Allergy, Etc. Flashcards
Type I Hypersensitivity
IgE mediated
Ex: Anaphylaxis, angioedema, food allergy, insect bite
Type II Hypersensitivity
IgG or IgM mediated
Complement activation involved
Ex: Transfusion reaction, hemolytic disease of newborn
Type III Hypersensitivity
IgG or IgM mediated
Antigen-antibody complexes
PSGN, RA, SLE
Type IV Hypersensitivity
Th1 cell mediated
DELAYED
Contact dermatitis (poison ivy), MS
“Contraindications” to allergy testing
Must stop antihistamines, beta agonists, TCAs prior to testing
No glycerin sensitivity (serves as control), no skin conditions (i.e. dermatographia)
Intradermal Dilutional Testing - what is the endpoint?
Endpoint is when you get > 2 mm from “control” - helps determine safe starting point for immunotherapy.
If you don’t get ANY 2 mm or more difference, it’s a negative test!
Only two branches of ICA in the nose
Anterior and posterior ethmoids (from ophthalmic branch of ICA) - you do NOT embolize these!
What is the dose of epi in an epi pen?
0.3 mg
Most prevalent allergens in:
Spring
Summer
Fall
Year Round
Spring: Tree pollen
Summer: Grasses
Fall: Ragweed
Mold: All year round
Kiesselbach’s Plexus
Septal b. of sup. labial (from facial –> ECA)
Anterior ethmoid (from ICA)
Sphenopalatine (from IMAX –> ECA)
Greater palatine (from IMAX –> ECA)
What fungus is associated with the Ohio and Mississippi river valley?
Histoplasmosis
Which chemokines are responsible for IgE recruitment and what type of inflammation is this?
IL-4, 5 and 13
Type TWO inflammation (CRSwNP)
Mechanism of Atrovent and uses?
Anticholinergic agent, aka ipratropium bromide, used for vasomotor rhinitis but also can be used for allergic rhinitis. Less effective for coughing, sneezing, etc.
One intranasal corticosteroid that is NOT safe for pregnancy?
Triamcinolone.
Mechanism of Montelukast + uses?
Leukotriene receptor antagonist, used for seasonal allergies.
Black box warning for psych side effects
OK to continue with allergy testing.
What has cross reactivity with latex?
Avocado, chestnut, banana, kiwi and papaya can exhibit allergy cross reactivity with latex.
Which interleukins are involved in TH1 vs TH2 response?
TH1: IL10, IL12, IFN gamma
TH2: IL4, 5 and 13 (dont forget IL33 is involved in activation of these)
CVID Features?
-Decreased IgG, IgA, some have low IgM
-Think young adults with respiratory disease, granulomas, malignancy
-TX: IVIG
Brutton’s agammaglobulinemia features?
-Tyrosine kinase issue affects B cells - can’t produce antibodies
-~6 months of age presentation, usuall in young boys
-Lots of sinopulmonary infections
-X linked!
What do TH1 and TH2 cells secrete?
TH1: IFN-gamma (–> macrophage activation, Il-2 expression)
TH2: IL-4, IL-5, IL-13
Type V hypersensitivity features and examples?
Ab resembles a ligand
Ex: Graves, Hashimotos, Myesthenia Gravis
Pathway for sublingual or subcutaneous immunotherapy and timeline? Contraindications? How to monitor?
Upregulated T reg cells produce IL-10, INHIBIT Th-2 (and switches to TH1 pathway).
3-5 years for TX
Serum total IgE/total IgE for monitoring
Contraindications: Pregnancy, autoimmune, anaphylaxis
How does RAST work and who is it good for?
In VITRO blood testing
Blood test looking at how much of patient’s IgE in serum binds to Ag (basically…). Compares IgE to specific allergen/Total IgE
-Must wait 4-6 weeks post allergic reaction
-Good for people who can’t stop certain medications, have high risk of anaphylaxis, dermatographia, etc.
-More SPECIFIC, LESS sensitive than skin testing
-Interpretation:
0-2 insignificant
3-6 significant
5-6 severed
Intradermal Dilution Testing
-Helpful for determining immunotherapy dosages
-Endpoint = first wheal > 2 mm from control (confirms where to start). You do one additional injected which should be > 2 mm from endpoint, thus CONFIRMING prior endpoint.
-Used as primary testing for penicillin, insect venoms (do 1-2 months after sting)
