Hypersensitivity disorders Flashcards
1
Q
what are the primary mechanisms of early and late-phase allergic rhinitis?
A
- Early phase mechanisms are allergen-induced mast cell secretion of histamine, prostaglandins, and leukotrienes
- late phase mechanisms are eosinophil chemotaxis caused by chemical mediators produced in the early reaction
2
Q
what is the most common cause of rhinitis during pregnancy?
A
Pre-existing allergic rhinitis (about one third of women experience worsening of symptoms udring pregnancy)
3
Q
Why can nasal congestion or rhinorrhea develop in hypothyroidism?
A
turbinate edema resulting from the release of thyroid-stimulating hormone
4
Q
Acute onset of unilateral, clear rhinorrhea that is worse when the patient leans forward should prompt evaluation with what test?
A
check beta-2 transferrin in nasal secretions for suspected CSF rhinorrhea
5
Q
what is the pathophysiologic mechanism for pale, boggy nasal mucosa in AR?
A
fluid extravasation leading to mucosal edema and venous constriction
6
Q
how does allergic fungal rhinosinusitis lead to bone destruction and extension outside the sinuses?
A
Expansile growth of fungal hyphae and generation of allergic mucin
7
Q
what lab values can be monitored to assess interval progression of AFRS s/p FESS?
A
increase in IgE >10% in post-surgical IgE correlate with increase risk of recurrence
8
Q
what value of total serum IgE is necessary to diagnose AFRS?
A
total IgE is not one of Bent and Kuhn diagnostic criteria of AFRS.
- need to meet all 5 major criteria
9
Q
In a patient with recurrent sinusitis and CT findings of pansinusitis and inspissated mucin, what role does SPT to aeroallergens play? (2)
A
- identification of fungal sensitization
- preparation for post-FESS allergen IT to fungal and nonfungal allergens.
10
Q
what is ciliary flushing, and in which condition is it found?
A
- ciliary flushing is an injection of the deep episcleral vessels, causing redness around the cornea
- seen in corneal inflammation, iridocyclitis, and acute glaucoma
11
Q
what is the treatment of choice for mild to moderate allergic conjunctivitis?
A
- antihistamine (H1) + mast cell stabilizer
12
Q
a 10 year old boy is seen for redness of his eyes. He has seasonal allergies and asthma. main complaints include itchy eyes, light sensitivity and feeling like sth is stuck in his eye. His sclera is injected and his R eyelid is lower than his left. what is the diagnosis?
A
Vernal keratoconjunctivitis
13
Q
a 45 year old woman presents with ocular pruritus. Also has redness of eyes, difficulty with light, and sometimes pain. She always feels dry and has issues with dry skin. Her eyes feel like leather and she lost her eyelashes. Denies any vision problems requiring glasses or contacts. What is the diagnosis?
A
Atopic keratoconjunctivitis
14
Q
sight threatening conditions include all of the following except:
- acute glaucoma
- uveitis
- infective conjunctivitis
- herpes simplex keratitis
A
infective conjunctivitis
15
Q
which contact lenses put the wearer at greatest risk for developing giant papillary conjunctivitis?
- hard contact lens
- extended-wear soft contact lens
- daily disposable soft contact lens
- rigid gas permeable contact lens
A
extended-wear soft contact lens
16
Q
which subtype of cataracts occur more frequently in patients exposed to glucocorticoids?
A
posterior subcapsular cataracts
17
Q
which cytokine is primarily associated with pruritus in atopic dermatitis?
A
IL-31
18
Q
what can a person with eczema develop after small pox vaccination?
A
Eczema vaccinatum (vaccinia virus disseminates to cause an extensive rash and systemic illness).
19
Q
evidence supports a role of which aeroallergen in AD?
A
dust mite
20
Q
which vaccine is contraindicated in severe AD?
A
small pox vaccine
21
Q
what do IL-4 and IL-13 do to cathelicidin in the skin?
A
inhibit cathelicidin expression
22
Q
which interleukins does dupilumab inhibit?
A
IL-4 and IL-13
23
Q
what age group is Dupilumab approved for AD?
A
6 months and older
24
Q
what are the causes of delayed peaked reaction (6-7 day) on patch testing? (3)
A
- metals
- neomycin
- corticosteroids
25
what is the most frequent infectious cause of asthma exacerbations?
Rhinovirus
26
what percentage of children will have episodes of wheezing in the first 3 years of life due to viral respiratory tract infections?
50%
27
sensitization to what aeroallergen in children under 6 years old is associated with development of persistent asthma by age 11 years?
Alternaria
28
What is part of Asthma Predictive Index (API)? (6)
better NPV than PPV
29
What is part of Pediatric Asthma Risk Score (PARS)?
better PPV than API
30
what biomarker can be readily measured and is increased in eosinophilic asthma?
exhaled nitric oxide
31
what is the cause of skeeter syndrome?
sensitization to mosquito salivary secretions
32
what immune deficiency is associated with an ice cube negative cold urticaria?
PLAID syndrome (PLC-gamma-2-associated antibody deficiency and immune dysregulation)
33
false-positive (irritant) results to intradermal testing are more likely above what venom concentration?
>1 ug/ml. (therefore, not recommended for diagnostic purposes)
34
a 35 year old female with hives lasting >6 mo complains of intermittent arthralgias and bruises on her arms/legs that are unsightly. What condition should you be concerned about?
- cholinergic urticaria
- urticarial vasculitis
- chronic spontaneous urticaria
- dermatographism
- urticarial vasculitis
35
what is the febrile illness that occurs in workers after exposure to dust contaminated by toxin-producing fungi in grain, hay and textiles and is 30-50 times more common than farmer's lung?
Organic dust toxic syndrome (ODTS)
36
Smoking is an associated risk factor for which agent of occupational asthma?
Platinum (welder, metal/chemical workers)
37
what is the usual causative agent in hot tub lung?
MAC (mycobacterium avium complex)
38
what is the most effective treatment for HP?
avoiding offending agent
39
what two immunizations are critical for COPD patients?
- yearly flu vaccine
- one-time 23-polyvalent pneumococcal vaccine
40
what medication is associated with red meat allergy (2)
- allergy to Fab segment of cetuximab via an allergy to galactose-alpha-1,3-galactose (alpha-gal)
- tickborne through Lone Star tick in the southeast US.
41
if severe hypotension occurs after a hymenoptera sting, what key blood test should be done?
tryptase
42
how many hours does it take for symptoms to peak after the application of a vibratory stimulus to the skin in patients with vibratory urticaria/angioedema?
4-6 hours
43
20% of patients with hypocomplementemic urticarial vasculitis syndrome (HUVS) have what chronic health conditions? (2)
Asthma and COPD
44
which medication is considered to be a risk factor for severe reaction to stings?
ACEI
45
what is the first step in evaluating ABPA in a patient with asthma?
establish IgE sensitization to Aspergillus via skin prick or serum specific IgE
46
patients sensitized to latex can also have a hypersensitivity reaction to which foods? (7)
ABC
Avocado, Banana, Chestnut, kiwi, white potato, bell pepper and tomato
47
updated GINA guidelines no longer recommends short-acting beta-2 agonist (SABA)-only treatment for Step 1. What medication should be used in its place for Step 1 treatment?
low dose ICS-LABA
48
what is the standard maintenance dose for venoms in children?
50 mcg
49
can you mix honeybee with vespids?
No
50
How is a definitive diagnosis of EoE made?
endoscopy with esophageal biopsy, >15 eos/hpf
51
serum total IgE levels usually exceed what level in ABPA?
>1000 ng/mL (>417 IU/mL)
52
Within 20 minutes of eating mahi mahi on vacation in Florida, a 39 year old man develops abdominal cramps, vomiting, swelling of tongue and trouble breathing. SPT to all white fish is negative. What is the cause of this illness?
scombroid fish poisoning
53
what is the classic finding on CT chest in patients with ABPA?
central bronchiectasis and "finger in glove"
54
which component protein of peanut is a Bet v1 homolog, heat labile and associated with mild OAS-like sx?
Ara h 8
55
what condition should be evaluated in patients with acute worsening of asthma sx, rise in serum total IgE and serum eosinophils?
ABPA (allergic bronchopulmonary aspergillosis)
56
a 6 year old boy camping in Texas awakens with diffuse hives, SOB, and wheezing after a painless bug bite. What insect would you be most concerned about?
Triatoma (kissing bug)
57
what are some common high molecular weight agents that can cause occupational asthma?(9)
- most derived from animals, plants and food
- furry animal proteins, shellfish proteins, flour, wheat, coffee, tobacco dust, psyllium, latex and enzymes (amylase, lipase, pectinase)
58
Can you mix wasps and vespids?
No
59
what are the most common food allergies in adults (3)?
- crustacean shellfish
- peanut
- tree nuts
60
Roofers, insulators, and painters (esp in autobody industry) can develop occupational asthma from being exposed to what?
isocyanates
61
what are the two most common forms of hypersensitivity pneumonitis?
Farmer's lung and bird fancier's lung
62
what does Toxicodendron cross-react with?
mango peels
- toxicodendron dermatitis (aka poison ivy, oak, and sumac) is the most common form of ACD. it is caused by urushiol, an oleoresin that is found in sap and oozes.
63
what drugs are commonly implicated in drug-induced ILD? (9)
- Amiodarone, beta blockers, cyclosporine, fluoxetine, heroin, methotrexate, nitrofurantoin, procarbazine, sulfasalazine.
64
a point mutation in what mast cell gene has been associated with idiopathic anaphylaxis?
an activating point mutation (D816V) in KIT.
65
exposure to anhydrides is common in what occupation?
manufacturing paint, plastic and epoxy.
66
what is the allergen in vespids?
Antigen 5 (reverse "V" is similar to "A")
67
workers in what field are at risk of occupational asthma due to exposure to plicatic acid? (3)
Woodworkers, carpenters, and mill workers exposed to western red cedar
68
what is the preferred inhaled corticosteroid for use during pregnancy?
Budesonide
69
How do you stage a COPD patient with FEV1/FVC ratio of 65% and FEV1 of 45%
GOLD stage 3 or severe COPD
70
GOLD stage for COPD
71
what type of emphysema is seen in alpha-1-antitrypsin deficiency?
Panacinar (or panlobular, involving lower lungs)
72
what is the typical presentation of acute hypersensitivity pneumonitis? (5)
- similar to infectious sx
- abrupt onset (4-6h after exposures) of fever, chills, malaise, nausea, cough, chest tightness, and dyspnea.
- PE: diffuse fine crackles.
- CXR: normal or transient patchy micronodular opacities.
- improvement within 12h to several days after removal of antigen
73
which cytokines induce isotype switching of B cells to IgE and support eosinophil survival? (3)
Th2 cytokines: IL 4,5,13
74
Maintenance dose for mixed vespids
300 mcg
75
what test should be obtained for a young non-smoker with symptoms and signs of COPD?
test for alpha-1-antitrypsin deficiency
76
what allergen is found in henna tattos?
paraphenylenediamine (PPD)
77
if a patient has typical sx of COPD but has normal spirometry, what is her stage?
GOLD stage 0 or at risk of COPD
78
what is typically found in BAL in patients with HP? (2)
marked BAL lymphocytosis (>50%) and CD4/8 ratio <1.0
79
what is the most common type of interstitial lung disease of unknown cause?
idiopathic pulmonary fibrosis
80
this protein is produced in eosinophils, appears as a colorless, needle shaped structure and is released in eosinophilic disorders like asthma
Charcot leyden crystals
81
hairdressers are at risk of developing occupational asthma due to what agents? (3)
persulfate (ammonium) salts
amines
latex
82
receptor for rhinovirus on T cells that play a role in signal transduction
ICAM-1 (binding of rhinovirus may lead to more severe or prolonged asthma flare)
83
factors that decrease FeNO (6)
caffeine
smoking
alcohol
CF
pulm HTN
prev use of spirometry
84
factors that increase FeNO (3)
viral URI
allergic rhinitis
nitrate rich food (like hot dogs)
85
Diagnostic criteria for asthma using methacholine challenge
measures airway hyperresponsiveness
- PC20 <4 mg/mL is diagnostic
- 4-16mg/mL suggestive if appropriate sxs are present
86
.
.
87
name three validated tools of asthma control
- asthma control questionnaire (ACQ)
- asthma control test (ACT)
- asthma therapy assessment questionnaire (ATAQ)
88
SMART management for asthma flare
- use of low-med dose of budesonide/formoterol for relief and maintenance
- reduce asthma flare and less ICS exposure
89
a short course of daily ICS for 0-4yo with recurrent viral-induced wheezing is recommended by?
EPR-3
90
what is a well-known complication of acute asthma flare?
PTX
91
onset of sx for exercise induced asthma (2)
10 min after aerobic activity, resolve by 15-30 min after
- FEV1 dec by >15% after exercise
92
lung volume changes in pregnancy
- inc minute ventilation (compensated resp. alkalosis) due to inc progesterone
- inc TV, dec RV and FRC (functional residual capacity)
93
EPR-3 classification of moderate persistent asthma severity for 0-4 yo
- daily sx
- 3-4 night time sx/month
- daily use of SABA
- some limitation in normal activity
- >2 flares/6mo OR >4 wheezing/1yr AND risk factors
- recommended step is Step 3 and consider oral steroids
94
EPR-3 classification of not well controlled asthma for 0-4 yo
- sx >2d/week
- night-time sx >1/mo
- some interference with normal activity
- SABA use > 2d/weel
- exacerbations 2-3x/yr
- recommended tx = one step up
95
EPR-3 classification of moderate persistent asthma severity for 5-11 yo
daily sx
night time >1x/week
daily SABA use
some limitation
FEV1 60-80%; FEV1/FVC 75-80%
>2 excerbations/yr
Step 3 tx, consider oral steroids
96
EPR-3 classification of not well controlled asthma for 5-11 yo (7)
sx >2x/week
night time >1x/month
some limitation
SABA use >2d/week
FEV1 60-80%
2-3 excerbations/yr
tx one step up
97
EPR-3 classification of moderate persistent asthma severity for >12 yo
daily sx
night time >1x/week
daily SABA
some limitation
FEV1 60-80%; FEV1/FVC dec by 5%
>2 exacerbations /yr
step 3, consider oral steroids
98
EPR-3 classification of not well controlled asthma for >12 yo
sx >2d/week
night time 1-2x/week
some limitatino
SABA >2d/week
FEV1 60-80%
ATAQ 1-2/ ACQ>1.5/ ACT 16-19
>2 exacerbations/yr
tx one step up
99
EPR-3 stepwise approach tx for 0-4yo. Step 1 and 3 (1,3)
step 1 = SABA PRN +daily ICS at the start of sx
step 3 = daily low dose ICS/LABA
low dose ICS+montelukast
med-dose ICS
100
EPR-3 stepwise approach tx for 5-11 yo. Step 1 and 3
step 1 = SABA prn
step 3 = low dose ICS/formoterol
med-dose ICS
low dose ICS/LABA
low dose ICS + LTRA
low dose ICS/theophylline
101
EPR-3 stepwise approach tx for >12yo. Step 1 and 3
step 1 = SABA prn
step 3= low dose ICS/formoterol
med dose ICS
low dose ICS/LABA
lose dose ICS+LAMA
low dose ICS +LTRA
low dose ICS + theophylline or zileuton
102
GINA 2020 stepwise approach tx for 0-4yo. Step 2 and 3
step 2 = daily low dose ICS // daily LTRA // intermittent short courses of ICS at onset of sx
Step 3 = double low dose ICS
low dose ICS +LTRA
SABA prn
103
GINA 2020 stepwise approach tx for 6-11yo. Step 1 and 3
step 1 =low dose ICS + SABA prn // daily low dose ICS
step 3 = low dose ICS/LABA // med dose ICS
low dose ICS + LTRA
104
GINA 2020 stepwise approach tx for >12yo. Step 1 and 3
step 1 = low dose bud/formeterol prn // low dose ICS+SABA
step 3 = low dose ICS/LABA
med dose ICS
low dose ICS + LTRA
(preferred reliever is bud/form)
105
MOA of benralizumab (2)
- binds to IL5Ralpha
- induce apoptosis of eos via interaction with NK cells by Ab dep cell mediated cytotoxicity
106
characteristics of class 1 food allergens (6)
glycoproteins
glycosylation residue
heat resistant
acid stable
stable to proteases
water soluble
107
characteristics of class 2 food allergens (3)
plant derived
labile
due to allergic sensitization to inhalant allergens
108
linear epitope is associated with
more prolonged allergy and more stable/persistent allergen
109
proteins and food allergens of milk
casein - Bos d 8 - major allergen, more persistent
whey (lactoglobulins) - Bos d 4-6 - heat labile
110
egg white proteins and allergens
ovomucoid - Gal d 1 - more persistent. best predictor of reaction to heated egg
ovalbumin - Gal d 2 - heat labile. associated with outgrowing egg allergy
ovotransferrin - Gal d 3 - heat labile
111
peanut protein and allergens (8)
vicilin (seed storage protein) - Ara h 1 - major. heat stable
conglutin (seed storage) - Ara h 2, 6, 7 - major, heat stable
glycinin (seed storage) - Ara h 3 - major. heat stable
profilin/ Bet v 2 homolog - Ara h 5 - heat labile
Bet v 1 homolog - Ara h 8 - heat labile. OAS
lipid transfer protein - Ara h 9 - stable protein
oleosin - Ara h 10, 11
defensins - Ara h 12, 13 - associated with severe anaphylaxis
112
soy bean protein and allergens
Bet v 1 homolog - Gly m 3,4 - mild sx and OAS
storage proteins - Gly m 5,6 - severe rxn
113
wheat protein and allergens
lipid transfer protein - Tri a 14
seed storage protein - Tri a 19 (omega 5 gliadin) - major. anaphylaxis and wheat dependent exercise induced anaphylaxis
114
fish protein and allergen
parvalbumin - Gad c 1, Gad m 1
115
shrimp protein and allergen
tropomyosin - Pen a 1, Pen m 1 - shrimp, cockroach and DM
116
cashew protein and allergen
albumin - Ana o 3 - predictive of allergy
117
hazelnut protein and allergens (4)
Bet v 1 homolog - Cor a 1 - heat labile, OAS
lipid transfer protein - Cor a 8 - severe rxn
globulin - Cor a 9 - severe rxn
Albumin - Cor a 14 - severe rxn
118
walnut protein and allergen (3)
seed storage proteins - Jug r 1,4 - severe rxns
Bet v 1 homolog - Jug r 5 - mild sx
119
when is it ok to test someone who has never eaten peanut before?
infant with IgE mediated egg allergy
infant with recalcitrant mod/sev AD
120
which peanut allergens does Palforzia contain?
Ara h 1,2,6
121
what is Heiner's syndrome
- non IgE mediated cow's milk induced pulmonary disease in chilren
- recurrent PNA, pulm infiltrates, hemosiderosis, Fe def anemia and FTT
- dx by history, peripheral eos, milk precipitins, lung biopsy, elimination diet
122
name cross-reactive allergens for venom (5)
123
treatment for food-induced rhinitis
intranasal ipratropium
124
which medication is ineffective for rhinitis of pregnancy?
intranasal steroids
125
Drugs that can cause drug-induced rhinitis (6)
- ASA/NSAIDs
- antihypertensives (bB or ACEi)
- intranasal decongestants - rebound
- OCPs
- Sildenafil (other PGD5 inhibitors)
- intranasal cocaine or methamphetamine
126
atrophic rhinitis (2)
- primary/idiopathic - usually in young/middle-aged pt in developing countries with a warm climate. colonization with Klebsiella
- secondary - usually due to sinonasal surgeries
127
NARES (5)
- symptoms of AR + eosinophilia on nasal smear
- anosmia, polyps, bronchial hyperreactivity
- no elevated total IgE or sIgE
- related to abnormal prostaglandin metabolism
- typically in middle aged men
128
which cytokine uniquely promotes airway mastocytosis and mast cell progenitor dev and localization to airway?
IL-9
129
pt population affected by AFRS
young, immunoCOMPETENT population
130
common fungi implicated in AFRS (4)
Aspergillus, Bipolaris, Curvularia, Drechslera
131
CT and MRI findings of AFRS
- CT: central hyper-attenuation and heterogeneous opacification
- MRI: peripheral enhancement (inflammation) with a dark center (fungal concretions)
132
Bent and Kuhn criteria for AFRS diagnosis (5)
need all five criteria
- type I hypersensitivity to fungi confirmed with SPT or sIgE
- nasal polyps
- characteristic CT findings
- noninvasive fungal hyphae in mucin OR positive fungal culture of mucin
- eosinophilic mucin without invasion into sinus tissue
133
epidemiology of vernal keratoconjunctivitis (3)
- sight-threatening bilateral eye disease seen in young atopic males
- warm and dry climates
- usually resolve by late puberty
134
clinical features of vernal keratoconjunctivitis (6)
- severe photophobia
- intense ocular itching
- papillary hypertrophy
- cobblestone papillae
- Horner-Trantas dots (peri-limbal white dots)
- keratoconus
135
clinical features of atopic keratoconjunctivitis (5)
- ocular pruritus with eczema
- can have loss of vision due to superficial punctate keratitis, corneal infiltrates, keratoconus and anterior subcapsular cataracts
136
steroids result in what type of cataracts?
posterior subcapsular cataracts
137
epidemiology of Giant Papillary conjunctivitis (3)
- associated with foreign body intolerance (ocular prostheses, sutures, contact lenses)
- extended wear > daily hard lens > daily soft lens
- can be aggravated by concomitant allergy
138
clinical features of vernal keratoconjunctivitis (3)
- ocular itching after lens removal
- morning mucus discharge
- tarsal papillary hypertrophy (initially smaller than VKC)
139
7 sight-threatening eye diseases
- acute glaucoma
- scleritis
- iritis
- uveitis
- herpes simplex keratitis
- atopic keratoconjunctivitis
- vernal conjunctivitis
140
malignancy that needs to be considered in an adult patient with new-onset dermatitis without a history of eczema/atopy
cutaneous T cell lymphoma (can be patchy)
141
which cytokine is implicated in itch?
IL-31
142
genetic mutations associated with AD (4)
FLG2
SPRR3
CLDN1
TMEM79
143
cytokines implicated in chronic eczema (30
IL-5, IL-12 and IFN gamma
- education is CHRONIC starting at FIVE through "G"rade TWELVE
144
What is different about FceRI receptors on Langerhans cells?
lack classic beta chain
145
distinguishing features of Zn deficiency (acrodermatitis enteropathica) -2
- periorificial rash
- does not respond to steroids
146
distinguishing features of pyridoxine deficiency (Vit B6 and niacin) -3
seizures, irritability, cheilitis
147
what is Crisaborole (3)
topical PDE4 inhibitor
- approved for mild/mod eczema >3mo old
- efficacy is uncertain
148
three characteristic features of asthmatic sputum
- Curschmann's spirals
- Creola bodies
- Charcot Leyden crystals
149
structural changes seen in asthma (3)
- small airway smooth mm hypertrophy
- thickening of reticular basement membrane
- subepithelial fibrosis
150
genetic factors associated with asthma (4)
- Chr. 5q - has IL-4 gene cluster
- b2 adrenoreceptor gene - affect response to b2 agonists
- Cd14 polymorphism - shift to Th1
- Chr 20p13 - has ADAM33 metalloproteinase that affects remodeling
151
which integrin ligand binds to rhinovirus that result in more severe and prolonged asthma flare?
ICAM-1
152
occupational contact dermatitis to chromium is seen in which population?
workers who handle wet cement
153
Contact dermatitis can be differentiated from irritant dermatitis based on which finding?
ACD is poorly defined, unlike irritant dermatitis
154
95% predictive values for milk allergy sIgE (2)
- <2yo: 5
- >2yo: 15
155
95% predictive values for egg allergy sIgE (2)
< 2yo: 2
> 2yo: 7
156
95% predictive value for soy allergy sIgE
sIgE of 65
157
95% predictive value for wheat allergy sIgE
80
158
95% predictive value for peanut allergy sIgE
14
159
95% predictive value for tree nut allergy sIgE
15
160
95% predictive value for fish allergy sIgE
20
161
4 pairs of cross-reactive food
- cashew-pistachio
- pecan- walnut
- almond- hazel nut
- lentil- chick pea
162
pt with alpha-gal can have reactions to which medication and food, aside from red meat? (2)
- cetuximab
- gelatin (contains alpha-gal)
163
what is Latex-Fruit syndrome?
30-50% of latex-allergic pts have reactions to some plant-derived foods, like Avocado, Banana, Chestnut, and Kiwi
164
pollen implicated for OAS to apple, plum, peach, pear, etc (씨 있는 과일)
Birch (Bet v 1)
165
pollens implicated in OAS to cantaloupe, watermelon, honeydew (2)
Ragweed, Orchard
166
pollen implicated in OAS celery, carrot, parsley, etc
Bet v 1
167
2 HLA molecules associated with celiac disease
HLA-DQ2,8
168
high levels of these cytokines correlate with hypotension during anaphylaxis (6)
IL-6, IL-10, TNF receptor I, tryptase, histamine, C3a
169
ACEI in VIT vs AIT
- theoretical increased risk in VIT, but no data for AIT
170
premedication protocol for contrast media (2)
- 50mg of prednisone 13, 7, and 1 hour before procedure + 50mg of benadryl 1h before
- use low or iso-osmolar, non ionic contrast material
171
what are latex allergens (5)
Hev b 1 -13
- endo-1,3 β-glucosidases (Hev b 2), patatin-like proteins (Hev b 7), profilins (Hev b 8), and nonspecific lipid transfer proteins (Hev b 12).
172
food associated with natural rubber allergen Hev b 2 (2)
Bell pepper, olive
173
food associated with natural rubber allergen Hev b 5 (3)
Kiwi, potato, sugar beet
174
food associated with natural rubber allergen Hev b 6 (4)
Avocado, banana, chestnut, sweet peper
175
food associated with natural rubber allergen Hev b 7 (2)
potato and tomato
176
food associated with natural rubber allergen Hev b 13
potato
177
Hev b proteins more commonly associated with health care workers (3)
Hev b 5, 6, 7
178
insects part of Family Apidae (2)
- honey bees (Apis Mellifera, includes Africanized killer bees)
- bumble bees (Bombus spp)
179
insects part of Family Vespidae (4)
- yellow jacket (Vespula spp)
- yellow hornet (Dolichovespular arenaria)
- white faced hornet (D. maculata)
- paper wasp (subfamily polistes spp)
180
characteristics of yellow jacket
- highly aggressive (around garbage cans or food)
- can sting repeatedly
- nests in concealed locations underground, wall cavities or decaying wood
181
key allergen for hornets
Dol m 5 - Antigen 5
182
major allergens for honeybee (5)
- Api m 1 = phospholipase A2
- Api m 2 = hyalurondiase
- Api m 3 = acid phosphatase
- Api m 7 = CUB serine protease
- Api m 10 = Icarapin
183
major allergens for hornet/vespid (3)
- Ves v 1 = phospholipase A1
- Ves v 2 = hyaluronidase
- Ves v 5 = antigen 5
184
major allergens for paper wasp (3)
- Pol a 1 = phospholipase A1
- Pol a 2 = hyaluronidase
- Pol a 5 = antigen 5
185
major allergens for fire ant (2)
Sol i 1 = phospholipase A2
Sol i 3 = antigen 5
186
injection schedule for VIT maintenance (3)
q4 weeks for 1-1.5yrs
q6-8 weeks until 4yrs
q12 forward
187
What agent should you suspect in an automobile worker with occupational asthma who works in finish coating?
Hexamethylene diisocyanate (HDI) as it is used extensively in spray paints.
188
what is Reactive airway dysfunction syndrome
a type of occupational asthma without latency and immunologic sensitization, occurring after a single massive irritant exposure with consequent severe airway injury
189
Occupational asthma related to western red cedar is due to exposure to?
Plicatic acid
190
what is the order of sx development in AERD? (3)
Rhinosinusitis with polyps, asthma, aspirin hypersensitivity
191
What is the target dose of aspirin desensitization to maintain cross- desensitization to any dose of all NSAIDs vs for AERD?
- 325mg for NSAIDs
- 650mg BID for AERD
192
characteristic bite of a kissing bug (triatoma)
nocturnal painless bite that causes erythematous urticarial nodule/plaque
193
what is an indoor allergen that cross-reacts with cockroaches?
Asian Lady Beetle (Harmonia Axyridis)
194
treatment for cold urticaria
cyproheptadine (C for cold)
195
what can be SPT positive in patients with cholinergic urticaria?
their own sweat
196
cold urticaria syndromes with negative ice cube test (6)
- PLAID (PLC-gamma-2-associated antibody deficiency and immune dysregulation)
- delayed cold urticaria
- cold-induced cholinergic urticaria
- systemic cold urticaria
- familial cold autoinflammatory syndromes (FCAS)
- cold-dependent dermographism
197
diagnostic criteria for hypocomplementemic Urticarial Vasculitis Syndrome
- needs both major criteria and at least 2 minor criteria
- Major: urticaria > 6mo, low C3/4/C1q
- Minor: venulitis of dermis on biopsy, arthralgias/arthritis, mild glomerulonephritis, uveitis or episcleritis, recurrent abdominal pain, positive C1q precipitin test with an associated low level of C1q
198
common agent associated with OA for carpenters and woodworkers
Plicatic acid (western red cedar wood dust) - activates complement
199
common agent associated with OA for roofers, insulators, painters
isocyanates
200
common agent associated with OA for nail salon workers, dental hygienists, and plastic manufacturers (2)
Acrylates, Epoxy
201
common agent associated with OA for manufacturers of paint, plastic, and epoxy resins
anhydrides
202
common agent associated with OA for hospital workers, laboratories (2)
formaldehyde, glutaraldehyde
203
common agent associated with OA for drug industry workers (2)
beta lactams, opiates
204
name LMW agents associated with OA (10)
- plicatic acid
- isocyanates
- acrylates
- epoxy
- metals
- dyes/bleaches
- anhydrides
- amines
- formaldehyde
- beta lactams/opiates
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diagnosis of OA with PFT (3)
- PFT or peak flow to be done q2h at work and at home for 2 weeks
- PEFR lower at work with variability >20%
- FEV1 reduction by 15-20% after exposure is suggestive
206
antigen for Farmer's lung
Thermophilic actinomyteces
207
antigen for humidifier fever/AC lung (3)
- Thermoactinomyces
- Klebsiella
- Acanthamoeba
208
antigen for hot tub lung (2)
MAC or Cladosporium
209
antigen for Woodworker's lung
Alternaria species
210
antigen for wheat weevil lung/miller's lung (2)
Sitophilus, Aspergillus fumigatus
211
antigen for chemical worker's lung (2)
- toluene diisocyanate (TDI)
- diphenylmethane diisocyanate (MDI)
212
antigen for epoxy resin worker's lung
phthalic acid
213
findings on BAL for HP (2)
lymphocytosis and low CD4/CD8 ratio (<1)
214
what is organic dust toxic syndrome (or pulmonary mycotoxicosis) (6)
- non-infectious, febrile illness after exposure to toxin-producing fungi
- more common than HP
- young patients
- usually during summer
- no prior sensitization is needed
- serologic response to common fungi may be absent
215
GOLD staging for COPD (5)
- GOLD 0 = at risk. normal spirometry but with sx
- GOLD 1 = mild. FEV1 >80%
- GOLD 2 = moderate. FEV1 50-80%
- GOLD 3 = severe. 30-50%
- GOLD 4 = very severe. FEV1 <30%.
216
pathogenesis of COPD (2)
- neutrophils, Mo and CD8 T cells release proteases that cause parenchymal lung destruction/ emphysema
- nicotine may also enhance tissue destruction
217
different types of emphysema and its associated dz (3)
- centrilobular emphysema = involves upper lobes. associated with cigarette
- panlobular = alpha1-antitrypsin deficiency
- paraseptal (distal acinar) = subpleural collections of gas in the periphery. associated with spontaneous PTX in young adults
218
what is the predominant histologic features in contact derm? (2)
lymphocytic infiltration and spongiosis
219
what is an Angry Back syndrome?
- strong reaction that can lead to negative sites appearing positive
220
don'ts for patch testing (5)
- no testing within 3 weeks of UV treatments, heavy sun exposure or tanning bed
- avoid using systemic and topical steroids in the area
- avoid using alcohol or other irritating substances prior to application
- avoid sweating or getting it wet
- avoid using razors to shave the area
221
allergens associated with contact derm on eyelids (3)
fragrances, nickel, formaldehyde
222
allergens associated with contact derm on hands and feet (3)
nickel, chromium, formaldehyde
223
allergens associated with contact derm on hands and perioral region (2)
- CAPB (cocamidopropyl butaime)
- fragrance
224
allergens associated with contact derm on eyelids and periaxillary area (2)
fragrance and formaldehyde
225
what is CAPB?
surfactant found in shampoos and other cleansers
226
interpretation of 1+ on patch test
erythema and edema that is palpable with slight infiltration that occupies 50% of the site
227
interpretation of 2+ on patch test
microvesicles and erythema that occupy at least 50% of site
228
interpretation of 3+ on patch test
confluent vesicles or bullae, ulcerative
229
irritant reaction on patch test
discrete, follicular or homogenous erythema without infiltration
230
what is the source of quaternium15? (3)
topical medications, creams, lotions
231
what are the sources of colophony? (5)
adhesives, glues, cosmetics, soaps, sealants
232
what are the sources of K dichromate? (3)
shoes, leather, stainless steel
233
what are the sources of bisphenol A and epichlorohydrin? (3)
sporting goods, vehicle parts, building construction
234
what are the sources of cobalt? (5)
dental implants
artificial joints
engines or rockets
leather
ceramics
235
what are the sources of chromates? (3)
textile
leather tanners
construction workers using wet cement
236
what can be used to test metals to see if it contains nickel?
dimethylglyoxime test (pink = positive)
237
toxicodendron dermatitis cross-reacts with what?
mango peels
- urushiol is the oleoresin that sensitizes pts
238
characteristics of contact derm to Alstroemeria (Peruvian lily) (3)
- causes hand eczema in flower workers
- intensely pruritic
- affects 1st three fingers, dorsal hands, forearms, V-region of neck and face
239
Balsam of Peru cross-reacts with? (2)
cinnamon and vanillin
240
name four major chemical classes of topical steroids (4)
Group A = hydrocortisone type
Group B = triamcinolone type
Group C = Betamethasone type
Group D = hydrocortisone-17-butyrate type
241
if positive for EDTA (ethylenediamine dihydrochloride) on patch test, what should you avoid? (3)
- aminophylline
- nystatin
- piperazine-based antihistamines (meclizine, cyclizine)
242
if positive for neomycin on patch test, what should you avoid? (5)
gentamicin
kanamycin
streptomycin
tobramycin
bacitracin
243
Females over age 15 have higher rate of anaphylaxis than males. The reason for this is unknown but may be due to?
Hormonal changes which increase sensitivity to anaphylaxis.
244
IL-33 may be important in anaphylaxis due to its role in?
245
impaired TLR2 expression has been linked with?
severe AD with frequent bacterial infections
246
skin finding of omenn sydrome
diffuse, exudative erythroderma
247
dock8 deficiency (5)
- difficult to treat viral skin infections
- also bacterial skin infections
- mucocutaneous candidiasis
- respiratory tract infections
- high incidence of malignancy
248
249
250
an allergen in Kissing Bug
Procalin
- Kissing bug = triatoma
251
Main allergens in baker's asthma (4)
- hydrolytic enzymes
- latex
- flour
- egg powder
252
How is pollination from angiosperms achieved?
Pollen constituents either diffuse out or are expelled from the grains onto the stigma surface, after which the pollen tube emerges and grows toward the ovum.
253
How is pollination from gymnosperms achieved?
Pollen is either trapped by a pollination drop that emanates from the exposed ovula or are engulfed by the ovula extensions.
254
scientific name of Lone Star tick
Amblyomma americanum
255
What is the family of small extracellular proteins that mammalian allergenics such as cat (Fel d 1) and cattle (Bos d 2) belong to?
- lipocalins
Allergenic source materials such as from rodents (Mus m 1) and dog (Can f 1) and cat (Fel d 1) belong to a family of small extracellular proteins called lipocalins.
256
agents that are associated with occupational asthma in auto body repair industry (3)
acrylates
isocyanates
amines
257
latex allergens for healthcare workers (2)
- Hev b 5 and 6.01/6.02
- Hev b 1 and 3 in pts with spinal bifida
258
High molecular weight protein has a molecular mass of?
> 10 kDa
259
260
Fire ant venom contains?
95% piperidine alkaloids
261
initial treatment for ABPA
oral steroids
262
which T helper cell type is predominant during acute vs chronic HP? (3)
- Th1 during acute
- Th2 during subacute/chronic
- increased Th17 response during subacute/chronic phage --> lymphocyte apoptosis and impaired Treg function (normal number)
263
allergen in HP for wind-pipe instrument players
Candida albicans
264
Aspergillus is associated with HP in which populations? (2)
Malt workers (moldy malt)
Wheat weevil or miller’s lung (moldy grains)
265
WHO criteria for systemic mastocytosis
1 Major + 1 minor
OR 3 minors
266
what type of mastocytosis has the worst prognosis?
Mastocytosis leukemia
267
Midostaurin is used for? (6)
- treatment of aggressive systemic mastocytosis, mast cell leukemia, and systemic mastocytosis associated with hematologic malignancy
- can be used regardless of kit mutation status
-***imatinib is only used for pts who DONT have kit mutation
268
What is a potential mechanism for thunderstorm asthma?
Ruptured grass pollen
269
examples of Type III hypersensitivity reactions (5)
- vasculitis
- glomerulonephritis
- SLE
- serum sickness
- Arthus reaction
270
symptoms to differentiate between infectious vs allergic conjunctivitis
Mucous stranding suggests a viral process, but secondary bacterial infections commonly lead to “glue eye".
- watery discharge and ocular pruritus for allergic conjunctivitis
- mucus stranding can also be seen with VKC**
271
age difference in AKC vs VKC
VKC- 3~20yo
AKC - 20~50yo
272
ocular pathology most likely seen in AKC (4)
Punctate epithelial keratopathy (most likely)
- corneal scarring and keratoconus can also be seen
- anterior or subcapsular cataracts
- shield ulcers
273
unique cytokine involved in irritant contact derm
IL-1alpha
- IL-1b and TNFa are involved in both ICD And ACD.
- IL-18 only in ACD.
274
characteristics of primary/idiopathic atrophic rhinitis (2)
- young-middle aged patients from developing countries with warm climate
- associated with Klebsiella colonization of the nose
275
LMW agents that can cause occupational asthma in pts who work with pain
- Acrylates
- anhydrides (can also cause AR)
- amines
276
rhinitis due to irritants is mediated by which receptor?
transient receptor potential ankyrin type 1 (TRPA1)
277
rare side effect associated with topical decongestants in children
seizure
278
risk of epistaxis with intranasal steroid
4-8%
279
definition of chronic rhinosinusitis in adults vs children (1)
sx >12 weeks for both
280
when is the best time to obtain sinus CT?
at baseline. after acute illness.
281
Which antibody is most associated with severe local eosinophilic inflammation in nasal polyposis?
IgE selective for Staphylococcus aureus enterotoxins
