Allergy and Immunologyy

What 5 foods cause 90% of foods causing atopic dermatitis?
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What 5 foods cause 90% of foods causing atopic dermatitis?
Milk
Egg
Soy
Wheat
Peanuts
What is the best first step in determining which foods could be triggering atopic dermatitis?
Food allergy testing, NOT random food elimination!
Exposure to THIS in infancy is a risk factor for asthma
High concentrations of dust mite allergen
Exposure to THIS in early childhood increases the risk for asthma, even without a family history
Tobacco smoke
Name the 4 horsemen of atopy?
Asthma
Allergic rhinitis
Eczema
Food allergy
Most important risk factor for a child developing atopy/allergic disease?
Parental history of atopy
1 parent with it: 50% risk
2 parents with it: 70% risk
Maternal diet does or does not play a role in subsequent development of atopy?
Does NOT
True or False: delaying exposure to fish, eggs, or peanut butter will help prevent allergies to these foods
FALSE!
This will be present in nasal secretions due to allergic rhinitis
Eosinophils - only this and NARES are diagnosed with a nasal smear
Define NARES
Non allergic rhinitis with eosinophilia syndrome
Both NARES and allergic rhinitis have eosinophils on nasal smear. How do you tell them apart?Nares: negative skin test and non elevated serum IgE Allergic rhinitis: positive skin test and elevated serum IgEKids with SCID usually present by this age?3 monthsWhat diagnosis would give you hypogammaglobulinemia and lymphopenia?SCIDWhat cell line(s) are affected in SCID?B and T cell linesBest treatment for complete digeorge syndromeThymidine transplantMost SCID inheritance is this type?X linked6 frequent presenting symptoms with SCIDAcute Ottis media Dermatitis Diarrhea FTT Thrush Life threatening infections4 face abnormalities with digeorgeLow ears Smooth philtrim Micrognathia HypertelorismDigeorge syndrome results from defects in which pharyngeal pouches?3rd and 4thProblems associated with deletions of chromosome 22?Cardiac Abnormal facies/atresia of esophagus Thymic hypoplasia/thyroid Cleft palate Hypocalcemia 22What immune alteration do you see with ataxia telangiectasia?Low IgA and IgMConsider THIS with a patient with recurrent bacterial infections, eczema, and petechiaeWiskott-Aldrich syndromeWhat immunodeficiency will cause no lymphoid tissue to develop?SCIDWhat immune cell dysfunction usually presents with recurrent Phoenicians infections?B cell disordersWhat cell type dysfunction usually presents with chronic or recurrent candida?T cell dysfunctionName the 2 primary in vitro allergy tests?RAST ELISAWhat's the most sensitive and cheapest allergy testing method?Skin testingAn IgE mediated allergy to penicillin will present withing how long?24 hours of administration Otherwise it is non IgE mediated Nd May simply be a viral ex anthemWhat allergy test is not affected by antihistamines?RASTWhat should you do if a 3-4 ,onto old gets urticaria after exposure to cows milk?Go to the allergistWhat should you do if a 3-4 month old child develops eczema after exposure to cows milk?Remove the offending agent (T cell mediated, not IgE)How long after a Hymenoptera sting do you need to wait before doing allergy testing4-6 weeksWhich type of allergy is IgE mediated?Type 1 hypersensitivity Worst comes first (anaphylaxis)Name 5 types of type 1 hypersensitivity reactions?Anaphylaxis UrticariaFood allergy Stings LatexHow are type 2 hypersensitivity reactions mediated?Antibody mediated (b is "2")Name the most common type of type 2 hypersensitivity reaction?Hemolytic anemiaWhat's the mechanism of hoe 3 sensitivity reactions?Immune complex (c is 3)Name a type of type 3 hypersensitivity reactionSerum sicknessWhat's the mechanism of oen4 hypersensitivity reactions?Delayed type (slowest is 4)Name one type 4 hypersensitivityPoison ivyHow effective is venom immunotherapy?98% effective at preventing future reactionsHow do you differentiate local Hymenoptera sting reaction from a surrounding cellulitis?Surrounding redness won't be tender with a sting, and the patient won't be febrile.What is the risk for future anaphylaxis if a patient has a significant local reaction to a sting?5-10%A child with a life threatening. Reaction to a bee sting should subsequently get THIS (aside from and Epi pen)Venom immunotherapyMost common cause of chronic urticaria?Food!Should patients with chronic urticaria get allergy testing?No!Allergy immunotherapy may take this long to produce symptom relief?2 years!At what weight do you graduate from 0.15mg Epi to 0.3mg?30kgHow far out can you experience late phase anaphylaxis symptoms?24 hoursVasodilation Vascular leak Smooth muscle spasm Are all parts of which phase of anaphylaxis?Initial responseMucosal edema Mucus secretion WBC infiltrates Epithelial damage Bronchodpasm Are all parts of which phase of anaphylaxisLate5 most common food allergies in PedsCows milk Eggs Peanuts Tree nuts Soy 6th is wheatWhich food allergies are usually outgrown by 5 years old?Wheat Milk Egg SoyAllergy to which 3 foods are usually not outgrown?Peanuts Tree nuts SeafoodWhat medication has peanut in it?Atrovent!Name the four types of rhinitisAllergic Infective Vasomotor Rhinitis medicomentosa (rebound)Top 4 causes of anaphylaxis in PedsFood Stings Vaccines MedicationsThe cutaneous manifestation of mastocytosis is urticaria pigmentosa. What does that look like?Red brown macules and a positive darier sign (urticaria on stroking)What is the mechanism behind contrast allergy?Osmolality/hypertonicity reaction triggering direct degranulation of mast cells and basophils. It is NOT IgE mediated!Is pretreatment against contrast allergy with Benadryl and/or steroids effective?Yes!What age group does transient hypogammaglobulinemia of infancy affect?6 months to 3-6 yearsWhat labs are low In Transient hypogammaglobulinemia of infancy?Low IgG and IgAName 6 humoral immune deficienciesBrutons disease CVID X linked hyper IgM syndrome Iga deficiency Job syndrome (hyper IgE) Transient hypogammaglobulinemia of infancyCGD usually presents before what age?5 yearsBest test for CGDNitroblue tetrazolium testWhat does the NBT test measure?Phagocytize oxidase activityWhat type of bacteria can't CGD pts kill?Catalase positive organismsCGD inheritance:2/3 x linked 1/3 a rThis disorder has delayed healing and doesn't make pusL A DThis disorder is most commonly associated with umbilical cord separation after 45 daysL A DTreatment for CGDAggressive antibiotic use3 innate immunodeficienciesCgd LAD Complement deficiencyTreatment for L A DBMT is curativeWorst two complement deficienciesC5 def and C9 def Recurrent or overwhelming meningococcemiaAll complement deficiencies are autosomal recessive except THISProperdin deficiency, which is x linked recessiveWhat immune test should you get if a person gets recurrent serious bacterial infectionsCH50What test(s) can be used to test for cell mediated immunity defects associated with t cell dysfunctionTB or candida skin testTest of choice for LADRoebuck skin windowThis test evaluates the humoral systemIg levelsThis defect usually presents with recurrent "less serious" infectionsB cell (humoral) defectsWhat should you order if you really suspect humoral defects but the IgG levels are normal?Specific immune antibodies (tetanus, rubella, pneumococcus)Which immune deficiency is associated with skeletal abnormalities and fracturesJob syndromeBest treatment for job syndrome (hyper IgE syndrome)Abx Steroids5 findings with job syndromeEosinophilia Eczema and skin infections Elevated IgE Sink pulmonary infections Coarse faciesMost humoral immunity defects present in what age range6 months to 1 yearIn what immunodeficiency is the treatment immunoglobulin replacement?Hyper IgM syndromePatients with THIS are exceptionally susceptible to coldsIga deficiency But it is usually asymptomatic!What test do you do for SCID?Fluorometric analysis of b t and nk cellsTreatment for SCIDSupportive early on, then bmtWhat do you worry about if a kid with SCID gets varicella?PoliomyelitisWhat us the cellular defect in Wiskott-Aldrich syndrome?Actin filament assembly problemWhat ig is low in Wiskott-Aldrich syndrome?IgMWhat is the inheritance pattern of Wiskott-Aldrich syndrome?X linkedThis immune disorder has a tendency to develop hematologist malignancies and autoimmune diseases?Wiskott-Aldrich syndrome.2 treatment options for WAS?BMT or cord blood transplant Monthly ivigName 4 disorders of cellular immunitySCID WAS A.T. Digeorge syndromeWhat is the mechanism of the disorder with hyper IgM syndrome?Absent CD-40 ligand in T cells disrupts B cell differentiationWhat diagnosis should you consider if a patient gets recurrent: Otitis Sinopulmonary infections PCP PNA diarrhea Opportunistic infectionsHyper IgM syndromeThese two immune disorders increase the risk of malignancy if you get ebv infectionWAS CVIDPatients with these two disorders need to get icing regularly to prevent recurrent bacterial infectionsCVID Brutons diseaseWhat's the most common primary immunodeficiencyCVIDWhat's the mechanism of CVID?Defective antibody response (B cells don't become plasma cells so they don't make the right amount of immunoglobulins - there is some but not enough)Rheumatoid arthritis Cytopenias Thyroid disease These are associated with this immunodeficiency?CVIDWhat's the diagnostic test for Brutons?IgG levels first If all levels are low, get B and T cell subsetsThis x linked disease makes you more likely to die if infected with EBVDuncan's disease Primary infection is 80% fatalMechanism of disease with Duncan's diseaseUncontrolled proliferation of T cells during infectionMost common presentation of Brutons disease?Recurrent infections with encapsulated organisms (pseudomonas, strep pneumoniae, h flu)What age do most Brutons patients present at?Less than 1 year but after 6 months.What is the gene associated with Brutons?BLK gene X linked