MSI Allergy

Question 1

Type 1 HS reaction (aka immediate reaction) involves ___- mediated release of antibodies against the soluble antigen. This results in MAST CELL DEGRANULATION and release of ________ and other inflammatory mediators.

Answer 1

IgE, histamine

Question 2

What type of hypersensitivity reaction causes allergic rhinitis, ocular allergic conjunctivitis, eczema, asthma, and anaphylaxis?

Answer 2

Type 1 hypersensitivity reaction (IgE mediated)

Question 3

Which type of allergic reaction has SYSTEMIC EFFECTS and is a life-threatening emergency?

Answer 3

Anaphylaxis- Type 1 HS reaction- IgE mediated

Question 4

Hygiene hypothesis: Early exposure to a diverse range of microorganisms and antigens may lead to overall ________ rates of allergies, asthma, and other immune disorders.

Answer 4

decreased

Question 5

Delayed mediators in the process of allergic reactions

Answer 5

Leukotrienes

Question 6

Leukotrienes are produced from arachidonic acid (via enzymes 5-Lipoxygenase and phospholipase A2) and have similar effects to…

Answer 6

histamine

Question 7

Mast cell activation converts membrane phospholipids into arachadonic acid via which enzyme?

Answer 7

phospholipase A2

Question 8

What substance, released from mast cells, stimulates bronchoconstriction, vascular permeability, eosinophil recruitment, and neutrophil recruitment?

Answer 8

Leukotrienes

Question 9

What substance, released from mast cells, plays a role in tissue remodeling, cellular recruitment, vascular permeability, and acute allergic disease?

Answer 9

proteases

Question 10

A clinical test for Type 1 (IgE) HS reactions to a variety of antigens injected or placed into small cuts in the skin produces what type of reaction?

Answer 10

“Wheal and flare”

Question 11

Activated T cell release of IL-5, IL-3, and GM-CSF promotes which type of allergic reaction? (Immediate or late?)

Answer 11

Late reaction- eosinophils migrate through the bloodstream to target tissue.

Question 12

Activated T cell release of IL-4 and IL-13 leads to which type of allergic reaction? (Immediate or late?)

Answer 12

Immediate- Membrane binding IgE activates B cells, which then activate mast cells. The activation of mast cells causes degranulation and the release of histamine and leukotrienes.

Question 13

People with ______ ________ are four times more likely to suffer from asthma, eczema, and food allergies

Answer 13

allergic rhinitis

Question 14

Biopsy of airways of patient with chronic asthma shows inflammatory infiltrate and airway changes known as __________ (thickened basement membrane and smooth muscle hyperplasia).

Answer 14

re-modelling

Question 15

Most patients with chronic asthma are sensitised to a variety of ________ allergens.

Answer 15

airborne

Question 16

Early phase of allergic reaction are based on the activation of _____ cells, which release mediators and cytokines

Answer 16

mast

Question 17

What type of cells take up allergen for processing and presentation to MHC class II molecules in the late phase allergic reaction?

Answer 17

neutrophils

Question 18

In the late phase allergic reaction, there is tissue redness and swelling d/t the arrival of cells to the area such as neutrophils, eosinophils, and lymphocytes (particularly ____ and ____ cells)

Answer 18

CD4 T cell, mast

Question 19

Late phase allergic reactions develop within _______ hours of exposure to the allergen

Answer 19

6-12

Question 20

CD4 subset ___

Cytokine: IFN-gamma, IL-12

Transcription factor: T-bet

Cytokines: IFN- gamma, lymphotoxin

Major functions: Anti-viral and mycobacterial effects, activation of macrophages to kill intracellular pathogens

Answer 20

Th1

Question 21

** CD4 subset ____ **

Cytokine: IL-4
Transcription factor: GATA-3
Cytokines: IL-4, IL-5, IL-13
Major functions: Antiparasitic responses. Stimulation of IgE and other Ab production, increases mucous production, promotes eosinophilia

Answer 21

Th2

Question 22

CD4 subset ____

Cytokine: IL-6, TGF-Beta1, IL-1 Beta
Transcription factor: ROR gamma t
Cytokines & mediators produced: IL-17A, IL-17F, IL-22
Major functions: Antibacterial and anti-fungal effects, recruitment and activation of PMNs

Answer 22

Th17

Question 23

CD4 subset ______

Cytokine: TGF-Beta 1, IL-10
Transcription factor: FOXp3
Cytokines: TGF-Beta 1, IL-10
Major functions: Suppression of T cell activation, inhibition of APC function

Answer 23

Treg

Question 24

___ cells are central players in immunity to helminths and are implicated in mediating the inflammatory pathology associated with allergies

Answer 24

Th2

Question 25

Biopsies of allergic inflammation are rich in T cells expressing ___ cytokines

Answer 25

Th2

Question 26

This Th2 mediator recruits mast cells

Answer 26

IL-9

Question 27

This Th2 mediator is required for eosinophil survival

Answer 27

IL-5

Question 28

These Th2 mediators promote mucus hypersecretion

Answer 28

IL-4 and IL-13

Question 29

This Th2 mediator is required for B cell class switching to IgE

Answer 29

IL-4

Question 30

The ___ hypothesis/model suggests a true role for T cells in chronic inflammation rather than just in causing IgE production- activated Th2 cells and other inflammatory cell accumulate, produce products that lead to disease

Answer 30

Th2

Question 31

The World Allergy Organisation estimates of allergy prevalence of the whole population by country ranges between __-__%

Answer 31

10-40%

Question 32

What is the most common chronic disease in Europe?

Answer 32

Allergies

Question 33

Up to __% of patients with allergies live with a severely debilitating form of their condition, and struggle daily with the fear of a possible asthma attack, anaphylactic shock, or even death from an allergic reaction

Answer 33

20

Question 34

__% of British adults now suffer from at least one allergy. Almost half of sufferers have more than one allergy.

Answer 34

44

Question 35

The % of children diagnosed with allergic _____ and ________ have both trebled over the last 30 years.

Answer 35

rhinitis, eczema

Question 36

Childhood allergy is strongly predicted by the presence of allergy in _________

Answer 36

parents

Question 37

Low hygiene levels, high pathogen load, helminth infection proposed to skew immunity from ___ to ___ and induce regulatory T cells

Answer 37

Th2 to Th1

Question 38

High hygiene levels, low pathogen load, and absence of helminth infection is proposed to skew immunity towards ___ cells and reduce production of regulatory T cells

Answer 38

Th2

Question 39

Detection of allergen-specific IgE can be tested in vivo by using what type of testing? What is a positive response?

Answer 39

Skin prick testing A wheal and flare response after 15 minutes is positive

Question 40

Laboratory diagnosis of allergies uses ________ testing- Detection of allergen-specific IgE in vitro (immobilised IgE Abs detected with polyclonal anti-IgE detection Ab).

Answer 40

ELISA NB: ELISA testing has replaced RAST testing

Question 41

Symptom relief in the treatment of allergies are nasal decongestants (act on alpha 1 adrenoreceptors to cause vasoconstriction), _________ (Beta 2 agonists promote smooth muscle relaxation), and epinephrine to oppose vasodilation and bronchoconstriction

Answer 41

salbutamol

Question 42

The two easiest and most helpful allergy drugs for early-phase mediators are antihistamines (H1 receptor) and ___________ receptor antagonists

Answer 42

Leukotriene

Question 43

First line medication to reduce the signs & sx of allergies is H1 antihistamines (MOA: _________ agonists at H1 histamine receptor). Best used before exposure to allergen.

Answer 43

inverse

Question 44

Hydroxyzine onset of action? ______ hours

Answer 44

20

Question 45

Leukotriene receptor antagonists (Montelukast) is effective in reducing early allergic responses, but inferior to H1 anti-histamines. Montelukast is beneficial in treating chronic ______ which is the main indication for its use.

Answer 45

asthma

Question 46

______ reduce immune activation by altering gene expression in numerous cell types, including T cells, B cells, and cells of the innate immune system. Their onset of action is delayed and they must be taken regularly.

Answer 46

Steroids

Question 47

Route of administration for beclametasone (for use in allergies)

Answer 47

Inhaled, nasal spray

Question 48

Route of administration for hydrocortisone (for use in allergies)

Answer 48

Topical - skin

Question 49

MOA of ___________: Binds to glucocorticoid receptor leading to downstream effects such as: Inhibition of phospholipase A2 Inhibition of Nuclear Factor-kappa B Inhibition of other inflammatory transcription factors Promotion of anti-inflammatory genes

Answer 49

hydrocortisone

Question 50

____________ is a recombinant, fully human IgG1 monoclonal Ab subcutaneously administered biological disease modifier which targets Tumour Necrosis Factor (TNF). Produced by recombinant DNA technology in a mammalian cell expression system and is purified by a process that includes specific viral inactivation and removal steps.

Answer 50

Adalimumab

Question 51

MOA of _____________ is primarily linked to the neutralization of TNF-alpha bioactivity by preventing the interaction of TNF alpha with the cell surface of TNF receptors. It inhibits several TNF-alpha induced events (eg the release of serum cytokines [IL-6], acute phase reactants of inflammation, matrix metalloproteases, and other markers of cartilage and synovium turnover, and the expression of adhesion molecules responsible for leukocyte migration. Also, it lyses TNF-expressing cells in the presence of complement.

Answer 51

Adalimumab

Question 52

Allergen-specific immunotherapy: Allergen doses administered subcut or sublingually Mainly used for venom allergy and rhinitis ``` Multiple immunological effects: Induce regulatory T cell responses to allergens Reduce ___ responses Induce allergen-specific IgG Abs Reduction in mast cell responsiveness Reduce allergen-specific IgE levels ```

Answer 52

Th2