Hypersensitivity Disorders Flashcards
(177 cards)
1
Q
Name some protective factors for allergic rhinitis
A
rural upbringing with early life exposure to farm animals, day care attendance, large family size, exposure to pets, number of siblings
2
Q
When does the late phase allergic response begin and how long does it last ?
A
4-8 hours; 24 hours
3
Q
What is typical of FeNo in allergic rhinitis and sinusitis, respectively?
A
high, low
4
Q
What is the term used to describe the effect by which progressively lower doses of allergen are needed to trigger subsequent symptoms?
A
priming
5
Q
What symptom is prominent in the late phase response of allergic rhinitis?
A
congestion
6
Q
What is the most effective medication for allergic rhinitis?
A
nasal steroids
7
Q
How is nonallergic rhinitis with eosinophilia (NARES) different from allergic rhinitis?
A
no elevated total or specific IgE
8
Q
Nasal crusting is characteristic of what kind of rhinitis?
A
atrophic
9
Q
Hormone induced rhinitis may be associated with what endocrine disorder?
A
hypothyroid - TSH stimulates edema in turbinates
10
Q
What are the common pathogens that cause bacterial acute rhinosinusitis?
A
strep pneumo, moraxella catarrhalis, haemophilus influenzae
11
Q
What is a Haller cell?
A
A pneumatized ethmoid cell that blocks the ostiomeatal complex
12
Q
Where do nasal polyps typically originate?
A
ethmoid sinuses
13
Q
Which mediators are increased in CRS without nasal polyps?
A
IL-3, PGE2
14
Q
Which mediators are increased in CRS with nasal polyps?
A
IL-5, Eotaxin, LCTC4/D4/E4
15
Q
Conjunctivitis with otitis is more likely caused by what organism?
A
H. influenzae
16
Q
How is recurrent otitis media defined?
A
> 3 episodes within 6 months or >4/yr
17
Q
What is the leading cause of hearing loss in children?
A
otitis media with effusion (non-infectious)
18
Q
What is a destructive, expanding accumulation of keratinized squamous epithelium in the middle ear or mastoid?
A
cholesteatoma
19
Q
Papillary hypertrophy, thick ropey ocular discharge, and Horner-Trantas dots are characteristic of what?
A
Vernal keratoconjuctivitis
20
Q
Where do cataracts arise due to steroid administration?
A
posterior capsule
21
Q
What is the greatest risk factor for giant papillary conjunctivitis?
A
contact lens use
22
Q
A decrease in what antimicrobial peptides increase the risk of infection in atopic dermatitis?
A
defensins, cathelicidin
23
Q
What are the cytokines involved in acute and chronic atopic dermatitis, respectively?
A
IL-4, IL-13; IL-5, IL-12, IFNγ
24
Q
Polymorphisms in which TLR is linked to severe atopic dermatitis with frequent bacterial infections?
A
TLR2
25
Loss of function mutations in what predisposes to development of atopic dermatitis?
filaggrin
26
What is the ligand for E selectin that helps T cells home to the skin in atopic dermatitis?
cutaneous lymphocte-associated antigen (CLA)
27
The presence of Birbeck granules are characteristic of what cell type?
Langerhans cells
28
Which cytokine is primarily associated with pruritis in atopic dermatitis?
IL-31
29
Where are cataracts due to atopic keratoconjunctivitis found?
anterior capsule
30
Deficiency of which antimicrobial peptide in atopic skin may contribute to eczema vaccinatum?
cathelicidin (LL-37)
31
A 3 y/o boy presents with bloody stools, ear drainage and eczema. What PID should be considered?
Wiscott-Aldrich syndrome
32
Vitamin D induces production of which antimicrobial peptide in atopic individuals?
cathelicidin (LL-37)
33
Accumulation of what cell type is associated with fatal asthma?
neutrophils
34
Hyperplasia of submucosal glands in asthma is promoted by which cytokine?
IL-9
35
Sensitization to what by age 6 is associated with persistence of asthma at age 11?
alternaria
36
A 5q31-33 polymorphism can contribute to atopic asthma by increasing production of which interleukin ?
IL-4
37
A β2-adrenoreceptor gene can lead to what?
decreased response to β2 agonist
38
What is the most frequent infections cause of asthma exacerbations?
rhinovirus
39
What is the asthma predictive index?
```
Major criteria (1 needed): parental asthma, dx of eczema, allergic sensitization
Minor criteria (2 needed): sensitization to foods, eosinophilia, wheezing apart from colds
```
40
Classify the asthma severity of a 3 y/o with daily symptoms, 3 nighttime awakenings/month, and daily SABA use. What initial step therapy should be used?
moderate persistent, step 3
41
Classify the asthma severity of a 8 y/o with symptoms/SABA use 4 days/week, 3 nighttime awakenings/month, and an FEV1 of 83%. What initial step therapy should be used?
mild persistent, step 2
42
Classify the asthma severity of a 8 y/o with symptoms/SABA use 4 days/week, weekly nighttime awakenings, and an FEV1 of 76%. What initial step therapy should be used?
moderate persistent; step 3
43
Classify the asthma severity of a 13 y/o with symptoms/SABA use 4 days/week, 3 nighttime awakenings/month, and an FEV1 of 83%. What initial step therapy should be used?
mild persistent, step 2
44
What initial step of therapy should be used for an 8 y/o with severe persistent asthma?
step 3-4
45
What initial step of therapy should be used for an 15 y/o with severe persistent asthma?
Step 4-5
46
Classify the asthma severity of a 3 y/o with daily symptoms, weekly nighttime awakenings, and SABA use several times per day. What initial step therapy should be used?
severe persistent; step 4
47
Classify the asthma severity of a 3 y/o with symptoms/SABA use 4 days/week, nighttime awakenings twice/month. What initial step therapy should be used?
mild persistent; step 2
48
Classify the asthma severity of an infant with 3 exacerbations in the last 6 months who's mother has asthma. No symptoms outside of exacerbations. What initial step therapy should be used?
mild persistent; step 2
49
Classify the asthma severity of a 23 y/o with 3 exacerbations/year and an FEV1 of 65%. What initial step therapy should be used?
moderate persistent; step 3
50
Assess the asthma control in a 2 y/o with symptoms 3 days/week with 1 nocturnal awakening/month and 2 exacerbations/year. What action should be taken?
not well controlled; step up 1 step
51
Assess the asthma control in a 10 y/o with symptoms 2 days/week with 1 nocturnal awakening/month and 1 exacerbation/year. What action should be taken?
controlled, no action
52
Assess the asthma control in a 14 y/o with symptoms throughout the day, 5 nocturnal awakenings/month, an FEV1 of 58% and 2 exacerbations/year. What action should be taken?
very poorly controlled; step up 1-2 steps and consider oral steroids
53
Assess the asthma control in a 2 y/o with daily symptoms, 5 nocturnal awakenings/month and 4 exacerbations/year. What action should be taken?
very poorly controlled; step up 1-2 steps, consider oral steroids
54
Assess the asthma control in a 10 y/o with symptoms 3 days/week with 2 nocturnal awakenings/month, and FEV1 of 78%, and 2 exacerbations/year. What action should be taken?
not well controlled; step up 1 step
55
Assess the asthma control in a 14 y/o with symptoms 5 days/week, 3 nocturnal awakenings/month, an FEV1 of 62% and 2 exacerbations/year. What action should be taken?
Not well controlled; step up one step
56
What is step 1 therapy for children ages 0-4?
SABA PRN
57
What is step 1 therapy for children ages 5-11?
SABA PRN
58
What is step 1 therapy for adults?
SABA PRN
59
What is step 2 therapy for children ages 0-4?
low dose ICS; alternative = montelukast or cromolyn
60
What is step 2 therapy for children ages 5-11?
low dose ICS; alternative = montelukast, theophylline or cromolyn
61
What is step 2 therapy for adults?
low dose ICS; alternative = montelukast, nedocromil, theophylline or cromolyn
62
What is step 3 therapy for children ages 0-4?
medium dose ICS
63
What is step 3 therapy for children ages 5-11?
low dose ICS + LABA or LTRA or theophylline; alternative = medium dose ICS
64
What is step 3 therapy for adults?
low dose ICS + LABA or LTRA or theophylline or zileuton; alternative = medium dose ICS
65
What is step 4 therapy for children ages 0-4?
medium dose ICS + LABA or LTRA
66
What is step 4 therapy for children ages 5-11?
medium dose ICS + LABA or LTRA or theophylline
67
What is step 4 therapy for adults?
medium dose ICS + LABA or LTRA or theophylline or zileuton
68
What is step 5 therapy for adults?
high dose ICS + LABA and consider omalizumab
69
What is step 5 therapy for children ages 5-11?
high dose ICS + LABA or LTRA or theophylline
70
What is step 5 therapy for children ages 0-4?
high dose ICS + LABA or LTRA
71
What is step 6 therapy for children ages 0-4?
high dose ICS + LABA or LTRA + oral corticosteroids
72
What is step 6 therapy for children ages 5-11?
high dose ICS + LABA or LTRA or theophylline + oral steroids
73
What is step 6 therapy for adults?
high dose ICS + LABA + oral steroids and consider omalizumab
74
What agents are the most common causes of occupational asthma?
latex, wheat, isocyanates, plicatic acid
75
Smoking is a risk factor for sensitization to what?
Platinum
76
β-1,3-glucan in fungal cell walls binds to what on macrophages?
dectin-1; important in ABPA
77
What serological marker can indicate an exacerbation of ABPA?
IgE doubles
78
What are the diagnostic criteria for allergic fungal sinusitis?
sensitization to fungi
nasal polyps
positive fungal stain of sinus contents
histology showing eosinophils, fungal elements
79
What are the CT findings in acute, subacute, and chronic hypersensitivity pneumonitis?
acute - normal or fleeting ground glass opacities
subacute - diffuse micronodules, air trapping, mild fibrosis
Chronic - ground glass, emphysema, honeycombing, micronodules
80
What antigen is implicated in farmer's lung (hypersensitivity pneumonitis)?
mold
81
What antigen is implicated in hot tub lung (hypersensitivity pneumonitis)?
mycobacterium avium
82
What antigen is implicated in bird fancier's lung (hypersensitivity pneumonitis)?
aspergillus and avian proteins
83
What antigen is implicated in air conditioner lung (hypersensitivity pneumonitis)?
aureobasidium
84
What are the diagnostic criteria for hypersensitivity pneumonitis?
```
HP symptoms
Evidence of exposure (history and +IgG)
Radiographic evidence
BAL showing >20% lymphocytes (low CD4:CD8 ratio)
symptoms on re-exposure
```
85
What is seen on biopsy in hypersensitivity pneumonitis?
noncaseating granulomas
lymphocytes
foamy histiocytes in alvioli
giant cells
86
What PFT findings are seen after exposure in hypersensitivity pneumonitis?
drop in FEV1, FVC and DLCO 4-6 hrs after exposure
87
What is the non-infectious febrile illness that occurs in workers after exposure to dust contaminated with toxin producing bacterial and/or fungal spores?
organic dust toxic syndrome (ODTS)
| - 30-50 x more common than hypersensitivity pneumonitis
88
What causes symptoms in silo unloaders disease?
acute exposure to NO2 leading to asphyxia
89
What causes symptoms in byssinosis?
dust inhalation of cotton, flax and hemp
90
What causes symptoms in humidifier fever?
toxic alveolitis due to endotoxin in recirculated water
91
What is the most common form of hypersensitivity pneumonitis?
farmer's lung - but more common is organic dust toxic syndrome which can occur after only one exposure
92
What is seen on PFTs in idiopathic pulmonary fibrosis (usual interstitial pneumonitis)?
restrictive pattern with reduced DLCO
93
What is seen on CT in idiopathic pulmonary fibrosis (usual interstitial pneumonitis)?
honeycombing, diffuse interstitial infiltrates
94
What are the GOLD criteria for grading severity of COPD?
GOLD 1: mild - FEV1 > 80%
GOLD 2: moderate - FEV1 50 - 80%
GOLD 3: severe - FEV1 30 - 50%
GOLD 4: FEV1
95
Which cell types are prominent in the airway in COPD?
neutrophils and macrophages
96
Sputum eosinophils are a marker of what in COPD?
viral exacerbation
97
Centrilobular emphysema seen in COPD is associated with what?
smoking
98
Panlobular emphysema seen in COPD is associated with what?
α1-antitrypsin deficiency
99
What is the only treatment that prolongs life in COPD?
O2 supplementation
100
A 39 y/o man eats tuna and within 20 minutes develops abdominal cramps, vomiting, swelling of the tongue and SOB. He has no hx of fish allergy and SPT is negative. What is the Dx?
scromboid poisoning - contaminated fish, resembles allergic reaction
101
How does sensitization take place in Class 1 and 2 allergens, respectively?
through the skin (foods); through the respiratory system (pollens with epitopes similar to food epitopes)
102
What is the difference between conformational and linear epitopes?
conformational epitopes allergenicity is dependent upon the folding into the 3D structure, linear are not
103
Name the antigen in birch and in apples/peaches that cross react.
Bet v 1 (birch), Mal d 1 (apple,peach)
104
What syndrome is characterized by recurrent pneumonia, pulm infiltrates, hemosiderosis, Fe def. anemia, failure to thrive, eosinophilia, and milk precipitins?
Heiner's syndrome
105
What does dermatitis herpetiformis look like and what is it associated with?
vesicular, pruritic lesions on sun exposed areas; celiac disease
106
In galactose-α-1,3-galactose hypersensitivity, how soon after ingestion do symptoms begin?
3-6 hours
107
What type of allergen is galactose-α-1,3-galactose, and what chemotherapeutic mAb does it react with?
carbohydrate part of a glycoprotein; cetuximab
108
Which peanut component is associated with systemic reactions?
Ara h 2
109
Which peanut component is associated with oral reactions?
Ara h 8
110
What are the most common causes of anaphylaxis?
food and drug reactions
111
How can chymase act to improve symptoms of anaphylaxis?
Can convert angiotensin I to II - improves BP
112
What are the diagnostic criteria for anaphylaxis?
hives and/or angioedema with at least 1 of:
| respiratory sx, drop in BP or end organ dysfunction
113
What % of anaphylactic episodes experience a biphasic or late phase reaction?
20%
114
What medications can modify the effects of anaphylaxis?
Beta blockers, ACEI, MAOIs (prevent degradation of epi)
| * tricyclics exaggerate the response to epi
115
How can you differentiate anaphylaxis from mastocytosis?
look at total tryptase and mature tryptase - mature tryptase is released in anaphylaxis
mastocytosis total/mature tryptase is >20
116
When should serum histamine be checked when evaluating possible anaphylaxis?
15-60 minutes - levels rise in 5 minutes but only remain elevated for 30-60 minutes
117
For how long does urinary histamine remain elevated after anaphylaxis?
24 hours
118
When does serum tryptase peak after anaphylaxis?
60-90 minutes - can remain elevated for up to 5 hours
119
Besides histamine and tryptase, what other serological marker is elevated in anaphylaxis?
platelet-activating factor
120
Which allergenic component is common to those with spina bifida?
latex - Hev b 1 and 3
121
Which latex component is common for health care worker reactions?
Hev b 5, 6, and 7
122
Which allergen cross reacts with bell pepper, kiwi, potato, avocado, and chestnut?
latex
123
Which foods are the most commonly implicated in food dependent exercise induced anaphylaxis?
celery and wheat
124
What is the major honeybee allergen?
Phospholipase A
125
What is the major vespid allergen?
hyaluronidase
126
If severe hypotension occurs after a hymenoptera sting, what key blood test should be ordered?
tryptase
127
Which biting insect is the most common cause of systemic reactions?
Triatoma (kissing bug) - bites are painless
128
What is a Type II hypersensitivity reaction?
antibody dependent cytotoxic reaction
129
What is a type III hypersensitivity reaction?
Immune complex reaction
130
What is a type IV hypersensitivity reaction?
cell mediated or delayed type
131
In a type IVa hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?
IFNγ; monocytes; eczema
132
In a type IVb hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?
IL-4 and IL-5; eosinophils; maculopapular or bullous rxn
133
In a type IVc hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?
perforin and granzyme; CD4 and CD8 T cells; maculopapular or bullous rxn
134
In a type IVd hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?
IL-8; neutrophils; pustular rxn
135
HLA-B*5701 is strongly associated with reactions to which drug?
abacavir
136
HLA-DR3 is associated with reactions to which medications?
insulin, penicillamine and gold
137
What is in the Pre-Pen (major determinants)?
benzylpenicilloyl polylysine
138
What is in the minor determinants for PCN testing?
PCN G
139
Which medication cross reacts with ceftaZidime?
aZtrionam
140
80% of people taking augmentin will have a skin reaction if infected with what?
EBV
141
HIV patients will very commonly have a type IV reaction to which medication?
Bactrim
142
Type I hypersensitivity reactions to Bactrim are due to what?
N4 sulfonamidoyl hapten
143
What is the mechanism in radiocontrast reactions?
direct mast cell stimulation
144
Which medications are common causes of SJS and TEN?
PCN, sulfonamides, antconvulsants, NSAIDS, allopurinol
145
Which medications are common to DRESS?
anticonvulsants, sulfonamides, allopurinol, minocycline
146
What are the symptoms of dress?
fever, lymphadenopathy, hepatitis, facial edema weeks after therapy
147
Perioperative reactions are commonly due to which agents?
quaternary ammonium muscle relaxants (succinylcholine)
148
Fever, rash, bronchospasm, capillary leak syndrome, meningoencephalopathy, and elevated LFTs after rituximab (anti-CD20) is likely what Dx?
cytokine release syndrome
| also due to muromonab (anti-CD3)
149
Which autoantibody is associated with drug induced cutaneous lupus?
anti-Ro (SSA)
150
Which autoantibody is associated with drug induced systemic lupus?
antihistone
151
How is acute urticaria defined?
less than 6 weeks
152
Which autoantibody is common in chronic idiopathic urticaria?
thyroid
153
How can you distinguish between cholinergic urticaria and exercise induced anaphylaxis?
EIA will not react with passive heating
154
What syndrome is characterized by urticaria with arthritis, obstructive lung disease, glomerulonephritis, uveitis, angioedema and recurrent abdominal pain? Also has low C3, C4, C1q, anti-C1q Ab and elevated ESR?
Hypocomplementemic urticarial vasculitis syndrome
155
How are patch tests graded?
Irritant
+/- = unlikely
+ = erythema and palpable edema
++ = microvesicles and erythema > 50% patch
+++ = confluent vesicldes or bullae, ulcerative
156
What is a common contact allergen for cement workers?
Chromates
157
What does the dimethylglyoxime test evaluate?
presence of nickel-containing material
158
What fruit can poison ivy/oak cross react with?
mango peels
159
What is the most common cause of eczema in flower workers?
peruvian lily
160
What is the common allergen in fragrances?
Balsam of Peru
161
What common allergen is a preservative found in fabrics?
Quaternium-15 (releases formaldehyde)
162
What is the most common contact allergen in hair dressers?
paraphenylenediamine
163
What is a common allergen in nail polishes?
ethylacrylate
164
What is the most common topical antibiotic causing contact dermatitis?
neomycin
165
What is systemic contact dermatitis?
the term used for generalized allergic contact dermatitis due to ingestion of an allergen
166
Which vaccines are live?
```
MMR
nasal flu
polio
rotavirus
smallpox
shingles
varicella
```
167
How far apart should live vaccines be separated if not given the same day?
28 days
168
What are the common allergic components in vaccines?
gelatin, egg, latex, yeast
169
What recommendations regarding an egg containing vaccine should be given to someone who has an egg allergy with hives only?
give vaccine and observe in PCP office for 30 minutes
170
What recommendations regarding an egg containing vaccine should be given to someone who has an egg allergy with anaphylaxis?
give vaccine and observe in allergist office and observe for 30 minutes
171
What are the contraindications to vaccinations?
previous anaphylaxis to vaccine
| encephalopathy
172
What is the most common cause of bronchiolitis?
RSV
173
What is the monoclonal antibody against RSV and when should it be given?
Palivizumab - give monthly to high-risk infants youger than 2 yrs
174
What is the major cause of croup?
parainfluenza virus
175
What is the common radiographic sign seen in croup?
subglottic narrowing (steeple sign)
176
What are the time classifications for acute, subacute and chronic rhinosinusitis?
Less than 4 weeks, 4-8 weeks, 8-12 weeks
177
What must the particle size be to cause hypersensitivity pneumonitis?
less than 5 micrometers
