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Immune System > Session 2 > Flashcards

Session 2 Flashcards

1
Q

What is allergy?

A

Is not a disease itself but a mechanism leading to disease

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2
Q

Define allergy?

A

Immunological hypersensitivity that can lead to a variety of different disease via different pathomechanisms with different approaches in diagnosis, therapy and prevention

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3
Q

Define allergen

A

Any substance stimulating the production of IgE or a cellular immune response. Usually a protein, but can be carbohydrates (much less common)

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4
Q

Define sensitivity

A

Normal response to a stimulus

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5
Q

Define hypersensitivity

A

Abnormally strong response to a stimulus

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6
Q

Define sensitisation

A

Production of IgE antibodies (detected by serum IgE assay) after repeated exposure to an allergen

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7
Q

Define allergy

A

A hypersensitivity reaction initiated by specific immunological mechanisms. This can be IgE mediated or non IgE mediated

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8
Q

Define atopy

A

A tendency to produce IgE antibodies in response to ordinary exposure to potential allergens.

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9
Q

What is atopy strongly associated with?

A

Asthma, rhinitis, eczema and food allergy

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10
Q

Define anaphylaxis

A

A serious allergic reaction with bronchial, laryngeal and cardiovascular involvement that is rapid in onset and can cause death

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11
Q

Define food

A

A substance whether processed, semi processed, or raw which is intended for human consumption.

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12
Q

Define food allergy

A

Immunologically mediated adverse reaction to food

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13
Q

Give some examples of major allergic disease

A

Rhinitis (hay fever), conjunctivitis, asthma, eczema, utritcaria, insect, drug or food

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14
Q

Are allergies common?

A

YES - nearly half of UK adults suffer from at least one allergy

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15
Q

Why is allergy associated with significant morbidity?

A

Persistent symptoms of hay fever impair sleep and reduce productivity.
Recurrent hospital admissions for asthma cause high absenteeism.
Restrictive diets in food allergy cause social exclusion and malnutrition.

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16
Q

Define food allergy

A

An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a food

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17
Q

Define food intolerance

A

Numerous (frequently reported) adverse responses to foods that do not involve an immune response

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18
Q

What is the different between a food allergy and a food intolerance?

A

Food allergy involves an immune response but an intolerance does not

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19
Q

What are the two main different groups of food reactions?

A
  • Non immune mediated (primary food intolerances)

- Immune mediated (allergy)

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20
Q

What are the causes of non-immune mediated food reaction?

A

Due to the

  • food characteristics or
  • Host characteristics
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21
Q

What are the two different types of immune mediated food reactions?

A

IgE mediated and non IgE mediated

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22
Q

What is the symptom onset of IgE mediated food allergy?

A

5 - 30 mins

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23
Q

What are the common foods that can cause an IgE mediated food allergy?

A

Milk, eggs
Peanuts and tree nuts
Fish and shellfish
Fruit and vegetables

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24
Q

What is the usual presenting age of IgE mediated food allergy?

A

Variable - age of contact
All milk allergy by 1 year
PFS in adolescence

25
Q

What is the prognosis of IgE mediated food allergy?

A

Milk and egg allergy can resolve, other persistent into adulthood

26
Q

What is the symptom onset of patients with non-IgE mediated food allergy?

A

Delayed - hours to days

27
Q

What are the common foods that are responsible for a non-IgE mediated food allergy?

A

Milk and soya, wheat, rice and oats

28
Q

What is the presenting age of someone with non IgE mediated immune response ?

A

Infancy and early childhood. All milk allergy by 1 year

29
Q

What is the prognosis of someone with non-IgE mediated food allergy?

A

Resolve earlier than IgE. Many by school age

30
Q

What are some of the symptoms of someone with an IgE mediated food allergy?

A

Skin - pruritus, acute urticaria, acute angiooedema
GI - colicky abdo pain, angiooedema of lips, oral pruritus, nausea, vomiting
Resp - blocker, runny nose, wheeze, cough
CVS - pallor, drowsy, hypotensive

31
Q

What are some of the symptoms of the non-IgE mediated food allergy?

A

The symptoms are more vague.

32
Q

What are some different presentations of immediate-onset food allergy?

A

Urticaria, angiooedema, anaphylaxis, food associated exercise induced anaphylaxis and pollen food syndrome

33
Q

What is food associated exercise induced anaphylaxis?

A

Food triggers anaphylaxis only if ingestion is followed temporally (within 2 hours) of exercise

34
Q

What is pollen food syndrome?

A

Pruritus and milk oedema confined to the oral cavity (lips, tongue, mouth and throat) uncommonly progressing. Associated with hay fever (raw fruit and veg)

35
Q

What are some different presentations of delayed onset food allergy?

A

Proctocolitis, enterocollitis, eosinophilia oesophagitis and good protein induced enterocolitis syndrome

36
Q

What are symptoms of protocolitis?

A

Passage of bright red blood in mucous stools in otherwise asymptomatic infants

37
Q

What are symptoms of enterocolitis?

A

Multiple and varying GI symptoms including feed refusal, persistent vomiting, abdominal cramps, loose and frequent stools and constipation

38
Q

What food allergy is enterocolitis associated with?

A

Milk, eggs and wheat

39
Q

What are the presentations of eosinophilia oesophagitis?

A

Reflux symptoms, vomiting, dysphagia and food impaction ( food get stuck when you swallow)

40
Q

What effect will heat have cows milk with regards to allergy?

A

Casein is more heat resistant than whey. It forms bonds in food matrix to reduce availability and allergenicity. Up to 70% milk allergic can tolerate baked milk

41
Q

How can you change the allergenicity of peanuts?

A

Increase if dry roasted and decreased if boiled/fried

42
Q

How can you reduce the allergenicity of egg whites?

A

Well cooked egg much less allergenic than raw egg

43
Q

How can you change the allergenicity of fish?

A

Fish protein is very heat stable but canned tuna and salmon are significantly less allergenic

44
Q

How can you change the allergenicity of an apple?

A

Apple proteins are exquisitely heat sensitive

45
Q

If you are allergic to milk, can you drink goats milk and if not why?

A

No - because the two animals are too similar hence they share a lot of similar proteins which means you are probably allergic to both

46
Q

What’s the food allergy march?

A

It describes different food allergy timing

47
Q

What is the process of food allergy diagnosis?

A

Medical history, physical examination, screening tests and then diagnosis verification

48
Q

What sort of questions would you ask in a medical history of someone with a food allergy?

A

Context of reaction
Presenting symptoms
Food considerations

49
Q

What screening test would you do for IgE mediated good allergy?

A

Skin prick tests and blood specific IgE

50
Q

What screening tests would you do for IgE and non IgE mediated food allergies?

A

Elimation diet

51
Q

How will you confirm the food allergy diagnosis?

A

Controlled oral food challenges

52
Q

What method is used for food allergy diagnosis?

A

Typical immunoassay for detection of specific IgE in 3 steps

53
Q

What are the 3 steps of typical immunoassay for detection of specific IgE?

A
  • Allergen is absorbed and immobilised to a solid phase
  • Patient’s serum is added followed by incubation for 30-60 mins followed by several washing steps
  • Allergen-bound IgE is detected by an enzymatically labelled anti-human IgE monoclonal antibody
54
Q

What techniques would you use for food sensitivity NOT allergy?

A

Detect IgE

  • Serum specific IgE
  • Skin prick tests
55
Q

How can you determine the likelihood of allergy by a skin prick test?

A

Size of skin prick test correlates with likelihood of allergy

56
Q

If someone comes in with a possible allergy - how are you more likely to get a true positive and true negative?

A

With an allergy focused clinical history and focused testing

57
Q

Is someone comes in with a possible allergy, how are you more likely to get a false positive?

A

Multiple testing without allergy-focused clinical history

58
Q

If the skin prick test weal size is less than or equal to 8mm, what does this indicate?

A

95% predictive value for allergy

Immune System (3 decks)

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