Ch. 5 Hypersensitivity Disorders Flashcards Preview

ACAAI Review 3rd Edition > Ch. 5 Hypersensitivity Disorders > Flashcards

Flashcards in Ch. 5 Hypersensitivity Disorders Deck (185):
1

the late allergic response is characterized by what symptoms?

nasal congestion, mucus production

2

what percentage of chronic rhinitis patients have non-allergic triggers?

30-50%

3

most effective medicine for AR?

intranasal steroid

4

side effects of H1 antihistamines?

muscarinic: dry mouth, urine retention
alpha: hypotension, dizziness, reflex tachycardia
5-HT: increased appetite

5

mechanism of H1 antihistamines

inverse agonists, down regulating H1 receptor constitutive activity

6

unlike NARES, localized AR (entropy) is diagnostically different how?

Local AR responds to nasal allergen provocation testing (local specific IgE)

7

NARES has what percentage of eosinophils on nasal smear?

>20%

8

Colonization of which pathogen in primary atrophic rhinitis?

Klebsiella ozaenae

9

Treatment of atrophic rhinitis

nasal irrigation and topical antibiotics

10

symptoms of atrophic rhinitis

nasal crusting, pain, nasal congestion, foul smell

11

What medication is ineffective in rhinitis of pregnancy?

intranasal corticosteroids

12

Rhinitis of pregnancy begins and ends?

starts 2nd trimester, resolves within 2 weeks postpartum

13

Difference between AR and infectious rhinitis

infection is not pruritic and limited duration

14

CSF leak characteristics

triggered by trauma, unilateral, rhinorrhea

15

Evaluation for CSF leak

check B2-transferrin in nasal secretions

16

AFRS on CT scan?

hyperlattenuation, heterogeneous opacification with inspissated secretions in sinuses, bony demineralization, and erosion

17

AFRS on MRI?

peripheral enhancement with a dark center, higher peripheral signal characteristics corresponding to inflamed mucosa, reduced central signal intensity corresponding to fungal concretions

18

Fungi associated with AFRS

Aspergillus, Alternaria, Curvularia, Penicillium, Fusarium, Bipolaris

19

Diagnostic criteria for AFRS

+SPT or sIgE to fungi, nasal polyps, characteristic CT findings, non-invasive fungal hyphae (stain with PAS or GMS) in mucin OR positive fungal culture of mucin, eosinophil mucin without invasion into sinus tissue

20

Treatment of AFRS

endoscopic surgery, oral corticosteroids for 3 months, topical nasal corticosteroids, and AIT

21

conjunctivitis that occurs predominantly in males, peak incidence 3-20 years old

vernal keratoconjunctivitis

22

conjunctivitis with equal predilection for males and females, sight threatening, peak incidence age 20-50 years

atopic keratoconjunctivitis

23

symptoms and signs of VKC

severe photophobia, ocular itching
papillary hypertrophy (>1mm), Horner-Trantas dots

24

symptoms and signs of AKC

ocular pruritus with atopic dermatitis, keratoconus is a distinguishing feature, anterior sub capsular cataracts

25

Steroid administration results in what type of cataract?

posterior sub capsular cataracts

26

features of GPC? giant papillary conjunctivitis

ocular itching after lens removal, intolerance to contact lens, morning mucus discharge, tarsal papillary hypertrophy (>0.3mm) smaller than VKC

27

IgE to what bacterial toxin is produced in AD (atopic dermatitis?)

IgE to S. aureus toxins

28

Which chemokines are specific for AD and increase with acute symptoms?

CTACK, CCL27, TARC

29

what may explain the increased susceptibility of AD skin to infections?

decrease or absence of human B defensins and cathelicidin LL-37

30

cytokines involved in acute AD?

acute: IL-4, -13

31

cytokines involved in chronic AD?

chronic: IL-5, -12, IFNg

32

which cytokines have been shown to down regulate filaggrin expression?

IL-4, -13

33

expression of what protein is inversely correlated to Th2 in AD?

claudin-1 (CLDN1)

34

most memory T lymphocytes in AD express what ligand that binds to E-selectin?

CLA (cutaneous lymphocyte associated antigen)

35

the FcER1 on Langerhans cells differs from that on mast cells and basophils how?

lacks the beta chain

36

What organisms are AD patients susceptible to?

S.aureus, herpes simplex, molluscum contagiosum, Malassezia fyrfur/Pityrosporum orbiculare, Pityrosporum ovale

37

severe reaction to smallpox vaccination in patients with AD

eczema vaccinatum

38

atopic keratoconjunctivitis is associated what type of cataracts?

anterior cataracts

39

what cell type is seen in fatal asthma

neutrophil accumulation

40

chromosome that contains IL-4 gene cluster important for atopy/asthma development

chr 5q

41

sensitization to what perennial allergen by age 6 years is associated with persistent asthma by age 11

Alternaria

42

Samter's triad

asthma, nasal polyps, aspirin sensitivity

43

definition of reversibility on spirometry

improvement of 12% in FEV1 (and FEF25-75 in children only); increase in PEF >20%

44

methacholine challenge is positive for hyper responsiveness if

PC 20 <4mg/mL
(4-16 mg/mL is probably if appropriate symptoms are present)

45

asthma predictive index major criteria

parental asthma, physician dx of AD, sensitization to aeroallergens

46

asthma predictive index minor criteria

sensitization to food, >4% eosinophils, wheezing apart from colds

47

the API is positive if...?

one major -OR- two minor criteria are met

48

asthma impairment domains

symptoms, functional limitation

49

asthma risk domains

exacerbations, lung function, medication adverse effects

50

diagnosis of exercise induced bronchospasm

FEV1 decrease >15% after exercise challenge test

51

asthma severity if child age 0-4 has >2 days/week symptoms, 1-2x month awakenings, >2 days/week SABA use?

mild persistent

52

asthma severity if child age 5-11, >2 days/week symptoms, 3-4x month awakenings, >2 days/week SABA?

mild persistent

53

asthma severity if child age 0-4, daily symptoms, 3-4x month nighttime awakening, daily SABA use?

moderate persistent

54

asthma severity if child, age 5-11, daily symptoms, >1x/week nighttime awakening, daily SABA use?

moderate persistent

55

start a controller in child <4 years if....

>2 exacerbations in 6 months, or >4 wheezing episodes in 1 year lasting >1 day AND risk factors for persistent asthma

56

asthma severity in patient age 12 or older, <2 days/week symptoms, <2x/month awakening, <2 days/week SABA, 0-1 prednisone in 1 year

intermittent asthma

57

asthma severity in patient age 12+, >2 days/week symptoms, >3-4x month awakenings, >2days/week SABA

mild persistent

58

asthma severity in patient age 12+, daily symptoms, >1/week awakening, daily SABA use

moderate persistent

59

Step 1 therapy

SABA prn

60

Step 2 therapy? which severity to start?

mild persistent for all ages
low dose ICS (preferred)
montelukast (alternative for age <4 and +)
nedocromil or theophylline (also alternatives for age 5+)

61

Step 3 preferred therapy? when to start?

moderate persistent asthma
medium dose ICS (age 0-4)
low dose ICS + LABA (age 5+)

62

what makes food allergens allergenic?

10-70kd, glycosylation, heat resistant, acid stable, stable to proteases, water soluble

63

Heiner syndrome symptoms

recurrent pneumonia, pulm infiltrate, hemosiderosis, iron def anemia, FTT

64

diagnosis of Heiner syndrome

history, peripheral eosinophilia, lung biopsy, milk precipitins, and elimination diet

65

foods implicated in food-associated exercise-induced

celery, wheat, milk
shellfish, fish, fruit

66

fruits involved in latex fruit syndrome

banana, avocado, chestnut, kiwi

67

pollen-food association for timothy grass

swiss chard, orange

68

pollen-food association for orchard

cantaloupe, honeydew, watermelon, peanut, white potato, tomato

69

pollen-food association for ragweed

cantaloupe, honeydew, watermelon, zucchin, cucumber, banana

70

pollen-food association for mugwort

celery, carrot, parsley, caraway, fennel, coriander, mustard, cauliflower, cabbage, broccoli, garlic, onion

71

pollen-food association for birch

apple, beach, plum, pear, cherry, apricot, almond, celery, carrot, parsley, caraway, fennel, coriander, soybean, peanut, hazelnut

72

gal-alpha-1,3-gal is found in what drug?

cetuximab

73

LEAP study results - infants with atopic dermatitis and/or egg allergy - fed peanut starting age 4 months until 60 months.

86% RR in peanut allergy for infants without sensitization, 77% RR in peanut allergy for infants with sensitization (W1-4mm)

74

most common cause of anaphylaxis

food and drug

75

What marker has been shown to be positive correlated with the severity of anaphylaxis?

PAF levels

76

What marker has been shown to inversely correlate with anaphylaxis severity?

PAF acetylhydrolase levels

77

what 5 mediators positively correlate with hypotension during anaphylaxis?

IL-6, TNF receptor 1, tryptase, histamine, C3a

78

fatality in anaphylaxis is due to?

circulatory collapse or respiratory failure

79

what is the ratio of total/mature tryptase in mastocytosis?

>20 (note:<10 is other cause)

80

which mediator correlates best with symptoms of anaphylaxis?

histamine

81

What is oversulfated chrondroitin sulfate?

contaminant in heparin that is cuased by activation of the contact system, contains C5a and results in hypotension, abd pain, variable angioedema, but no pruritus or urticaria

82

histamine release is within 5 minutes, but levels remain elevated for how long?

30-60 minutes

83

urinary histamine metabolites remain elevated for?

24 hours

84

serum tryptase levels are released within 15 minutes but peak when?

60-90 minutes

85

natural rubber latex is a cytoplasmic exudate of what tree?

Hevea brasiliensis

86

major latex allergen in sensitized patients with spina bifida that are minor allergens in health care workers

Hev b 1 and Hev b 3

87

major latex allergen in sensitized health care workers

Hev b 5, 6, 7

88

most common foods associated with EIA?

wheat, celery

89

fire ant venom contains what allergen

piperidine alkaloids

90

major allergen in honeybee venom

phospholipase A2, Api m 1

91

major allergen in hornet and yellow jacket

phospholipase A1, Ves v1 (does not cross react with honeybee)
hyaluronidase, Ves v2
antigen 5, Ves v5

92

major allergen in paper wasp

phospholipase A1, Pol a1
hyaluronidase, Pol a2
antigen 5, Pol a 5

93

mixed vespid maintenance dose

300ug

94

single antigen venom maintenance dose

100ug

95

what is Skeeter syndrome

large local reaction to mosquito bite with fever

96

allergen in biting insects are found in?

saliva

97

which biting insect has cross reactivity with cockroach on skin testing

asian lady beetle

98

which venoms are corss-reactive

hornet and yellow jacket

99

major allergen in ant

Phospholipase A2, Sol i1
Antigen 5, Sol i 3

100

local heat urticaria test

apply water heated to 45C in a test tube on skin for 5 min

101

cold urticaria test

ice cube test place on skin for 5 min

102

cholinergic urticaria test

exercise for 15 mins past point of sweating or passive elevation of core body temperature by submerging patient's arm in 42C hot water bath until core temp increases >0.7C

103

solar urticaria test

skin exposed to UVA and UVB of varying wavelengths using a monochromatic light source

104

aquagenic urticaria test

apply 35C water compress to upper body for 30 minutes

105

delayed pressure urticaria/angioedema test

sling attached to 10-15lb weight is placed over arm or shoulder for 15 minutes. Patient response over next 2-24 hours.

106

cold urticaria with negative ice cube test

cold-induced cholinergic urticaria, systemic cold urticaria, familial cold auto inflammatory syndromes, and cold-dependent dermatographism

107

Schnitzler syndrome is associated with what findings?

IgM monoclonal paraproteinemia, nonpruritic urticaria, elevated ESR, and neutrophilic infiltrate on biopsy

108

treatment of Schnitzler syndrome

anti-IL-1

109

lab findings in hypocomplementemic urticarial vasculitis

low C3, C4, C1q, anti-C1q antibody, elevated ESR

110

difference between work exacerbated asthma and occupational asthma

occupational asthma - symptoms do not occur outside of workplace. work-exacerbated asthma has asthma pre-existing with increased symptoms at work

111

reactive airway dysfunction syndrome?

single high level exposure resulting in symptoms within 24 hours and are persistent.

112

laboratory workers may take how many years to sensitize?

2 years

113

occupational asthma in carpenters, woodworkers due to?

plicatic acid

114

occupational asthma in nail salon workers and dental hygienists due to?

acrylates

115

occupational asthma in body shop or auto industry or roofing/insulation or spray pain/foam coatings due to?

isocyanates

116

occupational asthma in welder, metal/chemical workers due to?

platinum salts, potassium dichromate

117

occupation asthma in hairdresser due to?

persulfate salts (ammonium persulfate)

118

occupational asthma in plastic due to?

anhydrides

119

PFT in occupational asthma

FEV1 reduction by 15-20% after exposure of occupation trigger; inhalation challenge is gold standard (limited availability)

120

hypersensitivity pneumonitis is characterized by what T cell phenotype?

Th1 phenotype
predominance of CD8+ T cells

121

BAL findings in HP?

lymphocytosis >50%
low CD4/CD8 ratio <1

122

histopathology in HP

poorly formed, noncaseating granulomas or mononuclear infiltrate

123

PFT findings in HP

decreased FEV1, FVC, DLCO after 4-6 hours of exposure, restrictive pattern in advance disease

124

CT findings in acute HP

fleeting ground glass opacities

125

CT findings in subacute HP

diffuse micro nodules, air trapping, mild fibrosis

126

CT findings in chronic HP

ground glass opacities, emphysema, honeycombing, and parenchymal micronodules

127

what bad habit is associated with decreased risk of HP

smoking

128

antigen causing farmer's lung

thermophilic actinomycetes
(thermoactinomyces vulgarism, Saccharopolyspora rectivirgula)

129

antigen causing bagassosis (moldy sugar cane)

thermoactinomyces sacchari

130

antigen causing hot tub lung

mycobacterium avid complex or Cladosporium

131

antigen causing basement shower lung

epicoccum nigrum

132

antigen causing wine growers lung

botrytis cinerea

133

antigen causing malt worker's lung

Aspergillus

134

antigen causing cheese worker's lung

Penicillium casei

135

antigen causing detergent workers lung

Bacillus subtilis

136

chemical worker's lung antigen

toluene diisocyante (TDI), diphenylmethane diisocyanate (MDI)

137

plastic workers lung antigen

trimellitic anhydride

138

epoxy resin worker's lung antigen

phthalic acid

139

bird fancier's lung antigen

Avian proteins

140

el niño lung antigen

Pezizia

141

Saxophonists lung antigen

Candida albicans

142

wheat weevil lung/miller's lung antigen

Sitophilus

143

machine operators lung antigen

Pseudomonas, Acinetobacter, or Mycobacter

144

woodworker's lung antigen

Alternaria

145

humidifier fever/AC lung antigen

thermoactinomyces (T. vulgarism, T. saccharin, T. candidus, Klebsiella, Acanthamoeba)

146

antigen in summer type HP (contaminated houses)

Trichosporum cutaneum (common in Japan)

147

What is organic dust toxic syndrome (ODTS, pulmonary mycotoxicosis)

non-infectious febrile illness after exposure to dust contaminated by toxin-producingg fungi (in grain, hay, textiles); usually young patients, no prior sensitization, lack of serologic response to common fungal antigens

148

What diagnosis is 50 times more common in farmers than farmer's lung?

ODTS (organic dust toxic syndrome)

149

ABPA occurs exclusively in which patients?

asthma or CF

150

ABPA diagnosis in asthma?

+SPT to A. fumigatus, total IgE>1000ng/mL (417 IU/mL), elevated IgG and IgE to A. fumigates, central bronchiectasis, peripheral eosinophilia >1000/mm3

151

ABPA diagnosis in CF?

+SPT A. fumigatus, total IgE >1200ng/mL (500 IU/mL), IgG or IgE to A. fumigatus, fixed chest film abnormalities, clinical deterioration not due to other causes

152

what is the purpose of anti fungal therapy (itraconazole or voriconazole) in ABPA?

for exacerbations or if patient cannot be tapered off steroids; it decreases antigenic stimulus for bronchial inflammation, decrease sIgE to Aspergillus, and decrease dose of steroids

153

what marker indicates a flare of ABPA?

doubling of baseline IgE

154

goal of treatment of ABPA

prevent bronchiectasis or pulmonary fibrosis and worsening lung function

155

airway inflammation in COPD is characterized by?

neutrophils, macrophages, and CD8+ T cells

156

the emphysematous findings of COPD and alpha-antitrypsin deficiency differs how?

COPD is centrilobular (proximal acinar) upper lobes vs AAT is pan lobular (panacinar) lower lobes

157

test for AAT in what patient?

young (<45 years), nonsmoker, symptoms of COPD and persistent airflow obstruction on spirometry

158

when do you use ICS in COPD

only in moderate to severe COPD with symptoms despite bronchodilators

159

what has smoking cessation been shown to do in COPD

returns rate of loss of function to normal (decline of 60cc/year to 30cc/year)

160

What treatments in COPD decreases mortality

supplemental oxygen, smoking cessation, and lung volume reduction surgery

161

Spirometry or PFTs in ILD

restriction: decrease FEV1 and FVC, normal or high FEV1/FVC, increased lung volumes, decrease DLCO

162

what is the pathologic pattern in UIP (usual interstitial pneumonitis)

heterogeneous fibrosis prominent in the periphery, minimal inflammation

163

CT findings in IPF

bibasilar, peripheral reticular pattern, focal honeycombing

164

CT findings in NSIP

ground glass and fibrotic changes

165

CT findings in COP

alveolar filling, air bronchograms mimicking acute pneumonia

166

histologic features of contact dermatitis

lymphocytic infiltration and spongiosis

167

+1 reaction in contact dermatitis?

erythema, edema that is palpable, occupies >50% of patch test site

168

+2 reaction in contact dermatitis

micro vesicles and erythema that occupy at least 50% of patch test site

169

+3 reaction in contact dermatitis

confluent vesicles or bullae, ulcerative

170

how to test for nickel in products?

dimethylglyoxime test (pink = positive)

171

allergen in stainless steel, metals?

potassium dichromate

172

allergen in poison ivy/sumac/oak

uroshiol (Toxicodendron dermatitis)

173

poison ivy is cross-reactive with?

mango peels

174

the sensitizing substances in most plants are present in?

oleoresin

175

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

Alstroemeria (Peruvian lily)

176

allergen in fragrances

balsam of peru

177

balsam of peru cross reacts with?

cinnamon and vanillin

178

allergen in cosmetic that is a preservative that is the most common cause of ACD in the U.S.

quarternium-15

179

most commonly used preservative in cosmetics, but an UNCOMMON cause of ACD

parabens

180

most common cause of ACD in hair dressers? also seen in henna tattoos

paraphenylenediamine

181

allergen in acrylic nails?

ethylacrylate

182

what are the 4 major classes of sensitizing corticosteroids?

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

183

if ACD to ethylenediamine dihydrochloride (EDTA), what you should avoid?

nystatin, aminophylline, meclizine, cyclizine

184

if ACD to neomycin, what to avoid?

gentamicin, kanamycin, streptomycin, tobramycin

185

What is "Baboon syndrome"

when patients allergic to topical antihistamines develop systemic CD after systemic administration of antihistamine- there is indurated erythema in the groin area of afflicted patients