2012

Question 1

what environmental changes in the past 3 decades have made more problems for people with allergies?

Answer 1

1. Increased PM2.5 causes lung irritation and asthma exacerbations
2. Increased pollution leads to increased asthma exacerbations
3. Global warming causing longer seasons with increased pollination
4. increased CO2 level increases pollination of plants
5. warm temps expand hickory and oak habitats
6. warmer temps can increase fungal allergens

Question 2

what is the mechanism of chronic autoimmune urticaria, how might Xolair help?

Answer 2

• AA mechanism from aa’s to IgE and FECR1 causing release of mast cells, basophils and histamine leading to vasodilation and plasma extravasation
• Xolair works by binding the FC region of IgE and preventing further cross linked and release of mediators by forming IgE complexes the Xolair IGE complex is cleared by the hepatic reticuloendothelial system

Question 3

DRESS:

1. pathophysiology
2. clinical features
3. most common drug culprits

Answer 3

1. type 3 t cell mediated delayed drug eruption that occurs secondary to an offending medication
   - two major mechanisms: drug specific immune response, CD4 and CD8 cells produce INF-g and TNF and cause immune activation
   - HHV6 reactivation with a subsequent anti viral immune response
2. fever, splenomegaly, lymphadenopathy, rash, elevated eosinophils, atypical lymphocytosis
3. allopurinal, phenytoin, carbamazepine, lamotragine

Question 4

name 4 types of occular allergy

• mechanism
• exam findings
• treatment

Answer 4

AKC

• type 1 and type 4
• conjunctival edema, dermatitis and pruritis, papillae are on lower tarsus and inferior fornix
• avoid triggers, cold compresses, topical AH and mast cell stabilizers

VKC

• type 1 and type 4
• cobblestoning papillae on the upper lid, horner trantas dots and corneal shield ulcers
• avoid triggers, cold compresses, topical AH, and mast cell stabilizers
• steroids by an optho only, AIT, topical calcineurin inhibitors

GPC

• type 1 and type 4
• tarsal pappilla, discharge and CL debris , giant papillae on upper tarrsal

perennial or seasonal allergic conjunctivitis

• type 1 (IgE mediated)
• conjunctival inflammation, redness and edema

Question 5

red flags in occular allergy

Answer 5

1. photophobia and pain with light
2. pupillary abnormalities
3. blurred vision
4. ciliary flush

Question 6

what is an at risk infant for atopy

Answer 6

food allergy

• first degree relative with atopy
• decreasing birth order
• AD

asthma

• allergen exposure
• fam hx of atopy
• maternal smoking
• prematurity
• wheeze without colds

AR

• high SES
• sIgE > 100 before age 6
• SPT to aeroallergen positive
• asthma

eczema

• family history
• loss of filagrin gene mutation

Question 7

what is meant by primary prevention

Answer 7

• interventions to prevent a disease from occurring

Question 8

what advice to you give to a mother to prevent allergies

Answer 8

2021 consensus for primary prevention of food allergy through nutrition

1. consider infants with severe AD highest risk
2. introduce peanut to all infants irrespective of relative risk at 6 months though not before 4 months
3. introduce egg to all infants irrespective of relative risk at 6 months, but not before 4 months
4. do not deliberately delay the intro of foods that are potentially allergenic
5. infants should be fed a diverse diet as this may foster prevention of food allergy
6. do not routinely recommended HF for prevention of food allergy
7. do not recommend avoidance of allergenic foods during pregnancy of lactation as a means of prevention

Question 9

how is IgA formed and describe its transport across the luminal surface of the gut

Answer 9

T cell dependant mechanism

• M cells transport antigen to peyers patches
• DCs in PP capture these antigens
• DC migrate and present the antigen to a naive CD4 T cell
• activated T cells become helper T cells and interact with B cells
• T cell CD40L binding to B cell CD40 stimulates class switching to IgA

Question 10

differences between primary and secondary immune response

Answer 10

1. Primary
   - naive B cells
   - smaller peak response
   - IgM >IgG in terms of antibody isotype
   - lower antibody affinity
2. Secondary
   - Memory B cells
   - larger peak response
   - related increased in IgG (heavy chain isoswitching)
   - high antibody affinity

Question 11

what are some advantages of component testing

Answer 11

• can help identify if risks for systemic rxn
• OAS clarification
• can help with establishing suitability for OFCs
• do not have to stop medications for blood work

Question 12

cryoglobulinemias name all 3 types

Answer 12

Type 1 - monoclonal Igs (IgG and IgM) (MGUS, MM)

Type 2 - monoclonal IgM, RF, polyclonal IgG (SLE, Hep C)

Type 3 - polyclonal IgG and IgM (Hep C)