voice wheezing whistling sound when breezing coughing difficulty breathing abdominal pain nausea diarrhoea ```
59
hives
releasing of plasma into epidermis due to vascular leak
60
clinical presentation of asthma
shortness of breath - exercise and interval expiratory wheeze cough, especially nocturnal episodic reversible diagnosis based on likelihood and assessment
61
when making an asthma diagnosis
rationale for the diagnosis needs to be documentation
62
differential diagnoses in asthma
``` hyperventilation in teenagers viral induced wheeze primary ciliary dyskinesia bronchiectasis cystic fibrosis vocal cord dysfunction persistent bacterial bronchitis ```
63
asthma triggers
``` exercise pollen house dust mites saliva on fur stress emotions - anger etc. insects cold air infections smoking pollution person specific ```
64
hypothetical causes of atopy
vitamin D hypothesis antibiotics dual allergen hypothesis - how you are exposed to allergens hygiene hypothesis
65
treating chronic asthma and chronic urticaria
monoclonal antibody - omalizumab - anti IgE
66
treating chronic eczema
dupilumab

Physiology (46 decks)

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