Podcast
Questions and Answers
Which of the following is the MOST accurate definition of atopy?
Which of the following is the MOST accurate definition of atopy?
- A non-specific inflammatory reaction to irritants.
- Acquired resistance to common allergens after repeated exposure.
- An acute immune response to a specific allergen.
- An inherited predisposition to produce IgE antibodies in response to common environmental allergens. (correct)
Which of the following is the MOST common characteristic of atopic allergens that promotes priming of T helper cells?
Which of the following is the MOST common characteristic of atopic allergens that promotes priming of T helper cells?
- Protein structure (correct)
- Carbohydrate content
- Nucleic acid sequence
- Lipid composition
Allergic rhinitis, a common atopic condition, is characterized by inflammation of the nasal passages. What is the typical prevalence of allergic rhinitis in the North American population?
Allergic rhinitis, a common atopic condition, is characterized by inflammation of the nasal passages. What is the typical prevalence of allergic rhinitis in the North American population?
- 50-75%
- Less than 1%
- 10-30% (correct)
- 1-5%
A patient presents with symptoms suggestive of atopy, but their serum IgE levels are within the normal range. Why might serum IgE not be a reliable measure of atopy?
A patient presents with symptoms suggestive of atopy, but their serum IgE levels are within the normal range. Why might serum IgE not be a reliable measure of atopy?
If both parents have atopy, what is the approximate probability that their child will also develop atopy?
If both parents have atopy, what is the approximate probability that their child will also develop atopy?
What is the PRIMARY role of pharmacists in managing atopic diseases?
What is the PRIMARY role of pharmacists in managing atopic diseases?
Which of the following is the MOST likely mechanism for the development of atopy?
Which of the following is the MOST likely mechanism for the development of atopy?
What is the typical molecular weight range for atopic allergens?
What is the typical molecular weight range for atopic allergens?
A patient reports experiencing seasonal allergy symptoms, primarily affecting their respiratory system. Which of the following is the MOST likely category of allergen?
A patient reports experiencing seasonal allergy symptoms, primarily affecting their respiratory system. Which of the following is the MOST likely category of allergen?
Which of the following describes Allergic Gastroenteropathy?
Which of the following describes Allergic Gastroenteropathy?
Unlike atopic allergy, non-atopic IgE-mediated allergy is typically characterized by which of the following?
Unlike atopic allergy, non-atopic IgE-mediated allergy is typically characterized by which of the following?
Which of the following is a COMMON example of a non-atopic allergen that might lead to an IgE-mediated allergic reaction?
Which of the following is a COMMON example of a non-atopic allergen that might lead to an IgE-mediated allergic reaction?
During anaphylaxis, what physiological event contributes MOST significantly to the rapid decrease in blood pressure?
During anaphylaxis, what physiological event contributes MOST significantly to the rapid decrease in blood pressure?
Which of the following BEST describes the timing of the early phase of an IgE-mediated allergic reaction?
Which of the following BEST describes the timing of the early phase of an IgE-mediated allergic reaction?
Which of the following mediators is PRIMARILY associated with the early phase of mast cell activation?
Which of the following mediators is PRIMARILY associated with the early phase of mast cell activation?
Which of the following is an expected response seen in the respiratory tract as a result of mast cell degranulation?
Which of the following is an expected response seen in the respiratory tract as a result of mast cell degranulation?
Which of the following best describes the physiological process behind anaphylactoid reactions?
Which of the following best describes the physiological process behind anaphylactoid reactions?
Immune complex diseases like Serum Sickness are examples of which type of hypersensitivity reaction?
Immune complex diseases like Serum Sickness are examples of which type of hypersensitivity reaction?
What is a key characteristic of the antigens involved in Type III hypersensitivity reactions?
What is a key characteristic of the antigens involved in Type III hypersensitivity reactions?
In Type III hypersensitivity, the size and pathogenicity of immune complexes depends on the
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In Type III hypersensitivity, the size and pathogenicity of immune complexes depends on the $
What outcome is expected with an overabundance of anaphylatoxins?
What outcome is expected with an overabundance of anaphylatoxins?
Which situation is MOST indicative of Arthus reaction?
Which situation is MOST indicative of Arthus reaction?
A patient who received equine antisera for treatment of a snake bite develops fever, joint pain, and skin rash approximately one week later. What condition is MOST likely affecting this patient?
A patient who received equine antisera for treatment of a snake bite develops fever, joint pain, and skin rash approximately one week later. What condition is MOST likely affecting this patient?
In serum sickness, immune complexes deposit in various tissues, leading to inflammation. Which of the following is a COMMON site of immune complex deposition in serum sickness?
In serum sickness, immune complexes deposit in various tissues, leading to inflammation. Which of the following is a COMMON site of immune complex deposition in serum sickness?
A farmer develops chronic respiratory symptoms, including cough and shortness of breath, after years of working in a dusty barn. Testing reveals the presence of IgG antibodies against fungal spores. What condition is the MOST likely cause of these symptoms?
A farmer develops chronic respiratory symptoms, including cough and shortness of breath, after years of working in a dusty barn. Testing reveals the presence of IgG antibodies against fungal spores. What condition is the MOST likely cause of these symptoms?
Which type of hypersensitivity reaction is MOST closely associated with allergic contact dermatitis?
Which type of hypersensitivity reaction is MOST closely associated with allergic contact dermatitis?
What characteristic feature defines the allergens involved in allergic contact dermatitis?
What characteristic feature defines the allergens involved in allergic contact dermatitis?
Following exposure to poison ivy, a patient develops a localized skin rash characterized by erythema, vesicles, and intense itching. Which cells are PRIMARILY responsible for mediating this reaction?
Following exposure to poison ivy, a patient develops a localized skin rash characterized by erythema, vesicles, and intense itching. Which cells are PRIMARILY responsible for mediating this reaction?
In the context of drug allergies, what is a hapten?
In the context of drug allergies, what is a hapten?
How does the route of drug administration typically affect the likelihood and severity of allergic reactions?
How does the route of drug administration typically affect the likelihood and severity of allergic reactions?
Which of the following is MOST important when diagnosing a possible drug allergy?
Which of the following is MOST important when diagnosing a possible drug allergy?
A patient with a confirmed penicillin allergy needs treatment for a bacterial infection. What should you consider?
A patient with a confirmed penicillin allergy needs treatment for a bacterial infection. What should you consider?
Penicillin allergy is PRIMARILY mediated by?
Penicillin allergy is PRIMARILY mediated by?
A diagnostic test is available for Penicillin allergy, the agent responsible is?
A diagnostic test is available for Penicillin allergy, the agent responsible is?
Compared to animal-derived insulin, human insulin has a lower?
Compared to animal-derived insulin, human insulin has a lower?
What is a PRIMARY difference between continuous and intermittent insulin administration?
What is a PRIMARY difference between continuous and intermittent insulin administration?
A patient experiences urticaria and angioedema shortly after receiving radiocontrast media during a CT scan. Which type of reaction is MOST likely occurring?
A patient experiences urticaria and angioedema shortly after receiving radiocontrast media during a CT scan. Which type of reaction is MOST likely occurring?
Toxic Epidermal Necrolysis (TEN) is believed to be caused by?
Toxic Epidermal Necrolysis (TEN) is believed to be caused by?
A researcher is investigating the T cell response in atopic individuals. Which T cell imbalance is MOST likely to be observed in these patients compared to non-atopic individuals?
A researcher is investigating the T cell response in atopic individuals. Which T cell imbalance is MOST likely to be observed in these patients compared to non-atopic individuals?
An infant is exposed to a common environmental allergen. What factor would MOST significantly increase the likelihood of developing atopy?
An infant is exposed to a common environmental allergen. What factor would MOST significantly increase the likelihood of developing atopy?
A biotechnology company is developing a novel therapeutic protein. What characteristic of this protein is MOST likely to increase its potential to act as an atopic allergen?
A biotechnology company is developing a novel therapeutic protein. What characteristic of this protein is MOST likely to increase its potential to act as an atopic allergen?
A patient with allergic rhinitis is undergoing allergy testing. What allergen is MOST likely to be identified as a trigger for their symptoms?
A patient with allergic rhinitis is undergoing allergy testing. What allergen is MOST likely to be identified as a trigger for their symptoms?
A patient presents with suspected atopic dermatitis. What additional symptom would MOST strongly suggest this diagnosis is part of a broader atopic syndrome?
A patient presents with suspected atopic dermatitis. What additional symptom would MOST strongly suggest this diagnosis is part of a broader atopic syndrome?
A researcher is comparing extrinsic and intrinsic asthma. Which characteristic is MOST indicative of extrinsic asthma?
A researcher is comparing extrinsic and intrinsic asthma. Which characteristic is MOST indicative of extrinsic asthma?
Following exposure to an allergen, a patient experiences an immediate reaction characterized by histamine release. What phase of the IgE-mediated allergic reaction is the patient experiencing?
Following exposure to an allergen, a patient experiences an immediate reaction characterized by histamine release. What phase of the IgE-mediated allergic reaction is the patient experiencing?
A patient is experiencing a late-phase allergic reaction. What mediators are MOST likely contributing to the prolonged inflammation?
A patient is experiencing a late-phase allergic reaction. What mediators are MOST likely contributing to the prolonged inflammation?
During mast cell degranulation, what is the MAIN role of histamine?
During mast cell degranulation, what is the MAIN role of histamine?
Which mechanism is MOST characteristic of anaphylactoid reactions?
Which mechanism is MOST characteristic of anaphylactoid reactions?
A patient with a known bee sting allergy is stung. What physiological response is MOST directly responsible for the rapid development of hypotension?
A patient with a known bee sting allergy is stung. What physiological response is MOST directly responsible for the rapid development of hypotension?
What is the typical time course for resolution of the late phase of an IgE-mediated allergic reaction, assuming no further allergen exposure?
What is the typical time course for resolution of the late phase of an IgE-mediated allergic reaction, assuming no further allergen exposure?
A researcher is conducting a study on non-atopic allergies. What route of exposure to an allergen is MOST likely to result in a systemic allergic reaction?
A researcher is conducting a study on non-atopic allergies. What route of exposure to an allergen is MOST likely to result in a systemic allergic reaction?
A patient develops urticaria and angioedema. What exposure is MOST suggestive of a non-atopic IgE-mediated allergic reaction?
A patient develops urticaria and angioedema. What exposure is MOST suggestive of a non-atopic IgE-mediated allergic reaction?
A patient has a known allergy to bee stings and carries an epinephrine auto-injector. By what mechanism does epinephrine counteract the effects of anaphylaxis MAINLY?
A patient has a known allergy to bee stings and carries an epinephrine auto-injector. By what mechanism does epinephrine counteract the effects of anaphylaxis MAINLY?
A biochemist is studying haptens. Which of the following BEST describes a hapten's role in an allergic reaction?
A biochemist is studying haptens. Which of the following BEST describes a hapten's role in an allergic reaction?
A researcher is investigating Type III hypersensitivity reactions. What is a KEY requirement for the antigens involved in these reactions?
A researcher is investigating Type III hypersensitivity reactions. What is a KEY requirement for the antigens involved in these reactions?
What immunological outcome results from an overabundance of anaphylatoxins during a Type III hypersensitivity reaction?
What immunological outcome results from an overabundance of anaphylatoxins during a Type III hypersensitivity reaction?
A clinician suspects a patient is experiencing an Arthus reaction. What scenario is MOST indicative of such a reaction?
A clinician suspects a patient is experiencing an Arthus reaction. What scenario is MOST indicative of such a reaction?
A patient presents with fever, joint pain, and skin rash one week after receiving equine-derived antitoxin. Activation of what processes is MOST likely causing these symptoms?
A patient presents with fever, joint pain, and skin rash one week after receiving equine-derived antitoxin. Activation of what processes is MOST likely causing these symptoms?
A patient's blood tests reveal lung damage. What is the MOST likely cause of this damage in the context of farmer's lung?
A patient's blood tests reveal lung damage. What is the MOST likely cause of this damage in the context of farmer's lung?
Nickel allergy MOST commonly manifests as?
Nickel allergy MOST commonly manifests as?
What step is REQUIRED for allergic contact dermatitis to occur?
What step is REQUIRED for allergic contact dermatitis to occur?
A patient developed a rash consisting of erythema, vesicles, and intense itching after using a new laundry detergent. What mediators are MOST directly responsible for the symptoms observed in this type of hypersensitivity reaction?
A patient developed a rash consisting of erythema, vesicles, and intense itching after using a new laundry detergent. What mediators are MOST directly responsible for the symptoms observed in this type of hypersensitivity reaction?
If a patient has a confirmed penicillin allergy, what change in management is MOST appropriate?
If a patient has a confirmed penicillin allergy, what change in management is MOST appropriate?
What are features that are MOST indicative of penicillin allergy?
What are features that are MOST indicative of penicillin allergy?
What is tested when administering penicilloyl polylysine?
What is tested when administering penicilloyl polylysine?
With regards to an allergic immune response; compare animal-derived insulin to human insulin:
With regards to an allergic immune response; compare animal-derived insulin to human insulin:
What is the most distinguishing factor between Continous vs. Intermittent insulin administration?
What is the most distinguishing factor between Continous vs. Intermittent insulin administration?
A patient experiences urticaria and angioedema shortly after receiving radiocontrast media during a CT scan. Which immunological mechanism is MOST likely?
A patient experiences urticaria and angioedema shortly after receiving radiocontrast media during a CT scan. Which immunological mechanism is MOST likely?
What is a primary contributor to Toxic Epidermal Necrolysis (TEN)?
What is a primary contributor to Toxic Epidermal Necrolysis (TEN)?
What is the molecular weight range for MOST typical atopic allergens?
What is the molecular weight range for MOST typical atopic allergens?
What class of allergens are responsible for seasonal allergies affecting the respiratory system?
What class of allergens are responsible for seasonal allergies affecting the respiratory system?
What is the difference between extrinsic and intrinsic atopic allergy?
What is the difference between extrinsic and intrinsic atopic allergy?
How does age correlate with atopic allergy?
How does age correlate with atopic allergy?
The symptoms of Type III hypersensitivity are a result of:
The symptoms of Type III hypersensitivity are a result of:
What is a key characteristic of atopy?
What is a key characteristic of atopy?
Which of the following is a function of allergens?
Which of the following is a function of allergens?
What class is penicillin allergy typically?
What class is penicillin allergy typically?
What causes an "Arthus Reaction"?
What causes an "Arthus Reaction"?
Which route of administration for a compound gives the MOST reactions?
Which route of administration for a compound gives the MOST reactions?
A patient exhibits symptoms that appear to be allergy-related, but it is determined that their condition is not IgE-mediated. Which of the following conditions is the MOST likely alternative explanation?
A patient exhibits symptoms that appear to be allergy-related, but it is determined that their condition is not IgE-mediated. Which of the following conditions is the MOST likely alternative explanation?
During sensitization to an atopic allergen, what event is CRUCIAL for initiating the allergic cascade?
During sensitization to an atopic allergen, what event is CRUCIAL for initiating the allergic cascade?
A patient with extrinsic asthma experiences bronchoconstriction following exposure to pollen. What event is the PRIMARY mechanism for this?
A patient with extrinsic asthma experiences bronchoconstriction following exposure to pollen. What event is the PRIMARY mechanism for this?
Why are inhaled allergens typically linked to atopic diseases?
Why are inhaled allergens typically linked to atopic diseases?
What immunological imbalance is the PRIMARY contributing factor to the development of atopy?
What immunological imbalance is the PRIMARY contributing factor to the development of atopy?
A child with atopic dermatitis also has allergic rhinitis and asthma. How can this constellation of symptoms be BEST described?
A child with atopic dermatitis also has allergic rhinitis and asthma. How can this constellation of symptoms be BEST described?
A patient with allergic rhinitis is exposed to a known allergen. What mediator is the MOST DIRECT cause of increased vascular permeability, leading to nasal congestion?
A patient with allergic rhinitis is exposed to a known allergen. What mediator is the MOST DIRECT cause of increased vascular permeability, leading to nasal congestion?
A patient has a history of food allergies and experiences a rapid onset of throat swelling and difficulty breathing after ingesting peanuts. What is the MOST appropriate immediate treatment goal?
A patient has a history of food allergies and experiences a rapid onset of throat swelling and difficulty breathing after ingesting peanuts. What is the MOST appropriate immediate treatment goal?
If a patient has a known penicillin allergy, what is the MOST appropriate approach when prescribing antibacterial therapy?
If a patient has a known penicillin allergy, what is the MOST appropriate approach when prescribing antibacterial therapy?
During diagnostic testing for penicillin allergy, penicilloyl polylysine is administered to assess what type of reaction?
During diagnostic testing for penicillin allergy, penicilloyl polylysine is administered to assess what type of reaction?
What is the key difference between continuous and intermittent insulin administration schedules in terms of allergic immune response?
What is the key difference between continuous and intermittent insulin administration schedules in terms of allergic immune response?
What is the underlying immunological event in Toxic Epidermal Necrolysis (TEN)?
What is the underlying immunological event in Toxic Epidermal Necrolysis (TEN)?
How can the route of drug administration affect the likelihood and severity of an allergic reaction?
How can the route of drug administration affect the likelihood and severity of an allergic reaction?
What is a PRIMARY requirement for the antigens involved in Type III hypersensitivity reactions?
What is a PRIMARY requirement for the antigens involved in Type III hypersensitivity reactions?
Allergic contact dermatitis is PRIMARILY mediated by which type of hypersensitivity reaction?
Allergic contact dermatitis is PRIMARILY mediated by which type of hypersensitivity reaction?
Which of the following is the MOST accurate statement regarding serum IgE levels in atopy?
Which of the following is the MOST accurate statement regarding serum IgE levels in atopy?
What is the PRIMARY characteristic of inhaled allergens that facilitates the priming of T helper 2 (Th2) cells?
What is the PRIMARY characteristic of inhaled allergens that facilitates the priming of T helper 2 (Th2) cells?
What is the typical prevalence of allergic rhinitis, a common atopic condition, in the North American population?
What is the typical prevalence of allergic rhinitis, a common atopic condition, in the North American population?
If one parent has atopy, what is the approximate probability that their child will also develop atopy?
If one parent has atopy, what is the approximate probability that their child will also develop atopy?
What is a KEY role of pharmacists in the care of atopic diseases?
What is a KEY role of pharmacists in the care of atopic diseases?
Which of the following mechanisms is MOST associated with the development of atopy?
Which of the following mechanisms is MOST associated with the development of atopy?
What is the typical molecular weight range observed for most atopic allergens?
What is the typical molecular weight range observed for most atopic allergens?
A patient reports year round allergy symptoms. Which of the following categories of allergen is MOST likely?
A patient reports year round allergy symptoms. Which of the following categories of allergen is MOST likely?
Which of the following is the MOST accurate description of non-atopic IgE-mediated allergy compared to atopic allergy?
Which of the following is the MOST accurate description of non-atopic IgE-mediated allergy compared to atopic allergy?
During anaphylaxis, the physiological event that contributes MOST significantly to the rapid decrease in blood pressure is
During anaphylaxis, the physiological event that contributes MOST significantly to the rapid decrease in blood pressure is
What is the role of histamine during mast cell degranulation?
What is the role of histamine during mast cell degranulation?
Unlike typical IgE-mediated allergic reactions, anaphylactoid reactions are primarily characterized by:
Unlike typical IgE-mediated allergic reactions, anaphylactoid reactions are primarily characterized by:
What is the role of environmental factors in the development of atopic allergy?
What is the role of environmental factors in the development of atopic allergy?
During mast cell degranulation caused by IgE-mediated allergic reactions, which of the following mediators is associated with the acute phase?
During mast cell degranulation caused by IgE-mediated allergic reactions, which of the following mediators is associated with the acute phase?
Which route of drug administration is MOST likely to induce an allergic reaction?
Which route of drug administration is MOST likely to induce an allergic reaction?
Which mediator is associated with the late phase of mast cell activation?
Which mediator is associated with the late phase of mast cell activation?
What type of hypersensitivity is mediated by small lipid molecules?
What type of hypersensitivity is mediated by small lipid molecules?
Why is continuous administration of insulin better than intermittent?
Why is continuous administration of insulin better than intermittent?
What hypersensitivity is tested by a Pre-Pen test?
What hypersensitivity is tested by a Pre-Pen test?
A patient who is taking a medication develops a fever, malaise, and a severe maculopapular rash on their face, arms, and trunk. The skin begins to slough off causing respiratory issues. What condition is MOST likely affecting this patient?
A patient who is taking a medication develops a fever, malaise, and a severe maculopapular rash on their face, arms, and trunk. The skin begins to slough off causing respiratory issues. What condition is MOST likely affecting this patient?
Allergic Rhinitis is which type of atopic reaction?
Allergic Rhinitis is which type of atopic reaction?
What feature is unique to Allergic Contact Dermatitis?
What feature is unique to Allergic Contact Dermatitis?
What is a sign of arthus reaction?
What is a sign of arthus reaction?
Serum sickness can be caused by?
Serum sickness can be caused by?
What type of cells are present in the early and late phases of inflammatory cells response?
What type of cells are present in the early and late phases of inflammatory cells response?
T cell regulation of IgE response is known as?
T cell regulation of IgE response is known as?
Dust mite allergens can be:
Dust mite allergens can be:
Hay fever and allergic asthma will fall under what category of atopic diseases:
Hay fever and allergic asthma will fall under what category of atopic diseases:
What are the products of mast cell degranulation?
What are the products of mast cell degranulation?
The skin condition called (Stevens Johnson Syndrome) is classified as:
The skin condition called (Stevens Johnson Syndrome) is classified as:
The early immune response can be:
The early immune response can be:
Allergies of the lungs or Allergic Bronchopulmonary Aspergillosis may include which allergy?
Allergies of the lungs or Allergic Bronchopulmonary Aspergillosis may include which allergy?
Which of the Coombs and Gell classifications are associated with drug allergy?
Which of the Coombs and Gell classifications are associated with drug allergy?
Non Atopic IgE mediated allergy is:
Non Atopic IgE mediated allergy is:
Extrinsic Allergic Aveolitis is from:
Extrinsic Allergic Aveolitis is from:
How are non-atopic IgE-mediated disease allergens usually delivered?
How are non-atopic IgE-mediated disease allergens usually delivered?
Which of the following best characterizes anaphylactoid reactions?
Which of the following best characterizes anaphylactoid reactions?
What is the mechanism of drug allergy?
What is the mechanism of drug allergy?
What is the primary cause of Toxic Epidermal Necrolysis (TEN)
What is the primary cause of Toxic Epidermal Necrolysis (TEN)
Anaphylactic shock most often occurs from what exposures?
Anaphylactic shock most often occurs from what exposures?
An individual with allergic rhinitis and asthma is said to have increased susceptibility to what type of environmental exposures?
An individual with allergic rhinitis and asthma is said to have increased susceptibility to what type of environmental exposures?
How does serum IgE level correlate with atopy?
How does serum IgE level correlate with atopy?
What best describes the role of a pharmacist in atopic diseases?
What best describes the role of a pharmacist in atopic diseases?
What is the primary immunological imbalance in the development of atopy?
What is the primary immunological imbalance in the development of atopy?
What range defines the typical molecular weight of atopic allergens?
What range defines the typical molecular weight of atopic allergens?
Seasonal allergies affecting the respiratory system is from what class of allergen?
Seasonal allergies affecting the respiratory system is from what class of allergen?
What kind of allergen is dust mites considered?
What kind of allergen is dust mites considered?
What is the importance of effector cells in the Adaptive Immune Response against helminth worms?
What is the importance of effector cells in the Adaptive Immune Response against helminth worms?
What is a known cause for atopic allergy?
What is a known cause for atopic allergy?
What is the role of dust mites in the dust allergen group?
What is the role of dust mites in the dust allergen group?
What are common causes of non-atopic IgE-mediated diseases?
What are common causes of non-atopic IgE-mediated diseases?
Non-atopic IgE-mediated allergy contrasts with atopic allergy of:
Non-atopic IgE-mediated allergy contrasts with atopic allergy of:
What best characterizes anaphylactoid reactions?
What best characterizes anaphylactoid reactions?
What is the timing for the early phase of an IgE-mediated allergic reaction?
What is the timing for the early phase of an IgE-mediated allergic reaction?
IgE-mediated allergy consists of an early phase and a late phase, which product or phase occurs later in the process?
IgE-mediated allergy consists of an early phase and a late phase, which product or phase occurs later in the process?
During anaphylaxis, which symptom is associated with it?
During anaphylaxis, which symptom is associated with it?
What does mast cell activation cause?
What does mast cell activation cause?
What is the primary function of antihistamines in patients with allergic rhinitis?
What is the primary function of antihistamines in patients with allergic rhinitis?
In Type III hypersensitivity, what occurs more with a mild case?
In Type III hypersensitivity, what occurs more with a mild case?
During Type III hypersensitivity, what is a requirement for the Antigen complex to complete?
During Type III hypersensitivity, what is a requirement for the Antigen complex to complete?
What is the primary result of complement activation during Type III hypersensitivity?
What is the primary result of complement activation during Type III hypersensitivity?
What follows the administration of protein to a highly immune individual?
What follows the administration of protein to a highly immune individual?
In the context of Type IV hypersensitivity, what best describes the function of effector T cells?
In the context of Type IV hypersensitivity, what best describes the function of effector T cells?
Cell-mediated allergy has an emphasis on
Cell-mediated allergy has an emphasis on
What is a key characteristic of allergens in allergic contact dermatitis?
What is a key characteristic of allergens in allergic contact dermatitis?
What is the relationship between Type III and Type IV reactions?
What is the relationship between Type III and Type IV reactions?
What can an immune response to a drug cause?
What can an immune response to a drug cause?
What are the components of a drug allergy?
What are the components of a drug allergy?
What drug administration route has the greatest incidence and severity?
What drug administration route has the greatest incidence and severity?
In the management of drug allergy, what information is needed for diagnosis?
In the management of drug allergy, what information is needed for diagnosis?
What is most likely to test positive on a penicillin allergy test?
What is most likely to test positive on a penicillin allergy test?
What is the most common type of reaction in Penicillin Allergy?
What is the most common type of reaction in Penicillin Allergy?
What would a Penicilloyl Polylysine [Pre-Pen®] determine?
What would a Penicilloyl Polylysine [Pre-Pen®] determine?
Why is continuous administration better that intermittent in insulin administration?
Why is continuous administration better that intermittent in insulin administration?
Anphylactoid reactions have common examples of:
Anphylactoid reactions have common examples of:
Which of the products would have an increase in allergenicity, compared to Human?
Which of the products would have an increase in allergenicity, compared to Human?
What are symptoms of Toxic Epidermal Necrolysis?
What are symptoms of Toxic Epidermal Necrolysis?
In the development of atopy, what is the significance of the balance between T helper 1 (Th1), T helper 2 (Th2), and T regulatory (Treg) cells?
In the development of atopy, what is the significance of the balance between T helper 1 (Th1), T helper 2 (Th2), and T regulatory (Treg) cells?
Why are airborne allergens more commonly associated with atopic diseases?
Why are airborne allergens more commonly associated with atopic diseases?
What role does the age of initial allergen exposure play in the development of atopic allergy?
What role does the age of initial allergen exposure play in the development of atopic allergy?
What is a key distinction between extrinsic and intrinsic asthma in the context of atopy?
What is a key distinction between extrinsic and intrinsic asthma in the context of atopy?
What role do dust mites play in atopic allergy?
What role do dust mites play in atopic allergy?
In the context of IgE-mediated allergic reactions, how do the mediators released during the early phase differ from those in the late phase?
In the context of IgE-mediated allergic reactions, how do the mediators released during the early phase differ from those in the late phase?
What is the role of histamine in the early phase of an IgE-mediated allergic reaction?
What is the role of histamine in the early phase of an IgE-mediated allergic reaction?
In contrast to typical IgE-mediated anaphylaxis, what is the PRIMARY mechanism behind anaphylactoid reactions?
In contrast to typical IgE-mediated anaphylaxis, what is the PRIMARY mechanism behind anaphylactoid reactions?
Why are ingested allergens more commonly associated with non-atopic IgE-mediated allergies than inhaled allergens?
Why are ingested allergens more commonly associated with non-atopic IgE-mediated allergies than inhaled allergens?
A patient develops urticaria and angioedema after receiving radiocontrast media. By what mechanism are the mast cells thought to activate?
A patient develops urticaria and angioedema after receiving radiocontrast media. By what mechanism are the mast cells thought to activate?
What immunological deficiency is thought to cause Toxic Epidermal Necrolysis (TEN)?
What immunological deficiency is thought to cause Toxic Epidermal Necrolysis (TEN)?
In Type III hypersensitivity reactions, the ensuing tissue damage is caused by?
In Type III hypersensitivity reactions, the ensuing tissue damage is caused by?
What is a key factor determining the pathogenicity of immune complexes in Type III hypersensitivity reactions?
What is a key factor determining the pathogenicity of immune complexes in Type III hypersensitivity reactions?
How does the antigen-antibody ratio affect the development of Type III hypersensitivity reactions?
How does the antigen-antibody ratio affect the development of Type III hypersensitivity reactions?
What characteristic is unique to allergic contact dermatitis, compared to other allergic reactions, regarding the allergens involved?
What characteristic is unique to allergic contact dermatitis, compared to other allergic reactions, regarding the allergens involved?
Flashcards
What is Atopy?
What is Atopy?
Inherited tendency for IgE mediated allergy to common environmental allergens.
Common pathologies with Atopy?
Common pathologies with Atopy?
Allergic Rhinitis, Allergic Asthma, Atopic Dermatitis, Allergic Gastroenteropathy.
Extrinsic vs Intrinsic Disease
Extrinsic vs Intrinsic Disease
Extrinsic is atopic; Intrinsic is non-immunological.
Probability of Atopy
Probability of Atopy
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Cause of Atopy
Cause of Atopy
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Atopic Allergens characteristics
Atopic Allergens characteristics
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Molecular type of inhaled allergens
Molecular type of inhaled allergens
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Most Common Atopic Allergens
Most Common Atopic Allergens
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Molds
Molds
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Animal Allergies
Animal Allergies
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Food Allergens
Food Allergens
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Allergic Asthma
Allergic Asthma
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Mast Cell Activation
Mast Cell Activation
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Atopic Dermatitis
Atopic Dermatitis
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Assignment
Assignment
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How are non-atopic IgE mediated disease allergensare delivered?
How are non-atopic IgE mediated disease allergensare delivered?
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Most Common Types of Non-Atopic IgE Allergens
Most Common Types of Non-Atopic IgE Allergens
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Terms that relate to non-atopic IgE mediated disease
Terms that relate to non-atopic IgE mediated disease
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Clinical Manifestations of Non-atopic IgE-mediated Allergy
Clinical Manifestations of Non-atopic IgE-mediated Allergy
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Anaphylactoid Reactions
Anaphylactoid Reactions
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Non-Atopic Allergens
Non-Atopic Allergens
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What is Anaphylaxis?
What is Anaphylaxis?
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What causes Urticaria
What causes Urticaria
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IgE-Mediated Allergy Time Course: Sensitization
IgE-Mediated Allergy Time Course: Sensitization
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What causes serum sickness?
What causes serum sickness?
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Describe Extrinsic Allergic Alveolitis
Describe Extrinsic Allergic Alveolitis
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Describe Delayed type reaction
Describe Delayed type reaction
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What Allergens are needed for Cell Allergy?
What Allergens are needed for Cell Allergy?
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How Is Drug Allergy manifested?
How Is Drug Allergy manifested?
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List Drug Allergy Factors
List Drug Allergy Factors
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Diagnose Drug Allergies by
Diagnose Drug Allergies by
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Low toxicity and highest incidence of drug allergy?
Low toxicity and highest incidence of drug allergy?
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Mechanism for X-reactivity?
Mechanism for X-reactivity?
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Penicilloyl Polylysine Pre-Pen
Penicilloyl Polylysine Pre-Pen
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Hyperirritable Shock Tissues
Hyperirritable Shock Tissues
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T Cell Regulation
T Cell Regulation
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Environmental Factors Affecting Atopy
Environmental Factors Affecting Atopy
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Low Dose Allergens
Low Dose Allergens
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Low Molecular Mass Allergen
Low Molecular Mass Allergen
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High Solubility Allergen
High Solubility Allergen
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High Stability Allergen
High Stability Allergen
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Peptides Binding Host MHC Class II
Peptides Binding Host MHC Class II
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How mast cells are triggered
How mast cells are triggered
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Immediate vs. Late Mast Cell Products
Immediate vs. Late Mast Cell Products
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Injected Non-Atopic Allergens
Injected Non-Atopic Allergens
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Early Phase Mediators
Early Phase Mediators
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Late phase mediators in allergy
Late phase mediators in allergy
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Shock Tissues
Shock Tissues
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Anaphylaxis Definition
Anaphylaxis Definition
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Anaphylactic Shock
Anaphylactic Shock
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Urticaria-Angioedema
Urticaria-Angioedema
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Serum Sickness Timeline
Serum Sickness Timeline
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Allergens needed for Extrinsic Allergic Alveolitis
Allergens needed for Extrinsic Allergic Alveolitis
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Arthus Reaction
Arthus Reaction
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Cell Mediated Allergy
Cell Mediated Allergy
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Adverse Reactions
Adverse Reactions
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Administration Route
Administration Route
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Diagnosing Drug Allergies
Diagnosing Drug Allergies
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Therapies for Drug Allergy
Therapies for Drug Allergy
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All four reaction mechanisms in penicillin may occur
All four reaction mechanisms in penicillin may occur
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Allergy Mechanism
Allergy Mechanism
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Are Penicillins and Cephalosporins used interchangeably?
Are Penicillins and Cephalosporins used interchangeably?
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Insulin Characteristics
Insulin Characteristics
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Insulin Reactions
Insulin Reactions
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Opiates-Codeine
Opiates-Codeine
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Stevens Johnson Syndrome
Stevens Johnson Syndrome
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Study Notes
- Atopic diseases involve terminology, general characteristics, and application of principles, but not specific details of diagnosis and therapy
Objectives in Studying Atopic Disease:
- Atopy definition, pathologies/symptoms, contrast between Extrinsic and Intrinsic, propensity chances, development mechanisms, characteristic features of atopic allergens, common diseases, mast cells activation, and mast cell products
Atopy Definition:
- Atopy is an inherited tendency for IgE-mediated allergy to common environmental allergens.
- Common allergens are inhalants and ingestants
- Includes allergic rhinitis (10-30%), allergic asthma (5%), atopic dermatitis in children (4-5%), and allergic gastroenteropathy
- Can also be asymptomatic
IgE-Mediated Diseases:
- Not all IgE-mediated diseases are atopic.
- Similar conditions can occur through non-immunologic mechanisms.
- Serum IgE is not a reliable measure.
Extrinsic vs Intrinsic Disease:
- Extrinsic disease is atopic versus intrinsic disease which is non-immunological
- Hyperirritable shock tissues may be a common denominator in manifestations
Atopy Prevalence and Probability:
- Atopy is prevalent in 10-30% of the North American population.
- The probability of atopy is 75% if both parents have it, and 50% if one parent has it.
- Pharmacists are involved in Rx, OTC, clinical, and specialty care
Understanding the Cause of Atopy:
- The cause relates to abnormal T cell regulation of IgE response regarding balance of TH1 vs TH2 vs Treg
- Also due to T₂ response
Additional Causes of Atopy:
- Abnormal absorption of allergens across mucosa, effect of age (outgrowing allergy)
- Hyperirritable shock tissues, with numerous possible causes including autonomic imbalance
- Autonomic imbalance includes b-adrenergic deficit in asthma
- Cytokine effects on physiology leading to cause vs. result, helminthiasis relationship, and environmental factors
- Environmental factors entail; age of initial exposure, concurrent infections, and location including helminthiasis.
Atopic Allergens:
- Typical protein immunogens that are somewhat smaller, with a molecular weight of 10,000-70,000
- Most allergens are airborne and may be seasonal or perennial.
- Sensitivity to multiple allergens is common
Features of Inhaled Allergens:
- Proteins, that induce T-cell responses
- Proteases are considered many allergens
Common Atopic Allergens:
- Pollens are the most common group.
- Examples include seasonal tree, grass, and weed pollens.
- House dust (dust bunnies) is the #1 allergen, a perennial.
- Dermatophagoides spp. a dust mite poo, is the allergenic component of house dust.
- Cockroach bits are also a common allergen.
Other Allergens:
- Fungal spores & fragments, perennial or seasonal
- Animals: danders, saliva, urine
- Foods: Unique & harder to evaluate, more common with non-atopic individuals
Atopic Diseases:
- Includes allergic rhinitis (hay fever) in 10-12% of the population
- Allergic asthma, or extrinsic asthma, present in 5% of the population has increasing morbidity/mortality.
- Aspirin intolerance occurs in 10% of asthmatics and is strongly associated with nasal polyps.
- Non-specific triggers are exercise, stress, cold, irritants, and drugs.
Allergic Reactions:
- Mast-cell activation causes blood vessel permeability and activation of epithelium
Atopic Dermatitis (Atopic Eczema):
- Appears in 4-5% children vs <1% adults
- Includes allergic contact dermatitis associated with altered barrier (stratum corneum) as well as atopic individual
- Does not correlate with other atopic symptoms necessarily
Common characteristics of atopy:
- Includes a genetic link
- Effects of seasonal and non-seasonal atopic allergens
- Atopic disease mechanisms, IgE-mast cell with early and late reactive substances
- Respiratory, skin, and gastrointestinal components
- Extrinsic and intrinsic disease differences
Non-Atopic IgE-Mediated Allergy:
- Differences exist between atopic and non-atopic disease, focusing on allergens and diseases
Objectives in Studying Non-Atopic IgE Mediated Diseases:
- Distinguishing between atopic and non-atopic IgE mediated pathologies
- Non-atopic IgE mediated disease allergens delivery
- The most common types of non-atopic IgE allergens
- Identifying symptoms, Sensitization, Early Phase, and Late Phase as they relate to non-atopic IgE mediated disease
- Mast cell activation
- Early and late phase mast cell products
- Basic pathologies of non-atopic IgE mediated disease and how mast cell mediators cause them
- Contrast between anaphylactoid response with anaphylaxis.
Non-Atopic IgE Mediated Allergic Reactions:
- Are not inherited, with shock tissue generally not hyperirritable
- Atopic patients may experience more serious disease than non-atopics
The Nature of Allergens:
- Ingestants and injectants lead to different allergy manifestations, such as anaphylaxis and urticaria-angioedema
Non-Atopic Allergens:
- Ingested; foods include peanuts, nuts, fish, and eggs common
- Drugs where almost any drug has the potential like Complete immunogen, Hapten, Idiosyncratic reactions such as Codeine, NSAIDs, Radiocontrast media (thickness)
Injected Allergens:
- Parenteral drugs and insect venom like bee, wasp, and ant
Time Course of Non-Atopic Pathology:
- Sensitization are Classic primary & secondary responses that can be inapparent
- Early Phase: Immediate (0-30 minutes) is Maximal by 60 minutes, with Preformed mediators like histamine
- Late Phase: 3-4 hours later is Maximal at 6-12 hours, resolving within 24 hours if no further exposure
- Platelet-activating factor (PAF), Leukotrienes, Eosinophils, Neutrophils
- Variability due to Multiple allergies, Mediator depletion, Continuous/multiple exposures.
IgE and Mast Cell Degranulation:
- Antigen in bloodstream enters tissues and activates connective tissue mast cells throughout the body
- Includes IgE-coated mast cells
Mast Cell Degranulation Triggers:
- Tissue and vascular system causes increased capillary permeability and entry of fluid into tissues
- Swelling of tissues including tongue
- Loss of blood pressure
- Reduced oxygen to tissues
- Irregular heartbeat
- Anaphylactic shock and loss of consciousness.
- Contraction of smooth muscle and constriction of throat and airways causes difficulty in swallowing and breathing while wheezing
- Contraction of smooth muscle and stomach cramps causing fluid outflow into gut, Diarrhea, and Vomiting.
Products of Mast Cell Degranulation:
- Enzymes like Tryptase, chymase, cathepsin G, and carboxypeptidase remodel connective tissue matrix
- Toxic Mediator Histamine and heparin kill parasites and cause Inc. vascular permeability and contraction of smooth muscle
- Cytokine TNF-a promotes inflammation, stimulates cytokine production, and activates endothelium
- Cytokine IL-4 and IL-13 Stimulate and amplify T2-cell response
- Cytokine IL-3, IL-5, and GM-CSF promote eosinophil production and activation
- Chemokine CCL3 attracts monocytes, macrophages, and neutrophils
- Lipid mediators Leukotrienes C4, D4, and E4 cause smooth muscle contraction and mucus secretion while Increasing vascular permeability
- Lipid mediator Platelet-activating factor attracts leukocytes and activates neutrophils, eosinophils, and platelets while amplifying production of lipid mediators
Inflammatory Cells:
- Early phase is a product of mast cells and basophils
- Late phase from eosinophils and neutrophils
- Mast cells have other receptors such as b-adrenergic and cholinergic
- non-immunologic stimuli such as opiates activate stimuli, and inhibit cromolyn as well as steroids
- Early phase; histamine and other preformed mediators
- Late phase; PAF, arachidonate metabolites, lysosomal enzymes.
Shock Tissues:
- Therapeutic agents may act on inflammatory cells and/or shock tissues (vessels, smooth muscles, etc)
- Manifestations can occur with both atopic and non-atopic disease.
- Hyperirritable tissues (e.g., bronchi, skin, etc.) common
Non-Atopic Clinical Manifestations:
- Anaphylaxis; generalized IgE-mediated reaction that often includes urticaria (Hives)-angioedema (and often rhinitis & asthma)
- Anaphylactic shock ; includes hypotension and cardiovascular collapse most often from injectants but not always
- Urticaria (Hives)-Angioedema; edematous, pruritic dermal reaction in subcutaneous tissues
- Urticaria most often from ingestants-foods and drugs, with 20% of population experiencings at some time.
- Anaphylactoid reactions; non-immunologic
Anaphylaxis Phases:
- Late reactaints that occur in Anaphylaxis
- Antigen challenge due to Immediate phase as well as Late phase
Anaphylactoid Responses:
- Non-immunological events are controversial
- No sensitization necessary
- Mast cells being mast cells, with something causes degranulation such as Codeine -opiate receptor, radio contrast dye-osmotic pressure
- Exercise asthma is somewhat similar.
Immune Complex Disease:
- Terminology, general characteristics, and application of principles, but not details of diagnosis and therapy
Immune Complex Disease
- Type III hypersensitivity reaction
Objectives in Studying Anaphylactoid Responses:
- Include, immune mediators, inflammation induction, physiological conditions, importance of Ag:Ab ratio, allergens, primary diseases, common symptoms, therapy for each
Immune Complex Disease:
- Is a product of highly immune individual (high levels circulating IgG) and exposed to high dose of antigen (usually protein)
Common Allergens;
- Classical complete immunogens (i.e., proteins)
- Complement activation resulting in anaphylatoxin + chemotactic activity
- Acute inflammation with neutrophil infiltration, leading to Vasculitis
- Arthus Reaction via Tetanus Toxoid or biopharmaceutical
- Serum Sickness is from Equine Antisera or streptokinase
- Serum Sickness Syndrome (milder) results from Haptens like iv penicillin
- Autoantigens lead to Rheumatoid disorders
Size of Complex Depends on Stoichiometry:
- Complex results from Little antibody, or an Early antibody response with an excess of antigen
- Comparable amounts of antigen and antibody forms at intermediate stages
- Large amounts of antibody forms during late responses, and little antigen
How the Size Forms:
- Small immune complexes formed that do not fix comp-lement and are not cleared from circulation in Early Responses
- Immune complexes can be formed that fix complement and are cleared from the circulation at Intermediate Stages
- Immune complexes form intermediate size that fix complement and are cleared from circulation in Late Responses
Clinical Occurrence in Immune Complex:
- Clinical occurrences appear due to Arthus Reactions:
- Mild maculopapular rash to hemorrhagic necrosis of classic animal reaction
- Follow administration of protein to a highly immune individual
- Booster doses of vaccines, immunotherapy, other protein drugs.
Serum Sickness in Immune Complex Diseases:
- Occurs in Primary within 1 week (4-21 days) after administration of foreign protein.
- Usually resolved in 1-4 weeks.
- Results in Secondary within 2-4 days after administration and often shorter course.
- Leads to Rash, swelling, pain at site of injection along with fever, headache, nausea, vomiting, malaise, arthralgia, and myalgia.
Serum Sickness Syndrome:
- Has haptens is milder a drug fever, and is much more common today
Autoimmune Diseases via the following :
- Rheumatoid arthritis, lupus, etc
Infectious Diseases via the following:
- Viral exanthems, fever, arthralgia, myalgia, and nephritis, etc
- Extrinsic Allergic Alveolitis: Initial stages regarding Hypersensitivity Pneumonitis or Farmers lung
- Allergic Bronchopulmonary Aspergillosis involving multiple mechanisms specifically infectious, allergic such as IgE-mediated, and Immune Complex Cell-mediated
Emphasis:
- Whats common is that IgG is formed, not IgE.
Drug Allergies:
- Involves general terminology, characteristics, and application of principles, but not specific details of diagnosis and therapy.
- Type IV hypersensitivity reactions are related to drug allergy
Objectives in Studying Drug Allergy:
- contrast the terms associated with adverse drug reactions like side effects, direct toxicity, idiosyncrasy, and allergy
- define physiological results of an immune response to a drug
- Describe what a hapten and carrier is or how they relate to drug allergy or Type II hypersensitivity
- Relate how to determine whether a patient presents with drug allergy versus toxicity
- Describe which Coombs and Gell classifications associate with drug allergy
- Describe at least one example of how a drug might become an allergen for each Coombs and Gell classification.
- Contrast anaphylaxis with an anaphylactoid response.
- Briefly describe mechanism of Toxic Epidermal Necrolysis and suggest possible treatment.
Drug Allergy:
- Mechanism can be ANY hypersensitivity reaction with adverse drug reactions
Responses to Drugs:
- Immune responses may result in no apparent effects-most common
- Tolerance increases to the drug where higher doses are necessary, leading to allergic disease
- Types of allergic diseases include IgE mediated, cytotoxic, Immune complex, and cell mediated
Drug Allergens:
- Haptens are the eception of proteins (and polysaccharides)
- Epitope of the allergic target may be a Drug, Drug metabolite, Drug or metabolite plus portion of the carrier, or Autoantigen
Factors of Drug Administration:
- Route of administration where Parenteral has greater incidence and severity in all mechanisms
- Oral has lower incidence and severity through IgE-mediated or CMI
- Topical primarily effects contact dermatitis with CMI, and some IgE-mediated)
Additional Factors:
- Dose causes greater allergic reaction as doses increase.
- Regimen provides greater opportunity for sensitization when longer in intermittent administration
Diagnosing and Managing Allergic Reactions:
- Testing including; Comprehensive History - Symptoms, Drug History, and Temporal Relationships of drug use
- Sensititvity testing, immediate sensitivity , patch tests, and In vitro tests
Therapeutic Measures:
- Provocation/challenge tests that are useful but risky
- Drug and chemically related agent avoidance
- Symptomatic therapy
- Only IgE-mediated mediator depletion desensitization
Penicillin Allergies:
- Low toxicity that causes the highest incidence of drug allergies by 2%
- IgG antibodies occur in most patients and frequently over reported at ~10%
- Is common across multiple allergies, but not absolute
All Four Allergic Mechanisms in Penicillins:
- IgE-mediated urticaria to anaphylaxis
- Cytotoxic includes Immune Complex through high dose parenteral thera
- Cell-mediated occupational disease
Determinants in Penicillin Allergies:
- Penicillo Polylysine can be diagnostic for allergy, since the mechanism of action and the mechanism of allergy stem from same reaction - includes x-reactivity for Penicillins and Cephalosporins
Insulin Allergies:
- Where only Human related versions cause specific Allergic reactions
- 50 amino acids MW of ~ 6,000 from Animal or Human synthetic source
- All highly purified, with Cross-reactivity between animal and human
- Animal products are Bovine > Porcine > Human
Insulin Allergy Mechanisms:
- Both IgE-mediated and Immune Complex based effects
- Limited from 1-3 weeks generally stops
- Rare serious reactions with uninterrupted use
Insulin Resistances:
- Non-immune tissue insensitivity is often associated with obesity
- Acute resistance during stress has infection, surgery, trauma, etc
- Chronic resistance can include high anti-insulin IgG levels more common with intermittent use
Managing the insulin:
- Intermittent usage classical primary-secondary responses
- Continuous administration provides at least partial tolerance
- Immunogen suppression of developing B cells and Immune complex suppression of peripheral B cells
Anaphylactoid Drug Reactions:
- Common Examples of Reactions include Radiocontrast media, Opiates, and Asprin
Toxic Epidermal Necrolysis:
- Form of Stevens Johnson Syndrome
Toxicities:
- Severe cutaneous hypersensitivity reaction is also known as Stevens-Johnson Syndrome
- Occurs at around 1-5/million
- Not really a "toxic" response
- Caused by failure to clear drug metabolites
Additional factors with toxicities:
- Drug or metabolites adhere to keratinocytes
- CD8+ and NK play a role by destruction keratinocytes in the epidermis specifically
- Mimics a pathogen
Symptoms of the allergic conditions:
-
Symptoms will occur between 1-3 weeks after initiation of therapy
-
Will cause Fever, malaise, and or Severe maculopapular rash on face, arms, or trunk
-
Severe cases may also cause skin to “slough” off from bronchial epithelium, which causes respiratory problems
-
Often fatal
-
Possible CsA treatment
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