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MBBS VI - Medicine Summary > Immunology and allergy handbook > Flashcards

Immunology and allergy handbook Flashcards

1
Q

What is the clinical criteria of anaphylaxis?

A

Any one of the 3

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2
Q

What is management of anaphylaxis?

A
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3
Q

What is management workflow for anaphylaxis patients?

A
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4
Q

How to assess in anaphylaxis for unidentified triggers/ allergens

A
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5
Q

What is gell and coombs classification of hypersensitivity reactions?

A
  1. Type I: IgE-mediated
  2. Type II: Antibody-mediated (Cytotoxic) 3. Type III: Immune complex-mediated
  3. Type IV: Cell-mediated
     Useful to differentiate into immediate vs non-immediate/delayed (from history) to guide investigation and management
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6
Q

What is the presentation of immediate type hypersensitivity
What is management

A
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7
Q

What is the presentation of delayed/non immediate type hypersensitivity
What is management

A
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8
Q

Indications for Immunology & Allergy evaluation

A

 No alternative drug available and consideration for desensitization
 Uncertain diagnosis or culprit drugs
Anticipated need for use of index or similar drugs in future & identify suitable alternatives (e.g. antibiotics / NSAIDs & aspirin)

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9
Q

Are most penicillin allergies true allergies
What is the cross reactivity with other B lactams

A
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10
Q

What is angioedema?

A

 Non-pitting transient subcutaneous or submucosal swelling
 Exclude airway obstruction, systemic involvement and anaphylaxis first (for acute management, see section on Anaphylaxis)
 Not all cases with angioedema are allergic reactions
 Differentiate into bradykinin or histamine-mediated (or others)

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11
Q

What is cause of histamine mediated angioedema
Clinical features
management

A
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12
Q

What is cause of bradykinin mediated angioedema
Clinical features
management

A
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13
Q

What is the JM foundation 10 warning signs of immunodeficiency in adults?

A
  1. > 2 ear infections in one year
  2. > 2 sinus infections in one year in the absence of allergies
  3. 1 pneumonia per year for more than one year
  4. Chronic diarrhoea with weight loss
  5. Repeat viral infections (colds, herpes, warts, condyloma)
  6. Recurrent need for intravenous antibiotics to clear infections 7. Recurrent, deep abscesses of the skin or internal organs
  7. Persistent thrush or fungal infection on skin or elsewhere
  8. Infection with normally harmless tuberculosis-like bacteria 10. Family history of a primary immunodeficiency
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14
Q

What is initial evluation in suspicion of immunodeficiency?

A

 Exclude common causes of secondary immunodeficiency (e.g.
diabetes mellitus, HIV infection, protein-losing states, chronic kidney disease, malignancies, chemotherapy or immunosuppression)
 Assess if disproportionately frequent or severe infections
 Assess if any unusual microorganisms or sites of infection
 Check immunization history and any adverse reactions
 Chart family tree and enquire about possible consanguinity
 Documentation of past infections and identification of phenotypes
 Consider Immunology & Allergy referral for workup and follow-up

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15
Q

What are 1st line screening tests for immunodeficiency?

A
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16
Q

What are 2nd line tests for susicion of immunodeficiency?

A
17
Q

What to be cautious of when working up a suspected immunodeficient patient?

A
18
Q

What are examples of combined immunodeficiences?
What clinical features?
What therapies?

A

e.g. Severe combined immunodeficiency, Hyper IgE syndrome, CD40L deficiency, Wiskott Aldrich syndrome, ataxia-telangiectasia
 Clinical features: Recurrent bacterial, viral and fungal infections, esp. opportunistic intracellular pathogens ±syndromic features
 Therapies: Prophylactic antimicrobials, Ig replacement, HSCT

19
Q

What are examples of antibody deficiencies?
What clinical features?
What therapies?

A

e.g. Agammaglobulinaemia, common variable immunodeficiency, B-cell depleting therapies, multiple myeloma, chronic lymphocytic leukaemia
 Clinical features: Recurrent/chronic sinopulmonary and GI infections, esp. encapsulated bacteria
 Therapies: Ig replacement, prophylactic antimicrobials

20
Q

What are examples of diseases of immune dysregulation?
What clinical features?
What therapies?

A

e.g. Autoimmune lymphoproliferative syndrome, haemophagocytic lymphohisocytosis, polyglandular autoimmune syndrome type 1
 Clinical features: Non-malignant lymphoadenopathy/splenomegaly,
autoimmunity, autoimmune cytopenias and haemophagocytosis
 Therapies: immunomodulation, HSCT

21
Q

What are examples of phagocytic defects?
What clinical features?
What therapies?

A

e.g. Chronic granulomatous disease, leukocyte adhesion deficiency,
Clinical features: Recurrent invasive skin and soft tissue infections/abscesses, esp. catalase-positive organisms and fungi
 Therapies: prophylactic antimicrobials, interferon-γ, G-CSF, HSCT

22
Q

What are examples of defects in intrinsic and innate immunity?
What clinical features?
What therapies?

A

e.g. Mendelian Susceptibility to mycobacterial disease, chronic mucocutaneous candidiasis, STAT1 Gain-of-Function defect
 Clinical features: Recurrent and severe mycobacterial, salmonella, viral/fungal infections, chronic mucocutaneous candidiasis
 Therapies: prophylactic antimicrobials, immunomodulation, HSCT

23
Q

What are examples of autoinflammatory disorders?
What clinical features?
What therapies?

A

e.g. Familial Mediterranean Fever, periodic fever syndromes
 Clinical features: Periodic/recurrent fevers and systemic inflammation (without infectious or autoimmune cause)
 Therapies: immunomodulation

24
Q

What are examples of complement deficiencies?
What clinical features?
What therapies?

A

e.g. early and terminal complement deficiencies, hereditary angioedema
 Clinical features: Recurrent pyogenic infections, disseminated Neisserial infections, recurrent angioedema without urticaria
 Therapies: vaccinations, prophylactic antibiotics, C1 esterase inhibitor replacement

MBBS VI - Medicine Summary (20 decks)

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