Allergy/Immunology

Question 1

Name implicated foods in oral pollen food allergy syndrome against Birch pollen.

Answer 1

apple, almond, carrot, celery, cherry, hazelnut, kiwi, peach, pear, plum (Stone fruits!)

Question 2

Name implicated foods in oral pollen food allergy syndrome against Ragweed pollen.

Answer 2

banana, cucumber, melons, sunflower seeds, zucchini( Melons and cylindrical things!)

Question 3

Name components of Innate immunity (4) and adaptive immunity (2).

Answer 3

innate- nonspecific. phagocytes/natural killer cells, skin/mucous membranes, complement system/proteins, innate lymphoid cells. adaptive - T cells and B cells. specific to antigen.

Question 4

Function, cell types, and inflammatory mediators of Th1, Th2, and Th17.

Answer 4

Th1 - neutrophils. IFN-y, IL-2. Delayed hypersensitivity, bacterial/viral immunity. Th2 - allergy, IgE. Mast cells, eosinophils, IL4, 5, 13. Th17 - autoimmunity; IL17.

Question 5

Name 3 specific entities implicated as Th2 dominant/eosinophilic entities in CRS.

Answer 5

AERD/asthma, AFRS, CRS w NP

Question 6

Specific functions of IL4, IL5, and IL13?

Answer 6

IL4 - IgE. IL5- eosinophil production. IL13 - polyp formation

Question 7

Shape and function of IgG, IgM, IgE, and IgA?

Answer 7

IgG - dimer, chronic immunity/memory. IgM - pentamer, acute response. IgE - dimer, allergy. IgA - dimer, mucous membranes. IgG crosses placenta. IgA is in breastmilk. IgE has lowest serum concentration

Question 8

Which immunoglobulin crosses placenta?

Answer 8

IgG

Question 9

Which immunoglobulin is in breastmilk?

Answer 9

Ig!

Question 10

Which immunoglobulin has the lowest serum concentration?

Answer 10

IgE

Question 11

IgE: found on surface of which cell types? Induced by what mediator? Inhibited by which mediator?

Answer 11

Basophils and mast cells. Induced by Ig4. Inhibited by IFNy [Also a fun fact: confers immunity to helminths]

Question 12

Fc vs Fab: heavy chain vs light chain? binds to cell or antigen? which determines Ig class?

Answer 12

Fc = heavy, binds to cell, determines Ig class. Fab = light chain, binds to antigen.

Question 13

IgG subclass deficiencies: which ones are a/w protein antigens? polysaccharide antigens? Which one is the most common subclass deficiency in children?

Answer 13

protein - 1&3. Polysaccharide = 2&4. IgG2 most common subclass def in children.

Question 14

What is the immunologic derangement in CVID

Answer 14

CVID = quantative + qualitaive issue with IgG.

Question 15

What is the immunologic derangement in Specific Polysaccharide Antibody Deficiency

Answer 15

SPAD = can’t produce sufficient antibodies to polysaccharide organisms.

Question 16

What is the immunologic derangement in Bruton’s agammaglobulinemia

Answer 16

Bruton’s = issue with B cell maturation.

Question 17

What is the immunologic derangement in Digeorge? What is the mnemonic CATCH-22?

Answer 17

DiGeorge = full syndrome, thymic aplasia. C= cardiac defects, A = atresia of the choanae, T= thymic aplasia, C = cleft palate, H = hypocalcemia. 22 = chr 22

Question 18

What is the immunologic derangement in Wiskott-Aldrich?

Answer 18

Wiskott-Aldrich = issue with WAS protein, eczema, bleeding + recurrent infections.

Question 19

Which immunologic derangement disorders cause susceptibility to encapsulated organisms?

Answer 19

Encapsulated organisms: SPAD, Bruton’s.

Question 20

Which immunologic derangement disorders are X-linked?

Answer 20

X-linked: Bruton’s, Wiskott-Aldrich.

Question 21

Which immunologic derangement disordershave B cell issues only? Which ones have B and T cell issues?

Answer 21

B cell issues: Bruton’s, SPAD. B&T issues = Wiskott Aldrich, also often CVID, DiGeorge.

Question 22

Which immunologic derangement disorder is implicated in CRSsNP? Which one will have absent tonsils/adenoids? Which one is missing thymus?

Answer 22

CRSsNP = SPAD. Absent tonsils/adenoids: Bruton’s. Absent thymus = DiGeorge.

Question 23

Name, Mechanism, and 1-2 Examples of each of the Gel-Coombs Hypersensitivity Reaction Types?

Answer 23

I = IgE mediated; anaphylaxis/allergy. II - cytotoxic. Antibody binds to cell and signals inflammatory cells/mediators. Ex - Hashimoto, hemolytic disease of the newborn, transfusion reactions. III= immune complex, antigen-antibody complexes deposit in tissues. Ex - SLE, glomerulonephritis. IV - delayed/cell-mediated. T cell mediated, NOT antibody. Ex- contact dermatitis

Question 24

Adult and Pediatric Doses of Epinephrine?

Answer 24

Adult = 0.3mg 1:1,000 epi. Pediatric = 0.1mg 1:1,000 epi. More precise is 0.01mg/kg. Given IM

Question 25

Effect of epinephrine on alpha, beta-1, and beta-2 receptors?

Answer 25

alpha = vasocontriction. beta 1 - incr cardiac contractility/rate. beta 2 - bronchodilation, inhibition of mast cell degranulation

Question 26

When do histamine and tryptase levels peak after an anaphylactic reaction?

Answer 26

15m for histamine, normal after ~30-40. 2h for tryptase, normal after 6h.

Question 27

Angioedema: mediator in allergy vs ACE?

Answer 27

allergy = mast cell mediated. ACE = kinin mediated.

Question 28

mode of inheritance for C1 esterase deficiency? screening test for this condition?

Answer 28

Autosomal dominant. quantitative C4 levels (always low)

Question 29

What is dupilumab and what is it used for?

Answer 29

dupilumab - monoclonal antibody against IL-4; used for refractory polyposis

Question 30

What is Samter’s triad/AERD? What is the MOA?

Answer 30

asthma, nasal polyposis, ASA sensitivity. MOA is disruption of the arachidonic acid pathway leading to increase in leukotrienes

Question 31

Name 3-5 benefits of aspirin rx after desensitization. Can it eliminate pre-existing polyps?

Answer 31

Decrease need for surgery, decrease episodes of infectious sinusitis, improve asthma control, improve sense of smell, reduce dosage of daily systemic steroids, decrease nasal congestion. Does NOT eliminate pre-existing polyps.

Question 32

Early vs Late phase of allergic response: a) timing of onset after exposure? b) mediators? c) symptoms?

Answer 32

early: 5-15 minutes, mediated by degranulation of mast cells/histamine, rhinorrhea/watery eyes. late: 3-4h, mediated by cellular infiltration with basophils/eosinophils, nasal congestion/postnasal drip

Question 33

Classification of allergic rhinitis: a) cutoff for intermittent vs persistent? b) mild vs moderate/severe?

Answer 33

a) intermittent = <4 days a week OR < 4 weeks. Persistent = >4 days a week AND >4 weeks. b) mild = no interference with daily life (sleep, work, etc). moderate = interference with one part of life. severe = interference with more than one part of life

Question 34

Name 3-4 nonallergic causes of rhinitis.

Answer 34

vasomotor, hormonal, atrophic, rhinitis medicomentosa, viral, systemic disease, drug-induced

Question 35

In vitro vs skin prick allergy testing: a) influenced by meds? b) cost? c) sensitivity?

Answer 35

a) skin prick influenced by meds, in vitro is not. b) in vitro more expensive c) skin prick more sensitive

Question 36

Do oral corticosteroids affect skin test results? Do leukotriene modifiers (-lukasts) affect skin test results?

Answer 36

Oral corticosteroids and leukotriene modifiers do NOT affected skin test results.

Question 37

Name 2-3 notable meds that affect skin test results.

Answer 37

Theophylline, H1&H2 blockers, TCAs, and topical steroids affect results.

Question 38

Explain how to identified the skin endpoint in skin endpoint titration.

Answer 38

Identify the last concentration that led to progressive enlargement beyond 5mm.

Question 39

What is a plateau response in skin testing and how to deal with it? What is a flash response and how to deal with it?

Answer 39

Plateau means it flattens out instead of getting progressively bigger — keep going until you get the progressive wheal. Flash response is a suddenly huge response compared to the previous dilution; stop testing and try again in 4-7 days.

Question 40

What is modified quantitative testing?

Answer 40

Hybrid testing that basically has replaced skin endpoint titration (SET). You do skin prick to get a range of likely dilutions to start with — then do intradermal testing to identify the specific one (rather than sequential identification like in SET).

Question 41

Assign seasonality to the following: ragweed, dust mites, grasses, trees, weed, outdoor molds, indoor molds

Answer 41

trees - spring. grasses - trees. weed/ragweed - fall. outdoor molds - perennial above freezing temperatures. indoor mold + dust mites - perennial.

Question 42

Latex-Fruit Syndrome. Name 4 fruits overlapping with latex allergy.

Answer 42

ABC Kiwi. Avocado, banana, chestnut, Kiwi.

Question 43

Name of the protein/allergen implicated in cat allergy?

Answer 43

Fel d1

Question 44

Name of the protein/allergen implicated most commonly in peanut allergy?

Answer 44

Ara h2

Question 45

What allergic rhinitis pharmacotherapy should be considered in a patient with exercise or cold-induced asthma?

Answer 45

Leukotriene receptor antagonists

Question 46

Name 2-3 mechanisms of success for immunotherapy.

Answer 46

Reduce allergen-specific IgE (after initial rise). Increased Th1 levels, induction of antigen-specific IgG4. Increase IL-10 secretion - reduces mast cell/eosinophil activation + induces T cell tolerance for specific antigens.

Question 47

What interleukin is implicated in inducing T cell tolerance for specific antigens in immunotherapy?

Answer 47

IL-10 implicated.

Question 48

Name 3-4 potential treatments for vasomotor rhinitis.

Answer 48

ipratropium, azelastine, capsaicin, vidian neuronectomy

Question 49

What oral medications can cause rhinitis medicamentosa and what is the treatment for this?

Answer 49

antihypertensives; change meds/cessation