Ch. 5 Hypersensitivity Disorder Flashcards Preview

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Flashcards in Ch. 5 Hypersensitivity Disorder Deck (99):
1

what is the cause of idiopathic atrophic rhinitis in a young/middle age female in a developing country near the equator?

Klebsiella ozaenae

2

name key drugs for medication induced rhinitis

B blockers, alpha agonists, phosphodiesterases (i.e. sildenafil), OCPs, ACE-I, gabapentin, risperidone, amitryptiline, ASA/NSAIDs (AERD)

3

what happens to eNO in Allergic rhinitis? Sinusitis?

increases; decreases

4

if worried about CSF leak, what should you check?

B2 transferrin in nasal secretions

5

what are in Charcot-Leyden crystals?

eosinophil degranulation products

6

what is the size of papillary hypertrophy in vernal keratoconjunctivitis? What are other features of VKC?

>1mm; Horner Trantas dots, photophobia, itching, shield ulcers; sight-threatening; male predominance (age 3-20); treatment with high dose pulse topical corticosteroids; topical calcineurin inhibitors, antihistamine drops +/- antibiotics

7

what are key clinical features of atopic keratoconjunctiivits?

ocular pruritis with atopic dermatitis; sight-threatening; punctate keratitis (visualized with dye), corneal infiltrates, keratoconus, anterior subcapsular cataracts

8

what is the % of eos in nasal smear in NARES

20

9

what is the size of papilary hypertrophy in Giant papillary conjunctivitis?

>0.3 mm (smaller than VKC)

10

what are 3 key chemokines that have been implicated in active atopic dermatitis?

CTACK, CCL27, TARC

11

what cytokines are involved in acute AD?

IL4, 13

12

what cytokines are involved in chronic AD

IL5, IL12, IFNgamma

13

what is unique about the FCeRI of Langerhan's cells?

lack the beta chain

14

what is associated with anterior cataracts? posterior?

anterior=atopic kc; posterior=prednisone

15

name 3 antimicrobial peptides? and what cells produce them?

H-B defensin (2 & 3) and human cathelicidin (LL-37); secreted by keratinocytes

16

what is the blackbox warning on topical tacrolimus

long term use may cause increased risk for infections (osteomyelitis and bullous impetigo; lymphoma and skin malignancy

17

an accumulation of what cell type in the airway is a hallmark of fatal asthma?

neutrophil

18

what type of collagen composes reticular basement membrane?

collagen type III

19

what is CD14

co receptor for TLR

20

what is a diagnostic methacholine challenge

PC20 <4mg/mL; 4-16 mg/mL is suggestive of diagnosis

21

what are major and minor criteria for Asthma Predictive Index

Major: parental asthma, physician diagnosed atopic dermatitis, aeroallergen sensitization; minor: eos>4%, food allergy, wheezing apart from colds. Need one major or two minor to be positive.

22

what is auriculotemporal syndrome (aka Frey's sydnrome)

transient, unilatera and/or bilateral facial flushing or sweating after ingestion of spicy or flavored foods; non-immune mediated; may be due to damage to auriculotemporal nerve

23

what are the protein allergens for milk?

Bos d4-8; casein and whey

24

what are the protein allergens for egg?

Gal d1-5; ovalbumin and ovamucoid

25

what are the protein allergens for shrimp?

lit v1, Pen a 1; tropomyosin

26

what is the protein allergen for fish

Gad d 5; parvalbumin

27

what are the protein allergens for peanut?

ara h 1-11; vicilin, conglutinin, glycinin

28

what are the protein allergens for soy?

Gly m 5

29

what are the protein allergens for hazelnut?

Cor a 8,9

30

what are the protein allergens for apple?

Mal d1,2

31

what is Heiner's syndrome?

Food hypersensitivity pulmonary syndrome; usually to cow's milk; recurrent pneumonia, pulmonary infiltrates, hemosiderosis, Fe deficiency anemia and FTT; peripheral eosinophilia, milk precipitans, lung biopsy; tx: elimination diet

32

common foods implicated in food-dependent-exercise-induced anaphylaxis

celery, wheat (omega-5-gliadin), shellfish, fruit, milk and fish

33

what foods/allergens cross react with birch?

apple, plum, peach, pear, cherry, apricot, almond (Rosaceae); celery, carot, parsely, caraway, fennel, corriander (Apiaceae); soybean, peanut (Fabaceae); hazelnut (betulaceae)

34

what foods/allergens cross react with ragweed?

cantaloupe, honeydew, watermelon, zucchini, cucumber (cucurbitaceae); banana (musaceae)

35

what foods/allergens cross react with mugwort?

celery, carot, parsely, caraway, fennel, corriander (Apiaceae); mustard, cauliflower, cabbage, broccoli (brassicaceae), garlic, onion (lilaceae)

36

what foods/allergens cross react with orchard grass?

cantaloupe, honeydew, watermelon (cucurbitaceae); peanut (fabaceae); white potato, tomato (solanaceae)

37

what foods/allergens cross react with timothy grass?

swiss chard (amaranthaceae), orange

38

what fruits cause latex fruit syndrome

banana, avocado, chestnut, kiwi

39

what is the allergen that causes delayed anaphylaxis (3-6 hours) after ingestion of red meat, lamb or pork?

galactose a 1,3 galactos (aka alpha-gal); lonestar tick; will also cause anaphylaxis to cetuximab (chemo)

40

what cytokines have been correlated with hypotension during anaphylaxis?

IL-6, TNF receptor1, mast cell tryptase, histamine, C3a

41

patients with spina bifida may have higher risk of anaphylaxis to latex? what allergens are commonly identified?

Hev b 1 and 3; these allergens are less common in healthcare workers

42

what latex allergens do healthcare workers react most frequently?

Hev b 5,6 7

43

fire ant venom contains this unique protein?

2-6, disubstituted piperdines (95%)

44

Honeybee relevant allergens

Apis mellifera; Phospholipase A2 (Api m 1) is most important; minor allergens include hyaluronidase, acid phosphatase, mellitin, CUB serine protease, icarapin

45

Hornet/yellow jacket key allergen

Vespinae family -> Vespula spp (yellow jacket) & Dolichovesupula arenaria and D. maculata (yellow and white faced hornet); key allergen is antigen 5 (Dol m 5); also phospholipase A1, hyaluronidase

46

paper wasp name and key allergen

Polistes ssp; phospholipase A1 (pol a 1); hyaluronidase (pol a 2); antigen 5 (pol a 5)

47

Honeybee characteristics; key facts (guess what I'm thinking)

usually not aggressive; stingers are left in skin after sting and kills bee; females can sting; although they do not sting often, reactions tend to be more severe

48

yellow jacket characteristics (nest, stinging,etc)

nests are layers of masticated wood, usually in the ground or in stumps; very aggressive, especially in fall; most common culprit in North America; usually the cause of stings while mowing, around garbage cans, soda/food, etc; can sting multiple times

49

hornets characteristics(nest, stinging,etc)

aerial nests, but otherwise similar in structure to yellow jackets; sting multiple times; vibration can set off their stinging behavior

50

paper wasp characteristics (nest, stinging, etc)

nests are single layer of open cells (i.e. classic comb appearance) found in eaves of windows or around homes; narrow wasp waist and dangling legs when flying; less aggressive than yellow jackets and hornets, but can sting repeatedly without losing stinger; common culprit in Gulf coast

51

what is PLAID syndrome?

Phospholipase Cy2 asociated antibody deficiency and immune dysregulation; cold-urticaria during infancy; negative ice cube test, but positive evaporative cooling; often have associated Ab deficiency

52

what are the cold urticaria syndromes that have negative ice cube test?

cold-induced cholinergic urticaria (i.e. exercise in cold air), systemic cold urticaria, familial cold autoinflammatory syndromes (FCAS) and cold-dependent dermatographism

53

what is Schnitzler syndrome?

IgM monocolonal paraproteinemia, nonpruritic urticaria, elevated ESR, and neutrophilic infiltrate on biopsy; treated with IL-1

54

what cell type might be found on urticarial biopsies of the autoinflammatory syndromes?

neutrophils

55

western red cedar mill workers, carpenters, woodworkers

plicatic acid; also important to know that plicatic acid activates complement

56

body shop, spray paint, foam insulation, roofing, auto industry

isocyonates (TDI is tolouene diisocyonate); 10% of exposed will get occupational asthma; bad prognosis despite removal of exposure; can induce reactions both immunologic and non-immunologic mechanisms

57

nail salon, dental hygienist, adhesive manufactorer

acrylates

58

metal/chemical workers, welders

platinum salts (less common, but 25% of exposed will get occupational asthma); smoking is a unique risk factor

59

hairdressers

persulfate/ammonium salts (hair bleach)

60

what are common high molecular weight sensitizers in occupational asthma?

animal proteins (rodent urine);25% of exposed will be sensitized within 2 years; flours in cereal makers, seafood handlers, bakers, textile workers

61

hospital workers, professional cleaners

formaldehyde, quarternary ammonium products

62

what is the CD4:CD8 ratio in acute hypersensitivity pneumonitis?

low <1; also CD8 lymphocytosis observed in COPD; CD4 lymphocytosis observed in granulomatous lung disease...TB, sarcoid, beryliosis

63

Farmer's lung

thermophillic actinomyteces; most common historically; exposure to moldy hay, grain, compost, silage, etc. needs to be distinguished from organic dust toxic syndrome

64

humidifier/AC lung

thermoactinomyces

65

hot tub lung

contaminated water with MAC (mac avium complex) or Cladosporium

66

bird fancier's lung/pigeon breeders lung

avian proteins from feathers, droppings, etc; common cause of HP

67

detergent workers lung

B. subtilis

68

woodworkers lung

moldy wood; Alternaria

69

True or False: Smoking cigarettes increases one's risk for hypersensitivity pneumonitis

False- cig smoking is associated with decrease risk of HP

70

bagassosis

thermoactinmyces sacchari; moldy sugar cane

71

basement shower lung

epicoccum

72

malt workers lung

aspergillus; malt, tobacco, soy

73

cheese workers lung

penicillium; exposure to moldy cheese

74

machine operator lung

pseudomonas, acinetobacter or mycobacter; contaminated metal working fluid

75

winegrower's lung

Botrytis cinerea; mold on grapes

76

el nino lung

Pizezia; exposure to mushrooms after a heavy rainfall

77

saxophonist lung

Candida albicans

78

epoxy resin worker's lung

Phtallic acid; exposure to heated epoxy resin

79

wheat weevil; miller's lung

Sitophilus; exposure to contaminated flour

80

plastic worker's lung

trimllitic anhydride

81

what PFT pattern would be appreciated in HP after inhalation/exposure?

decreased FEV1 and FVC and DLCO after 4-6 hours; restrictive pattern observed in chronic exposure

82

what is organic dust toxic syndrome?

non-infectious febrile illness that occurs after exposure to dust contaminated by toxin-producing fungi (often in grain or textiles); occurs in young patients; 30-50 x more common than HP; contracted during summer and complete recovery; no prior sensitization; no serologic response found to common fungal antigens

83

byssinosis

dust inhalation of cotton, flax or hemp; leads to bronchoconstriction that improves with time

84

how can total IgE help you in the management of ABPA

a rise (doubling) may indicate a flare of disease; treatment goal of reducing IgE by 35%; follow monthly

85

what are the GOLD criteria

GOLD 0- symptoms, but normal spiro=at risk; GOLD 1 - FEV1>80 %pred= mild;j GOLD 2 FEV1 50-80%pred= moderate; GOLD 3 FEV1 30-50% pred= severe; GOLD 4 FEV1<30% pred or <50% with chronic respiratory failure = very severe

86

what are the key cells that mediate airway inflammation in COPD

macrophages, neutrophils (release proteases) and CD8 T cells

87

what emphysema pattern would you see with alpha1antitrypsin deficiency

panlobular (panacinar) including lower lobe emphysema: think about A1AT deficiency in <45 with persistent airflow obstruction and no smoking history; bad phenotypes=ZZ and MZ; MM is normal

88

what is considered normal lung function losss (mL/year) ? in smokers?

loss of 30 mL/year is normal; doubled in smokers; smoking cessation leads to near normal lung function loss

89

what has been shown to reduce mortality in COPD

smoking cessation and oxygen therapy; lung reduction therapy?

90

what is the name of the test that detects presence of nickel for patients with ACD?

dimethylglyoxime test (turns pink if nickel is present)

91

Chromates are found in what (and can cause ACD)?

Cement (wet), textile, leather tanners

92

potassium dicrhomate is found in what?

stainless steel, chrome plating; tanned leathers

93

what causes poison ivy (aka Toxicodendron dermatitis)

type IV hypersensitivity to uroshiol; cross-reactive with mangoes

94

what is the most common cause of hand eczema in flower workers in US?

Peruvian lilly; Alstroemeria; first 3 fingers and dorsum of hand and forearm and v of neck

95

what is a common fragrance implicated in ACD?

Balsam of Peru (cross reactive with cinnamon and vanillin)

96

what is the most common formaldehyde releasing preservative that causes ACD?

Quaternium-15; although parabens are commonly used as preservative in cosmetics, they are an uncommon cause of ACD

97

what is the most common cause of ACD in hairdressers?

PPD (paraphenylediamine); can also be in henna tattoos

98

what are the 4 major classes of sensitizing corticosteroids?

Group A: hydrocortisone; Group B: triamcinolone: Group C: betamethasone; Group D hydrocortisone-17-butyrate

99

what is baboon syndrome?

a form of systemic allergic contact dermatitis; i.e. generalized ACD rash systemic administration of a drug, such as benadryl; get classic induration and erythema of groin region; can occur with systemic or intra-articular steroid injections after topical sensitization