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Middleton's Allergy Essentials > Chapt. 4: Indoor and Outdoor Allergens and Pollutants > Flashcards

Chapt. 4: Indoor and Outdoor Allergens and Pollutants Flashcards

1
Q

What is the primary composition of allergens in and outside the home?

A

Proteins

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2
Q

Major route of exposure both inside and outside the home

A

Inhalation

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3
Q

Submicronic particles are more likely to be associated with rhinitis or asthma?

A

Asthma

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4
Q

The main source of outdoor allergen exposure?

A

Pollens and fungi

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5
Q

Most significant allergen sources in the home?

A

Mites, cockroaches, pets such as dogs and cats

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6
Q

Atopic dermatitis and anaphylaxis are associated with what food allergen sources?

A

Peanuts, milk and fish

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7
Q

Rhinitis and asthma are associated with what aeroallergens?

A

pollens and house dust mites

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8
Q

Meaning of allergen?

A

describes any of those that are capable of stimulating the production of specific IgE in a genetically predisposed individual

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9
Q

Most clinically significant route of exposure to allergens?

A

Respiratory tract

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10
Q

Meaning of allergenic?

A

describes the IgE-inducing property of an allergen

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11
Q

The terms allergen, allergenic, and allergenicity are synonymous with what terms?

A

antigen, antigenic, and antigenicity

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12
Q

Meaning of cross-reactive allergen?

A

because of a significant sequence homology (common epitopes), a patient will produce an IgE response to a primary allergen and also react to a related one.

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13
Q

What are some cross-reactive allergens?

A

tropomyosins in mites, snails, cockroaches, shellfish

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14
Q

In pollens and distantly related fruits what are the common allergens?

A

profilins

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15
Q

What is the OAS (oral allergy syndrome)/PFS (pollen food syndrome)?

A

Patients who are sensitized to pollen via inhalation and react to distantly related fruits.

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16
Q

What are the most complex glycoprotein mixtures allergens?

A

pollens, fungal spores, seeds and mites

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17
Q

What are the least complex glycoprotein mixtures allergens?

A

animal danders, urine and from occupational sources

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18
Q

What is the percentage of polysensitization?

A

70%. Monosensitization often precedes polysensitization.

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19
Q

Meaning of “major” allergen?

A

Allergens in a particular source that are recognized by >50% or more of allergic individuals. The remaining ones are “minor”.

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20
Q

What is important to the aerosolized particles, the aerodynamic or the absolute size?

A

The aerodynamic size.

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21
Q

What size particles will give rise to nasal symptoms as opposed to asthma?

A

> 10 um. Submicronic particles enter the bronchi and give rise to lower airways inflammation, resulting in asthma

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22
Q

Size will also affect what property of the allergen?

A

The length of time the particles are suspended in the atmosphere, and thus the exposure

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23
Q

How to express pollen and fungal spores?

A

Number of grains/spores/m3 per 24hours or pollen index of developing symptoms using the terms “low” “moderate” “high” “very high” and “extreme”

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24
Q

What are haptens?

A

LMW chemically reactive compounds which are allergenic

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25
Q

What are the most common haptenic compounds in clinical practice?

A

The beta lactam antibiotics such as the benzyl penicillins.

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26
Q

Every protein allergen contains a number of potential epitopes, which are also known as antigenic determinants. what are these?

A

These represent linear amino acid sequences or adjacent sections of a sequence that engage with either the B cell receptor or its soluble antibody form or the T cell receptor sitting on the surface of a lymphocyte.

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27
Q

What is the number of amino acid residues comprising a B cell epitope that interacts with the actual binding site of a B cell receptor or allergen-specific IgE?

A

5 amino acid residues

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28
Q

Are lipids allergenic?

A

Do not appear to be, although the lipid content of some sources such as pollens may play an adjuvant role in sensitization.

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29
Q

The therapeutic murine monoclonal antibody Cetuximab may cause delayed anaphylaxis (3-6hours) in some patients after ingesting what?

A

Red meat.

30
Q

What is the proportion of individuals that are exposed who become sensitized to pollens and fungal spores?

A

30-40%

31
Q

How does the age of the pollen influence manifestations?

A

Immature and aging pollens are not as potent as mature pollens.

32
Q

Range of size of pollens?

A

5um - >200um

33
Q

What is the structure of pollen?

A

Cytoplasmic core, a multilayered, tough, sporopollenin-containing external wall layer (exine), with various apertures and an internal wall, the intine

34
Q

What is the exine structure in pollen?

A

Comprises three layers and provides the pollen with strong, mechanical resistance, enabling it to survive for long periods in the atmosphere.

35
Q

What is the single most important allergen source associated with asthma?

A

HDM

36
Q

Up to what percentage of asymptomatic individuals are sensitized to an indoor allergen?

A

15%

37
Q

What is the optimum growth temperature for mites?

A

18-27 degrees

38
Q

What is the atmospheric moisture requirement for HDM?

A

65-85% RH. (Absorbed through their joint legs or produced through metabolism because they are unable to drink).

39
Q

What are the allergenic components of cockroaches?

A

Associated with their feces, saliva, and debris of dead insects

40
Q

Cockroach allergen levels in bedrooms may correlate with the frequency of hospitalization, true or false?

A

True

41
Q

What are some cockroach allergens?

A

aspartate protease, lipocalin, GUT-1 associated group 1 allergens, digestive enzymes (amylase, trypsin), arginine kinase, actin-associated proteins.

42
Q

What are the 2 major sources of mammalian allergens?

A

Those containing lipocalcins (comprising >50% of all furry animal allergens) and the secretoglobins. (There is still a third minor group containing a small diversity of other proteins).

43
Q

Why can cat-allergic patients report symptoms on entering a house in which a cat is living?

A

Because 10-40% of cat allergens are carried on particles that are aerodynamically equivalent to 1-7um spheres that sediment only slowly, such that free undisturbed air concentrations of cat allergen may be 10-50x higher than that of HDM.

44
Q

What is the rate of air change/hour in modern housing?

A

0.2-0.5

45
Q

Inhalational exposure to cat or dog allergen in houses with these pets?

A

100-fold (1ug/day) greater in homes with pets

46
Q

Living in a house with a cat is selectively protective against developing a cat allergy. True or false?

A

True

47
Q

Dogs have a generally inhibitory effect for allergy. T/F?

A

True

48
Q

What are the predominant allergens in cat and rabbit dander?

A

secretoglobins. They may be immunomodulators because of their ability to bind lipid and activate TLR.

49
Q

What is the “pork-cat” syndrome?

A

Cross-reactivity with canine, porcine, and bovine albumins.

50
Q

What are the major allergens in dogs?

A

Lipocalcins (belonging to the calycine superfamily). They are produced in the liver or secretory glands and members of this family play a role in the binding and transport of small hydrophobic molecules such as vitamins and steroids.

51
Q

What are other dog allergens?

A

Serum albumin, immunoglobulins and kallikrein

52
Q

What is the prevalence of rat allergy in laboratory animal workers?

A

40%, with most becoming sensitized within 3 years of exposure (60%), and the remainder becoming sensitized within 5-20 years.

53
Q

How long does it take from removing a cat from the home for allergen level to decrease?

A

12-16 weeks after cat is removed. It will take >4 months for levels of cat allergens to fall below 8 ug/g dust.

54
Q

One of the most preventable risk factors contributing to the global burden of disease in allergy?

A

Air pollution

55
Q

What are some indoor pollutants?

A

Biomass burning and tobacco smoke

56
Q

What are the contaminants commonly responsible for poor air quality (both indoor and outdoor)?

A

Carbon monoxide, lead, sulphur dioxide, oxides of nitrogen, ozone, polyaromatic hydrocarbons, particulates, and miscellanous biologics such as LPS

57
Q

Which of the contaminants do NOT directly affect airway tone or promote inflammation directly or indirectly?

A

Carbon monoxide and lead

58
Q

What cellular mechanism is activated by these pollutants thus responses will be exaggerated in individuals with loss of function polymorphisms in antioxidant defense enzymes?

A

Oxidative stress

59
Q

What are the main sources of indoor air pollution?

A

Biomass combustion (wood, crop, dung, grass and coal), nitrogen oxides, tobacco smoke and LPS

60
Q

In indoor stoves lacking an effective flue, combustion is known to have a significant association with?

A

COPD and risk for lung cancer due to DNA damage

61
Q

What is responsible for the adverse effects of biomass combustion?

A

Due to polyaromatic hydrocarbons that can be metabolized to oxidants, including quinones

62
Q

How does ETS (Environmental tobacco smoke) contribute to the development of asthma?

A

Enhances allergen-induced IgE and IgG4 effects, and promotes a bias towards TH2 (IL-4, IL-5, IL-13 dependent) immune signaling at the expense of IFN-gamma production (i.e. TH1-mediated signaling)

63
Q

What aerodynamic diameter of particulates will gain entry to the whole respiratory tract, therefore constituting a high health risk?

A

Diameter of 2.5 um. >2.5um will impact the larger airways, but not the alveoli

64
Q

Toxic gas with a pungent, rotten odor whose contribution to acid aerosol formation means that it is extensively studied.

A

Sulfur dioxide

65
Q

S/s of sulfur dioxide inhalation?

A

Shortness of breath, respiratory discomfort, and premature death. It increases the likelihood of developing asthma or COPD and is correlated with the presence of current symptoms.

66
Q

What is the immediate effect of sulfur dioxide (<2mins.)?

A

Bronchospastic rather than inflammatory response, which involves wheezing, chest discomfort and dyspnea, but repeated exposure results in tachyphylaxis.

67
Q

Is there a strong association between ambient NO2 concentrations and both acute and chronic changes in lung function and the exacerbation of asthma?

A

Yes.

68
Q

What is the mechanism of NO2 on lung function?

A

Inflammatory neutrophilic infiltration.

69
Q

This is a pungent pale blue gas and its strongly oxidant action is damaging to mucous and respiratory tissues and therefore has the potential to modify responses to inhaled allergens?

A

Ozone

70
Q

How is ozone formed in the troposphere?

A

Formed by photochemical reaction between nitrogen oxides and volatile organic compounds from vehicle emissions and industrial discharges.

71
Q

Is a well-recognized trigger for asthma exacerbations, even at low levels of exposure, and there is a significantly increased risk of death from respiratory causes at higher levels

A

Ozone

Middleton's Allergy Essentials (6 decks)

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