[P] Lec 04: Hypersensitivity

Question 1

• Adaptive response to antigens or allergens which occurs in an exaggerated or inappropriate manner causing tissue damage
• Heightened state of immune response

Answer 1

Hypersensitivity

Question 2

1. Type 1 Hypersensitivity
2. Type 2 Hypersensitivity
3. Type 3 Hypersensitivity
4. Type 4 Hypersensitivity

A. Immune complex
B. Cell mediated/delayed type
C. Immediate/Anaphylactic
D. Cytotoxic

Answer 2

CDAB

Question 3

Type 1 Hypersensitivity

Antibody:
Effector cell:

Answer 3

Antibody: IgE
Effector cell: Mast cell

Question 4

Type 1 Hypersensitivity

TOF. The end of the activation phase is when the IgE Ab produced adheres to mast cells.

Answer 4

F (end of sensitization)

Question 5

Type 1 Hypersensitivity

TOF. There is NO
HYPERSENSITIVITY REACTION during sensitization.

Answer 5

T

Question 6

Type 1 Hypersensitivity

What activity/event should happen for the activation phase to commence?

Answer 6

Re-exposure

Question 7

Type 1 Hypersensitivity

TOF. The mediators released by the
mast cell causes anaphylactoid,
which is IgE mediated.

Answer 7

F (anaphylaxis)

Anaphylactoid → Ag will directly activate the mast cell leading to degranulation (no IgE,
thus, no sensitization phase happens)

Question 8

Type 1 Hypersensitivity

Common Allergen (Ag): Drugs, serum, venom
Route of entry: I/V
Response: Edema, vasodilation, asthma, laryngeal edema, shock, death

A. Food allergy
B. Bronchial asthma
C. Wheal and flare
D. Allergic Rhinitis and hay fever
E. Systemic anaphylaxis

Answer 8

E

Question 9

Type 1 Hypersensitivity

Common Allergen (Ag): Insect bites, sensitivity testing
Route of entry: Subcutaneous
Response: Local
vasodilation and local edema

A. Food allergy
B. Bronchial asthma
C. Wheal and flare
D. Allergic Rhinitis and hay fever
E. Systemic anaphylaxis

Answer 9

C

Question 10

Type 1 Hypersensitivity

Common Allergen (Ag): Pollen (ragweed), dust, mites, feces
Route of entry: Inhaled
Response: Edema of the
nose, irritation of nasal mucosa

A. Food allergy
B. Bronchial asthma
C. Wheal and flare
D. Allergic Rhinitis and hay fever
E. Systemic anaphylaxis

Answer 10

D

Question 11

Type 1 Hypersensitivity

Common Allergen (Ag): Pollen dust, mites, and feces
Route of entry: Inhaled
Response: Bronchial
constriction, increased mucous and
airway inflammation

A. Food allergy
B. Bronchial asthma
C. Wheal and flare
D. Allergic Rhinitis and hay fever
E. Systemic anaphylaxis

Answer 11

B

Question 12

Type 1 Hypersensitivity

Common Allergen (Ag): Fish, milk, egg, wheat
Route of entry: Oral
Response: Vomiting and
diarrhea, pruritis (itching), urticaria (hives)

A. Food allergy
B. Bronchial asthma
C. Wheal and flare
D. Allergic Rhinitis and hay fever
E. Systemic anaphylaxis

Answer 12

A

Question 13

Type 1 Hypersensitivity

Matching type:
1. 1000x more potent, Cause erythema (flare) and wheal
formation (umbok)
2. Vasodilation, Smooth muscle contraction, Bronchoconstriction, Increase mucus secretion

A. Histamine
B. Leukotriene

Answer 13

BA

paaral nalang ng table sa primary and secondary, treatment modality and clinical

Question 14

Type 1 Hypersensitivity

Enumerate clinical manifestations

Answer 14

1. Hay fever
2. Atopic Dermatitis or Eczema
3. Insect Venom
4. Anaphylaxis to drugs
5. Food and Latex Allergies
6. Allergy to animal and animal products

Question 15

Type 1 Hypersensitivity

Enumerate in vivo screening tests

Answer 15

Skin Prick Test, Intradermal Test, Prausnitz – Kustner Reaction

Question 16

Type 1 Hypersensitivity

DIAGNOSTIC TESTS (IN VITRO)

Answer 16

1) RAST (Radioallergosorbent Test/Assay)
2) RIST (Radioimmunosorbent Test/Assay)

Question 17

Type 1 Hypersensitivity

• Negative control: NSS
• Positive control: Histamine
• Result: 15 – 20 minutes
  o (+) Wheal/Induration is >3mm
  o Presence or absence of Flare

Answer 17

Skin Prick Test also known as Percutaneous or
Puncture test

Question 18

Type 1 Hypersensitivity

• 0.01 to 0.05 mL of test solution
• Positive result is the same with SPT:
  After 15 – 20 minutes,
  o (+) Wheal/Induration is >3mm
  o Presence or absence of Flar

Answer 18

Intradermal Test

Question 19

Type 1 Hypersensitivity

• Passive Cutaneous Anaphylaxis
• Obsolete method/test
• Serum passing
• If the injected individual will have wheal formation after 48 hours, it is considered positive

Answer 19

Prausnitz – Kustner Reaction

Question 20

Type 1 Hypersensitivity

Matching type:

1. Used to detect/determine specific IgE that is directed to a specific allergen
2. Used to measure the Total IgE in the serum or blood of a px

A. RAST
B. RIST

Answer 20

AB

Question 21

TYPE II Hypersensitivity

Antibody involved:

Answer 21

IgG and IgM

Question 22

TYPE II Hypersensitivity

Enumerate the clinical states

Answer 22

1. Transfusion Reactions
2. Hemolytic Disease of the Newborn
3. Autoimmune and Drug Induced Hemolytic Anemia
4. Drug-induced thrombocytopenic purpura
5. Good Pasture Syndrome
6. Myasthenia Gravis

Question 23

TYPE II Hypersensitivity

TESTS FOR TYPE II

Answer 23

Coomb’s test

Question 24

TYPE II Hypersensitivity

• Used to determine IN VIVO sensitization
• To check if the red cells of the patient is sensitized inside the body
• It is sensitized because of hemolytic transfusion reaction or HDN if the mother is Rh negative and the baby is Rh positive.
• It can also happen if there is
  autoimmune and drug induced hemolytic anemia.
• In here, we need to collect a sample of red cells and add a AhG reagent.
• Positive result: agglutination or hemolysis

Answer 24

DIRECT ANTIGLOBULIN TEST

Question 25

# TYPE II Hypersensitivity * Used to test IN VITRO sensitization * The principle of crossmatching. * In crossmatching we need to check if the red cell from the donor is compatible to the patient. * Sample is the red cell from the donor and then the serum from the patient because the serum contains antibody that is possibly directed to the red cells of the donor that’s why cross matching is performed. * In major cross-match, sample is donor’s red cell and the patient’s serum. * Positive result: agglutination or hemolysis * Now if there is agglutination or hemolysis, this means that the blood of the donor is incompatible

Answer 25

INDIRECT ANTIGLOBULIN TEST

Question 26

# TYPE III Hypersensitivity Antibody Involved:

Answer 26

IgG and IgM

Question 27

# TYPE III Hypersensitivity CLINICAL STATES | enumerate

Answer 27

* SLE, RA * Post Streptococcal Glomerulonephritis * Polyarteritis nodosa * Serum Sickness * Arthus reaction

Question 28

# TYPE III Hypersensitivity TESTS FOR TYPE III

Answer 28

1. C1Q BINDING 2. RAJI CELL ASSAY

Question 29

# TYPE III Hypersensitivity * Based on radiolabeled assay * Serum of SLE Px + Radioactive C1q + PEG = Radioactivity

Answer 29

C1Q BINDING

Question 30

# TYPE III Hypersensitivity has receptors for the complement components such as C3 that are participating in CIC

Answer 30

RAJI Cell Assay

Question 31

# TYPE IV Hypersensitivity Antibodies:

Answer 31

None

Question 32

# TYPE IV Hypersensitivity * Reactions involves sensitized (???)and release of its (???) as mediators and amplifiers * Symptoms peak between (???) to (???) hours after exposure to antigen

Answer 32

* T cells... lymphokines * 48-72 hours

Question 33

# TYPE IV Hypersensitivity Antigens that can trigger Type IV hypersensitivity: 1. Mycobacterium tuberculosis, Mycobacterium leprae Pneumocystis carinii, Leishmania species, and herpes simplex virus 2. Plants such as poison ivy and poison oak; Metals such as nickel salts, and components of hair dyes and cosmetics A. Contact Antigen B. Extracellular pathogens C. Intracellular pathogens

Answer 33

CA

Question 34

# TYPE IV Hypersensitivity Clinical states

Answer 34

* Contact Dermatitis * GVHD * Transplant Rejection * TB * Leprosy * Poison Ivy

Question 35

# TYPE IV Hypersensitivity → Gold standard for contact dermatitis → After 48 hours, redness with papules or tiny blisters is considered a positive test

Answer 35

SKIN PATCH TEST

Question 36

# TYPE IV Hypersensitivity * Used to determine exposure to M. tuberculosis antigen * A screening test but not diagnostic for TB * injected and after 48 hours, check for induration or wheal formation

Answer 36

TUBERCULIN/ MANTOUX/ PPD (PURIFIED PROTEIN DERIVATIVE) TEST

Question 37

# PPD * HIV positive * Recent contact with an active TB patient * Nodular or fibrotic changes on chest X-ray * Organ transplant A. >15mm B.>10mm C. >5mm

Answer 37

C

Question 38

# PPD * Recent arrivals (< 5 yrs) from high-prevalence countries * IV drug users * Resident/employee of high-risk congregate settings * Mycobacteriology lab personnel * Comorbid conditions * Children < 4 yrs old * Infants, children, & adolescents exposed to high risk categories A. >15mm B.>10mm C. >5mm

Answer 38

B

Question 39

# PPD * Persons with no known risk factors for TB A. >15mm B.>10mm C. >5mm

Answer 39

A