Allergy

Question 1

The early phase allergic reaction

• In allergic individuals, exposure to allergens (substance to which IgE antibodies may be produced) leads to the rapid development of symptoms
• This reaction develops within … or … of exposure and results from the binding of allergens to pre-formed IgE antibodies on the surface of … cells and …

Answer 1

• In allergic individuals, exposure to allergens (substance to which IgE antibodies may be produced) leads to the rapid development of symptoms
• This reaction develops within seconds or minutes of exposure and results from the binding of allergens to pre-formed IgE antibodies on the surface of mast cells and basophils

Question 2

Allergen=substance to which … antibodies may be produced

Answer 2

Allergen=substance to which IgE antibodies may be produced

Question 3

In allergic individuals, exposure to … leads to the rapid development of symptoms

Answer 3

In allergic individuals, exposure to allergens leads to the rapid development of symptoms

Question 4

Basic mechanism of the early phase allergic reaction

Answer 4

*

Question 5

Events the follow mast cell IgE ligation

• IgE binds its specific allergen
• …-… of IgE antibodies by allergen leads to clustering of FcεR1 receptors
• The intracellular portion of the receptor becomes …
• The resulting intracellular cascade leads to cellular …
• Mast cell ‘…’ releasing histamine, tryptase and other pre-formed mediators

Answer 5

• IgE binds its specific allergen
• Cross-linking of IgE antibodies by allergen leads to clustering of FcεR1 receptors
• The intracellular portion of the receptor becomes phosphorylated
• The resulting intracellular cascade leads to cellular activation
• Mast cell ‘degranulates’ releasing histamine, tryptase and other pre-formed mediators

Question 6

Events the follow mast cell IgE ligation

• IgE binds its specific allergen
• Cross-linking of IgE antibodies by allergen leads to … of FcεR1 receptors
• The … portion of the receptor becomes phosphorylated
• The resulting … cascade leads to cellular activation
• … cell ‘degranulates’ releasing …, tryptase and other pre-formed mediators

Answer 6

• IgE binds its specific allergen
• Cross-linking of IgE antibodies by allergen leads to clustering of FcεR1 receptors
• The intracellular portion of the receptor becomes phosphorylated
• The resulting intracellular cascade leads to cellular activation
• Mast cell ‘degranulates’ releasing histamine, tryptase and other pre-formed mediators

Question 7

Delayed mediators – leukotrienes (allergy)

Answer 7

Question 8

Pharmacological effects of mast cell mediators and leukotrienes

• Histamine effects (mast cell activation and granule release):
  
  • GI - Increased … secretion, increased … - … of GI tract contents (diarrhea, vomiting)
  • Airway - Decreased diameter, increased mucus … - congestion and blockage of airways (wheezing, …, …) - swelling and mucus secretion in nasal passages
  • Blood Vessels - Increased blood flow, increased … - increased fluid in tissues causing increased flow of … to … nodes, increased cells and proteins in tissues, increased … response in tissues

Answer 8

• Histamine effects:
  
  • GI - Increased fluid secretion, increased peristalsis - expulsion of GI tract contents (diarrhea, vomiting)
  • Airway - Decreased diameter, increased mucus secretion - congestion and blockage of airways (wheezing, coughing, phlegm) - swelling and mucus secretion in nasal passages
  • Blood Vessels - Increased blood flow, increased permeability - increased fluid in tissues causing increased flow of lymph to lymph nodes, increased cells and proteins in tissues, increased effector response in tissues

Question 9

Pharmacological effects of mast cell mediators and leukotrienes

• Histamine effects (… cell … and … release):
  
  • GI - Increased fluid secretion, increased peristalsis - expulsion of GI tract contents (…,…)
  • Airway - Decreased diameter, increased mucus secretion - congestion and blockage of airways (…, …, …) - swelling and mucus secretion in nasal passages
  • Blood Vessels - Increased blood flow, increased permeability - increased fluid in tissues causing increased flow of lymph to lymph nodes, increased cells and proteins in tissues, increased effector response in tissues

Answer 9

• Histamine effects (mast cell activation and granule release):
  
  • GI - Increased fluid secretion, increased peristalsis - expulsion of GI tract contents (diarrhea, vomiting)
  • Airway - Decreased diameter, increased mucus secretion - congestion and blockage of airways (wheezing, coughing, phlegm) - swelling and mucus secretion in nasal passages
  • Blood Vessels - Increased blood flow, increased permeability - increased fluid in tissues causing increased flow of lymph to lymph nodes, increased cells and proteins in tissues, increased effector response in tissues

Question 10

Examples of allergen sources

• Allergens are almost always otherwise … environmental …
• Of the thousands of environmental proteins that we meet, only a few hundred are recognised as allergens

Answer 10

• Allergens are almost always otherwise innocuous environmental proteins
• Of the thousands of environmental proteins that we meet, only a few hundred are recognised as allergens

Question 11

Give some examples of allergen sources

Answer 11

Question 12

General characteristics of allergens

Answer 12

Question 13

General characteristics of allergens

• … (there are a few minor exceptions)
• Physical properties that favour transition across … membranes
• Biologically active, often …
• Have moderate … with self-proteins

Answer 13

• Proteins (there are a few minor exceptions)
• Physical properties that favour transition across mucus membranes
• Biologically active, often enzymes
• Have moderate homology with self-proteins

Question 14

Clinical allergy syndromes: anaphylaxis

• ‘… …’ reaction
• Systemic release of … causes generalised vasodilatation & fluid loss from circulation to tissues
  
  • Cutaneous: hives, angioedema
  • Gut … release: vomiting, diarrhoea
  • Mucosal … release: laryngeal oedema, bronchoconstriction
  • Circulation: vasodilatation, hypotension
• Food, drugs and insect … commonest triggers in UK
• Cardinal features: typical symptoms, multi-system and dramatic, … follows exposure to allergen and tends to improve fairly … thereafter

Answer 14

• ‘Generalised allergic’ reaction
• Systemic release of histamine causes generalised vasodilatation & fluid loss from circulation to tissues
  
  • Cutaneous: hives, angioedema
  • Gut histamine release: vomiting, diarrhoea
  • Mucosal histamine release: laryngeal oedema, bronchoconstriction
  • Circulation: vasodilatation, hypotension
• Food, drugs and insect venom commonest triggers in UK
• Cardinal features: typical symptoms, multi-system and dramatic, rapidly follows exposure to allergen and tends to improve fairly quickly thereafter

Question 15

Clinical allergy syndromes: anaphylaxis

• ‘Generalised allergic’ reaction
• Systemic release of histamine causes generalised … & fluid … from circulation to tissues
  
  • Cutaneous: h.., angioedema
  • Gut histamine release: V, …
  • Mucosal histamine release: … oedema, broncho…
  • Circulation: vaso…, …tension
• …, drugs and insect venom commonest triggers in UK
• Cardinal features: typical symptoms, multi-system and dramatic, rapidly follows exposure to allergen and tends to improve fairly quickly thereafter

Answer 15

• ‘Generalised allergic’ reaction
• Systemic release of histamine causes generalised vasodilatation & fluid loss from circulation to tissues
  
  • Cutaneous: hives, angioedema
  • Gut histamine release: vomiting, diarrhoea
  • Mucosal histamine release: laryngeal oedema, bronchoconstriction
  • Circulation: vasodilatation, hypotension
• Food, drugs and insect venom commonest triggers in UK
• Cardinal features: typical symptoms, multi-system and dramatic, rapidly follows exposure to allergen and tends to improve fairly quickly thereafter

Question 16

Clinical allergy syndromes: oral allergy syndrome

• Most … type of food allergy amongst UK adults
• Ig… directed against pollen proteins …-reacts with homologous proteins in plant-derived foods
• Oral itching upon exposure to raw fruit, nuts and vegetables
• In UK:
  
  • Pollen = mainly …
  • Food = mainly … fruits

Answer 16

• Most common type of food allergy amongst UK adults
• IgE directed against pollen proteins cross-reacts with homologous proteins in plant-derived foods
• Oral itching upon exposure to raw fruit, nuts and vegetables
• In UK:
  
  • Pollen = mainly birch
  • Food = mainly Rosaceae fruits (such as apples, pears, quinces, apricots)

Question 17

Clinical allergy syndromes: oral allergy syndrome

• Most common type of food allergy amongst UK adults
• IgE directed against pollen proteins cross-reacts with homologous proteins in plant-derived foods
• Oral … upon exposure to .. fruit, nuts and vegetables
• In UK:
  
  • … = mainly birch
  • … = mainly Rosaceae fruits

Answer 17

• Most common type of food allergy amongst UK adults
• IgE directed against pollen proteins cross-reacts with homologous proteins in plant-derived foods
• Oral itching upon exposure to raw fruit, nuts and vegetables
• In UK:
  
  • Pollen = mainly birch
  • Food = mainly Rosaceae fruits

Question 18

Clinical allergy syndromes: airway disease

• R…
  
  • Sneezing, rhinorhoea, blockage due to a type … allergy
• … airway obstruction
  
  • Wheeze due to type … allergy
• Allergens/ symptoms may be:
  
  • Seasonal: pollens, m…
  • Episodic: o.., animal dander
• When symptoms are chronic, the inflammation becomes established and cannot be explained simply in terms of mast cell …

Answer 18

• Rhinitis
  
  • Sneezing, rhinorhoea, blockage due to a type 1 allergy
• Lower airway obstruction
  
  • Wheeze due to type 1 allergy
• Allergens/ symptoms may be:
  
  • Seasonal: pollens, moulds
  • Episodic: occupational, animal dander
• When symptoms are chronic, the inflammation becomes established and cannot be explained simply in terms of mast cell degranulation

Question 19

Clinical allergy syndromes: airway disease

• Rhinitis
  
  • S.., rhinorhoea, blockage due to a type 1 allergy
• Lower airway obstruction
  
  • … due to type … allergy
• Allergens/ symptoms may be:
  
  • Seasonal: P.., moulds
  • Episodic: occupational, A.. dander
• When symptoms are chronic, the inflammation becomes established and cannot be explained simply in terms of … cell degranulation

Answer 19

• Rhinitis
  
  • Sneezing, rhinorhoea, blockage due to a type 1 allergy
• Lower airway obstruction
  
  • Wheeze due to type 1 allergy
• Allergens/ symptoms may be:
  
  • Seasonal: pollens, moulds
  • Episodic: occupational, animal dander
• When symptoms are chronic, the inflammation becomes established and cannot be explained simply in terms of mast cell degranulation

Question 20

The immunological tightrope

• The immune system is constantly challenged with antigens&must somehow decide how to respond
  
  • … antigens vs non-…
  • Dangerous infections vs … organisms
  • … allergens such as foods and pollens

Answer 20

• The immune system is constantly challenged with antigens&must somehow decide how to respond
  
  • Self antigens vs non-self
  • Dangerous infections vs commensal organisms
  • Environmental allergens such as foods and pollens

Question 21

The immunological tightrope

• The immune system is constantly challenged with antigens&must somehow decide how to respond
  
  • Self antigens vs non-self
  • … infections vs commensal organisms
  • Environmental allergens such as … and …

Answer 21

• The immune system is constantly challenged with antigens&must somehow decide how to respond
  
  • Self antigens vs non-self
  • Dangerous infections vs commensal organisms
  • Environmental allergens such as foods and pollens

Question 22

Allergy - over the years:

Answer 22

Question 23

Chronic allergic inflammation: asthma

• Patients with chronic asthma have on-going symptoms
• Most patients are … to a variety of …. allergens
• Biopsy shows inflammatory … and airway changes known as ‘re-modelling’ – thickened basement membrane and smooth muscle hyper..
• The ‘early allergic reaction’ model does not provide a good explanation by itself

Answer 23

• Patients with chronic asthma have on-going symptoms
• Most patients are sensitised to a variety of airborne allergens
• Biopsy shows inflammatory infiltrate and airway changes known as ‘re-modelling’ – thickened basement membrane and smooth muscle hyperplasia
• The ‘early allergic reaction’ model does not provide a good explanation by itself

Question 24

Chronic allergic inflammation: asthma

• Patients with chronic asthma have on-going symptoms
• Most patients are sensitised to a variety of airborne allergens
• Biopsy shows inflammatory infiltrate and airway changes known as ‘re-…’ – thickened … membrane and smooth muscle …
• The ‘… allergic reaction’ model does not provide a good explanation by itself

Answer 24

• Patients with chronic asthma have on-going symptoms
• Most patients are sensitised to a variety of airborne allergens
• Biopsy shows inflammatory infiltrate and airway changes known as ‘re-modelling’ – thickened basement membrane and smooth muscle hyperplasia
• The ‘early allergic reaction’ model does not provide a good explanation by itself

Question 25

_The late phase allergic reaction_ * The ... ... reaction to allergen is followed some hours later by a second ‘late phase reaction’ * Biopsy of the late phase shows infiltration with inflammatory cells – particularly ... T cells, eosinophils and ... cells; provides some insight into chronic allergic inflammation, and often used as an experimental model

Answer 25

* The **early** phase reaction to allergen is followed some hours later by a second ‘late phase reaction’ * Biopsy of the late phase shows infiltration with inflammatory cells – particularly **CD4** T cells, eosinophils and **mast** cells; provides some insight into chronic allergic inflammation, and often used as an experimental model

Question 26

_T cell subsets_

Answer 26

Question 27

_T cell subsets_

Answer 27

Question 28

_Th2-biased infiltrate in asthmatic lung_

Answer 28

Question 29

_Alder allergy associated with Th2-biased responses to alder_

Answer 29

Question 30

_T cell subsets and the Th2 hypothesis_ * Th2 responses to allergens have been ... associated with allergic disease * ... of allergic inflammation are rich in T cells expressing Th2 cytokines * T cells from allergic patients stimulated with ... in the laboratory produce Th2 cytokines * Plenty of reasons to believe that Th2 responses may be important in allergy: * IL-... is required for B cell class switching to IgE * IL-.. and IL-... promote mucus hypersecretion * IL-5 is required for ... survival * IL-9 recruits ... cells

Answer 30

* Th2 responses to allergens have been **consistently** associated with allergic disease * **Biopsies** of allergic inflammation are rich in T cells expressing Th2 cytokines * T cells from allergic patients stimulated with **allergen** in the laboratory produce Th2 cytokines * Plenty of reasons to believe that Th2 responses may be important in allergy: * **IL-4** is required for B cell class switching to IgE * **IL-4** and **IL-13** promote mucus hypersecretion * IL-5 is required for **eosinophil** survival * IL-9 recruits **mast** cells

Question 31

_T cell subsets and the Th2 hypothesis_ * Th2 responses to allergens have been consistently associated with allergic disease * Biopsies of allergic inflammation are rich in T cells expressing Th2 cytokines * T cells from allergic patients stimulated with allergen in the laboratory produce Th2 cytokines * Plenty of reasons to believe that Th2 responses may be important in allergy: * IL-4 is required for B cell class switching to ... * IL-4 and IL-13 promote mucus ... * IL-... is required for eosinophil survival * IL-.. recruits mast cells

Answer 31

* Th2 responses to allergens have been consistently associated with allergic disease * Biopsies of allergic inflammation are rich in T cells expressing Th2 cytokines * T cells from allergic patients stimulated with allergen in the laboratory produce Th2 cytokines * Plenty of reasons to believe that Th2 responses may be important in allergy: * IL-4 is required for B cell class switching to **IgE** * IL-4 and IL-13 promote mucus **hypersecretion** * **IL-5** is required for eosinophil survival * **IL-9** recruits mast cells

Question 32

* Biopsies of allergic inflammation are rich in T cells expressing Th... cytokines * T cells from allergic patients stimulated with allergen in the laboratory produce Th... cytokines

Answer 32

* Biopsies of allergic inflammation are rich in T cells expressing **Th2** cytokines * T cells from allergic patients stimulated with allergen in the laboratory produce **Th2** cytokines

Question 33

_Chronic allergic disease: asthma (ACUTE responses)_ * Inflammatory mediators cause increased mucus ... and ... muscle contraction leading to airway ... * ... of cells from the circulation

Answer 33

* Inflammatory mediators cause increased mucus **secretion** and **smooth** muscle contraction leading to airway **obstruction** * **Recruitment** of cells from the circulation

Question 34

_Chronic allergic disease: asthma (CHRONIC responses)_ * Chronic response caused by ... and ... products * Activated Th... cells and other inflammatory cells accumulate * Th... products lead to chronic disease * IL4: mucus hypersecretion * IL-13: bronchial hyper-responsiveness * IL-5: eosinophil recruitment * IL-9: mast cell recruitment * This model suggests a true role for T cells in chronic inflammation rather than just in causing IgE production

Answer 34

* Chronic response caused by **cytokines** and **eosinophil** products * Activated **Th2** cells and other inflammatory cells accumulate * **Th2** products lead to chronic disease * IL4: mucus hypersecretion * IL-13: bronchial hyper-responsiveness * IL-5: eosinophil recruitment * IL-9: mast cell recruitment * This model suggests a true role for T cells in chronic inflammation rather than just in causing IgE production

Question 35

_Chronic allergic disease: asthma (CHRONIC responses)_ * Chronic response caused by cytokine and eosinophil products * Activated Th2 cells and other inflammatory cells accumulate * Th2 products lead to chronic disease * IL4: mucus ... * IL-13: bronchial ...-r... * IL-5: ... recruitment * IL-9: ... cell recruitment * This model suggests a true role for T cells in chronic inflammation rather than just in causing ... production

Answer 35

* Chronic response caused by cytokines and eosinophil products * Activated Th2 cells and other inflammatory cells accumulate * Th2 products lead to chronic disease * IL4: mucus **hypersecretion** * IL-13: bronchial **hyper-responsiveness** * IL-5: **eosinophil** recruitment * IL-9: **mast** cell recruitment * This model suggests a true role for T cells in chronic inflammation rather than just in causing **IgE** production

Question 36

_Potential factors in the aetiology of allergy: genetics_ * Childhood allergy is ... predicted by presence of allergy in parents, but difficult to unpick relative contribution of ... * Numerous genetic risk factors identified, but none particularly compelling * Notable that the allergy epidemic has occurred too ... to be explained entirely by genetics

Answer 36

* Childhood allergy is **strongly** predicted by presence of allergy in parents, but difficult to unpick relative contribution of **environment** * Numerous genetic risk factors identified, but none particularly compelling * Notable that the allergy epidemic has occurred too **quickly** to be explained entirely by genetics

Question 37

_Hygiene hypothesis: Strachan 1989_ * ... hygiene levels, ... pathogen load, helminth infection proposed to: * Skew immunity from Th... to Th... * Induce regulatory T cells * ... hygiene levels, ... pathogen load, absence of helminth infection proposed to: * Skew immunity towards Th... * Reduce production of regulatory T cells * Has proved resilient as a theory, but remains somewhat theoretical

Answer 37

* **Low** hygiene levels, **high** pathogen load, helminth infection proposed to: * Skew immunity from **Th2 to Th1** * Induce regulatory T cells * **High** hygiene levels, **low** pathogen load, absence of helminth infection proposed to: * Skew immunity towards **Th2** * Reduce production of regulatory T cells * Has proved resilient as a theory, but remains somewhat theoretical

Question 38

_Hygiene hypothesis: Strachan 1989_ * Low hygiene levels, high pathogen load, ... infection proposed to: * Skew immunity from Th2 to Th1 * ... regulatory T cells * High hygiene levels, low pathogen load, absence of ... infection proposed to: * Skew immunity towards Th2 * ... production of regulatory T cells * Has proved resilient as a theory, but remains somewhat theoretical

Answer 38

* Low hygiene levels, high pathogen load, **helminth** infection proposed to: * Skew immunity from Th2 to Th1 * **Induce** regulatory T cells * High hygiene levels, low pathogen load, absence of **helminth** infection proposed to: * Skew immunity towards Th2 * **Reduce** production of regulatory T cells * Has proved resilient as a theory, but remains somewhat theoretical

Question 39

_Detection of allergen-specific IgE in vivo: skin testing_ * Skin ... testing * Allergen extract applied as ... * ... layers of epidermis punctured with lancet * A wheal with ... response after 15 minutes is positive * Result needs interpretation in clinical context

Answer 39

* Skin **prick** testing * Allergen extract applied as **drops** * **Top** layers of epidermis punctured with lancet * A wheal with **flare** response after **15** minutes is positive * Result needs interpretation in clinical context

Question 40

In skin prick testing (allergy) a ... with flare response after ... minutes is positive

Answer 40

In skin prick testing (allergy) a **wheal** with flare response after **15** minutes is positive

Question 41

_Detection of allergen-specific IgE in vitro_ * Performed by radioallergosorbant (RAST) assay a very long time ago * Now usually by ..., but term ‘RAST’ still widely used clinically

Answer 41

* Performed by radioallergosorbant (RAST) assay a very long time ago * Now usually by **ELISA**, but term ‘RAST’ still widely used clinically

Question 42

_Treatment of allergy: Pure symptom relievers (don’t act on mediators, but act on other pathways that oppose actions of mediators)_

Answer 42

Question 43

_Treatment of allergy: Pure symptom relievers (don’t act on mediators, but act on other pathways that oppose actions of mediators)_ * Nasal decongestants * eg oxymetazoline * Act on ... adrenoreceptors to cause vasoconstriction * Only for short-term use * ... and systemic * B2 ... * Eg salbutamol * Act on lung B2 adrenoreceptors, cause smooth muscle ... * Epinephrine/Adrenaline * Systemic adrenergic effects oppose vasodilatation and bronchoconstriction

Answer 43

* Nasal decongestants * eg oxymetazoline * Act on **α1** adrenoreceptors to cause vasoconstriction * Only for short-term use * **Topical** and systemic * B2 **agonists** * Eg salbutamol * Act on lung B2 adrenoreceptors, cause smooth muscle **relaxation** * Epinephrine/Adrenaline * Systemic adrenergic effects oppose vasodilatation and bronchoconstriction

Question 44

_Treatment of allergy: Pure symptom relievers (don’t act on mediators, but act on other pathways that oppose actions of mediators)_ * Nasal decongestants * eg oxymetazoline * Act on α1 adrenoreceptors to cause ... * Only for short-term use * Topical and systemic * B2 agonists * Eg ... * Act on lung B2 adrenoreceptors, cause smooth muscle relaxation * Epinephrine/Adrenaline * Systemic adrenergic effects oppose ... and ...

Answer 44

* Nasal decongestants * eg oxymetazoline * Act on α1 adrenoreceptors to cause **vasoconstriction** * Only for short-term use * Topical and systemic * B2 agonists * Eg **salbutamol** * Act on lung B2 adrenoreceptors, cause smooth muscle relaxation * Epinephrine/Adrenaline * Systemic adrenergic effects oppose **vasodilatation and bronchoconstriction**

Question 45

_Treatment of allergy: drugs acting on early-phase mediators_

Answer 45

Question 46

_Mast cell stabilisers_ * Eg sodium cromoglycate * Reduce mast cell ... by unknown mechanism * Not ... absorbed – ... use only * Short ...-... requires frequent dosing * Main benefit is ...-free, but efficacy ...

Answer 46

* Eg sodium cromoglycate * Reduce mast cell **degranulation** by unknown mechanism * Not **orally** absorbed – **topical** use only * Short **half-life** requires frequent dosing * Main benefit is **steroid**-free, but efficacy **very poor**

Question 47

_H1 Antihistamines_ * Inverse ... at H1 histamine receptor * Best used before ... to allergen * 1st generation eg chlorpheniramine * Considerable ..., drug interactions * 2nd generation eg cerizine, loratidine, desloratidine, fexofenadine * No/ minimal ..., once-daily

Answer 47

* Inverse **agonists** at H1 histamine receptor * Best used before **exposure** to allergen * 1st generation eg chlorpheniramine * Considerable **sedation**, drug interactions * 2nd generation eg cerizine, loratidine, desloratidine, fexofenadine * No/ minimal **sedation**, once-daily

Question 48

_Leukotriene receptor antagonists_ * Only UK drug is ... * Effective in reducing ... allergic responses, but ... to H1 antihistamines * Unlike anti-histamines, beneficial in ... asthma, which is the main indication for their use

Answer 48

* Only UK drug is **montelukast** * Effective in reducing **early** allergic responses, but **inferior** to H1 antihistamines * Unlike anti-histamines, beneficial in **chronic** asthma, which is the main indication for their use

Question 49

_Treatment of allergic disease: corticosteroids_ * Steroids reduce immune activation by altering gene ... in numerous cell types, including T cells, B cells and cells of the ... immune system. Their onset of action is ... and they must be taken ...

Answer 49

* Steroids reduce immune activation by altering gene **expression** in numerous cell types, including T cells, B cells and cells of the **innate** immune system. Their onset of action is **delayed** and they must be taken **regularly**

Question 50

_Corticosteroids - Types_ * Inhaled - eg b..., fluticasone * Nasal - eg b..., mometasone, fluticasone * Skin - h... and opthalmic drops * Topical prep may cause local and even .. side effects * Oral, ... and depot prep available

Answer 50

* Inhaled - eg **beclamathosome**, fluticasone * Nasal - eg **beclamathasone**, mometasone, fluticasone * Skin - **hydrocortisone** and opthalmic drops * Topical prep may cause local and even **systemic** side effects * Oral, **IV** and depot prep available

Question 51

_Treatment of allergic disease: Omalizumab_ * Omalizumab is a ... ... directed against ..., used for atopic asthma (amongst other things)

Answer 51

* Omalizumab is a **monoclonal antibody** directed against **IgE**, used for atopic asthma (amongst other things)

Question 52

...lizumab is a monoclonal antibody directed against IgE, used for atopic ... (amongst other things)

Answer 52

**Omalizumab** is a monoclonal antibody directed against IgE, used for atopic **asthma** (amongst other things)

Question 53

Omalizumab is a monoclonal antibody directed against ...., used for ... asthma (amongst other things)

Answer 53

Omalizumab is a monoclonal antibody directed against **IgE**, used for **atopic** asthma (amongst other things)

Question 54

_Treatment of allergic disease: allergen-specific immunotherapy_ * Allergen doses administered by ... injection or sub... * Provide ...-term protection * Mainly ... allergy and rhinitis * Multiple immunological effects: * Induce regulatory T cell responses to allergens * Reduce Th... responses * Induce allergen-specific ... antibodies * Reduction in mast cell responsiveness * Reduce allergen-specific IgE levels

Answer 54

* Allergen doses administered by **subcutaneous** injection or **sublingually** * Provide **long**-term protection * Mainly **venom** allergy and rhinitis * Multiple immunological effects: * Induce regulatory T cell responses to allergens * Reduce **Th2** responses * Induce allergen-specific **IgG** antibodies * Reduction in mast cell responsiveness * Reduce allergen-specific IgE levels

Question 55

_Treatment of allergic disease: allergen-specific immunotherapy_ * Allergen doses administered by subcutaneous injection or sublingually * Provide long-term protection * Mainly venom allergy and ... * Multiple immunological effects: * Induce ... T cell responses to allergens * Reduce Th2 responses * Induce allergen-specific IgG antibodies * Reduction in ... cell responsiveness * Reduce allergen-specific ... levels

Answer 55

* Allergen doses administered by subcutaneous injection or sublingually * Provide long-term protection * Mainly venom allergy and **rhinitis** * Multiple immunological effects: * Induce **regulatory** T cell responses to allergens * Reduce Th2 responses * Induce allergen-specific IgG antibodies * Reduction in **mast** cell responsiveness * Reduce allergen-specific **IgE** levels

Question 56

_Contact dermatitis vs type 1 allergy​_

Answer 56

Question 57

_Contact dermatitis vs type 1 allergy​_

Answer 57

Question 58

_Skin prick testing vs patch testing_

Answer 58