ALLERGY AND IMMUNOLOGY Flashcards by Verona Coralie Desulme

Antibody that has a major role in allergic
conditions, e.g., anaphylaxis, atopy, asthma,
allergic rhinitis, food allergies

IgE

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Antibody that mediates type I hypersensitivity
reaction

IgE

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First antibody produced in an infection

IgM

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An antibody found in body mucosal secretions

IgA

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What is the prevalence of atopic disorders in
children with one affected parent?

Up to 60%

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What is the prevalence of atopic disorders in
children with 2 affected parents?

Up to 80% (family history is critical in all atopic
disorders)

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What are atopic disorders?

Atopic dermatitis, asthma, allergic rhinitis, and
food allergies

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What are the indications of allergy testing?

Significant allergies, e.g., asthma, anaphylaxis,
food or drug allergies, difficult to treat allergies
or requirement for specific treatment

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An infant with severe eczema and/or severe egg
allergy

Evaluate for peanut reactivity with either skinprick testing and/or serum IgE levels, and if
necessary, oral food challenge

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Which allergy test is preferred in cases of
dermatographism, generalized dermatitis, or a
clinical history of severe anaphylactic reactions to a given food?

Radioallergosorbent test (RAST) (allergenspecific
IgE antibody)

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Which allergy test is associated with a high false
positive rate?

Both skin-prick testing and serum IgE levels

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Child currently on diphenhydramine for allergies is scheduled for skin allergy testing. When should diphenhydramine be stopped?

At least 5 days prior to testing

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Child currently on cetirizine for allergies is
scheduled for skin allergy testing. When should
cetirizine be stopped?

At least 7 days prior to testing

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Child currently on amitriptyline for migraine
headache prophylaxis is scheduled for skin allergy testing. When should amitriptyline be stopped?

At least 2 weeks prior to testing

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What is the first step that should be taken in the
management of allergic rhinitis?

Avoidance or reduction of allergen exposures

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The first-line pharmacologic treatment of allergic rhinitis

Intranasal steroids and/or second-generation oral antihistamines

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Common complications of untreated allergic
rhinitis

Recurrent acute otitis media, sinusitis, chronic
cough, and asthma

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Complications of prolonged use of nasal
adrenergic drops

Rhinitis medicamentosa

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An 8-year-old male presents with congestion, itchy nose, and watery eyes. Symptoms are exacerbated when playing with the pet cat. He loves his cat. What is the most effective treatment?

Avoid the trigger (e.g., by keeping the cat at
least outside the bedroom or the house all the
time; HEPA filters can help)

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Child with a history of pollen allergy develops
rapid onset of itching, swelling of the lips, mouth, and throat when eating raw fruits and vegetables. What is the most likely cause?

Oral allergy syndrome (OAS) (cross-reactivity
with pollen)

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What is the best treatment for OAS?

Avoid offending foods

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How long do the allergies to peanuts, tree nuts,
seafood, and fish last?

Lifelong allergies

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How long do the allergies to milk, eggs, and soy
last?

Most children outgrow by 5 years of age

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A 2-month-old exclusively breastfed infant is seen for bloody stools; weight gain is appropriate, and physical exam is normal

Reassurance (counsel mother to avoid dairy, soy, eggs for 2 weeks, then re-evaluate)

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Induration reaction to TB testing after 72 h is an example of

Type IV: cell-mediated hypersensitivity

Allergy to contrast media is an example of

Non-IgE mediated

Child with a history of severe allergic reaction to radiographic contrast media is going for CT scan with IV contrast

Administer prednisone and diphenhydramine before injection or choose other alternative imaging tests

Child with a history of severe allergic reaction to seafood is going for an abdominal CT scan with oral and IV contrast. Does he or she need a pretreatment with prednisone and diphenhydramine?

No (iodine allergy is not a risk factor for allergic-type contrast reactions)

A 16-year-old male with a new watch notices an area of erythema located on the wrist where the watch was worn. No other lesions

Type 4—contact dermatitis, a delayed hypersensitivity reaction

What is the best treatment in cases of contact dermatitis?

Avoid offending agents

Child received penicillin 10 days ago for the first time, presents with fever, nausea, vomiting, pruritic skin rash (urticaria), angioedema, joint pain, lymphadenopathy, myalgia, and proteinuria

Serum sickness

A common trigger of allergic reactions in a patient with spina bifida or congenital urogenital problems

Latex

What is the most common specific autoimmune association with chronic urticaria?

Autoimmune thyroid disease (laboratory evaluation should include thyroid-stimulating hormone (TSH) level and thyroid antibodies)

Sudden onset of lip swelling, abdominal pain, swelling of both feet, non-pruritic erythematous skin rash; one family member has the same condition

Hereditary angioedema

What is the cause of hereditary angioedema (HAE)?

Low levels or decreased function of plasma protein C1 inhibitor (C1-INH). (Autosomal dominant)

Initial screening test for a patient with suspected hereditary angioedema

C4 level most reliable and cost-effective screening test for HAE

The test that can differentiate between various types of hereditary angioedema

C1-INH functional assay

A 6-year-old male with yellow-tan macules located on the upper extremities. Parents notice localized erythema following scratching of the lesions and after taking a hot shower

Mastocytosis—Darier sign: urticaria after stroking lesions

Common diagnostic lab for mastocytosis

Elevated tryptase levels

A 15-year-old male presents with several erythematous, pruritic circumscribed lesions that occur with exercise

Exercise-induced urticaria

Child presents a few minutes after eating peanut butter with urticaria, skin flushing, pruritus, angioedema, rhinorrhea, wheezing, shortness of breath, abdominal pain, vomiting, diarrhea, lightheadedness. What is the next best step?

IM epinephrine to administer as quickly as possible

Child with a history of life-threatening reaction to a bee sting is coming to your office for a follow-up after he was discharged from the ER with EpiPen prescription. What is the next best step?

Referral to an allergist for immunotherapy

A 4-year-old male scheduled for a well child check; he was recently treated with a 5-day course of oral steroids for asthma exacerbation. Which vaccines can be given?

All vaccines including MMR and varicella

A 4-year-old male scheduled for a well child check; he has been treated with high dose steroids for 4 weeks. Should the MMR and varicella vaccines be given?

No—patients receiving high steroids for greater than 2 weeks should be off steroids for at least 1 month

Child is being treated with intranasal steroids for allergic rhinitis. Should the MMR and varicella vaccines be given?

Yes

What is the best initial test for any child with suspected immunodeficiency?

Complete blood count (CBC)

Patient with recurrent meningococcal meningitis

The defect in terminal complement C5–C9 deficiency

Initial screening test for a patient with suspected complement deficiency, e.g., recurrent (Neisseria meningitidis) meningitis

(CH50) test

Complement deficiency that increases the risk of systemic lupus erythematosus

C2 deficiency

What is the best screening test for cell-mediated immunity associated with T-cell defects?

T-cell phenotyping (CD4/CD8, memory vs. naïve T cells) and T-cell proliferative responses

What is the best initial test for an infant with suspected humoral immune deficiency?

Immunoglobulin levels

An 8-week-old boy presents with diarrhea, pneumonia, persistent oral thrush, eczematous-like skin lesions, sepsis, lymphopenia, and failure to thrive

Severe combined immunodeficiency (SCID)

The enzyme deficiency that is found in SCID?

Adenosine deaminase deficiency

A 9-month-old boy, previously healthy, presents with recurrent otitis media, 2 episodes of pneumonia in the last 2 months, persistent giardiasis. O/E: the lymph nodes, the tonsils are absent

X-linked agammaglobulinemia (usually starts after first 6 months of life)

Adolescent presents with recurrent sinus and pulmonary infections due to encapsulated bacteria, malabsorption, hepatosplenomegaly, and low level of immunoglobulins (IgG, IgM, and IgA)

Common variable immunodeficiency

The best treatment for a child with asymptomatic transient hypogammaglobulinemia of infancy

Observation (no treatment is necessary)

An 8-year-old boy presents with eczema, recurrent Staphylococcus aureus skin infections without inflammatory response “cold abscess,” pneumatoceles, coarse facial features, eosinophilia, and IgE level is 80,000 IU

Job syndrome (autosomal dominant hyper-IgE syndrome)

A 5-month-old presents with Pneumocystis jiroveci pneumonia, mouth ulcers, severe neutropenia, recurrent sinusitis, otitis media, chronic diarrhea, failure to thrive, and negative HIV

X-linked hyper IgM syndrome

A 4-year-old boy with recurrent skin abscesses, spleen and liver abscesses, and osteomyelitis

Chronic granulomatous disease (X-linked)

Test of choice in a patient with a suspected chronic granulomatous disease

DHR oxidation is preferred, NBT reduction can be used

Severe progressive infectious mononucleosis and Epstein–Barr virus (EBV) fulminant hepatitis

X-linked lymphoproliferative syndrome (Duncan syndrome)

Highly elevated WBC in a 10-week-old infant who still has an umbilical cord

Leukocyte adhesion defect type I

Test of choice in a patient with suspected leukocyte adhesion defect

Flow cytometry beta 2 integrin CD11b/CD18 on leukocytes

Newborn with hypocalcemia, tetralogy of Fallot, interrupted aortic arch, and abnormal facial features

DiGeorge anomaly (deletion of chromosome 22q11.2)

Recurrent ear infections, eczema, profuse bleeding during a circumcision procedure, thrombocytopenia, and small platelets

Wiskott–Aldrich syndrome

Persistent thrush, nail dystrophy, and endocrinopathies

Chronic mucocutaneous candidiasis

Short stature, fine hair, and severe varicella infection

Cartilage-hair hypoplasia with short-limbed dwarfism

Oculocutaneous albinism, recurrent infections, and easy bruising

Chédiak–Higashi syndrome

Candidiasis with raw egg ingestion

Biotin-dependent carboxylases deficiency

A 4-year-old with short stature, micrognathia, telangiectasia, immunodeficiency, learning disability, deficiency of DNA ligase I

Bloom syndrome

An 8-year-old boy presents with recurrent ear and sinus infections, ataxia, oculocutaneous telangiectasia, and elevated α1-fetoprotein

Ataxia–telangiectasia (autosomal recessive)

ALLERGY AND IMMUNOLOGY Flashcards

(71 cards)