Hypersensitivity

Card Set Information

Author:
trincam2008
ID:
276411
Filename:
Hypersensitivity
Updated:
2014-06-08 18:48:44
Tags:
path immuno hypersensitivity
Folders:
path,immuno
Description:
Type I-IV, syndrome, diagnosis
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  1. Type I?
    What causes? Mediated by?
    • - Immediate reaction - provoked by re-exposure to an allergen.
    • - IgE mediated: mast cells release mediator resulting in vasodilation, increased permeability, smooth muscle spasm.
  2. Type II?
    What causes? Mediated by? Results in?
    • - IgG or IgM reactive with cell or matrix ass. self antigen
    • - Results in tissue damage, receptor blockage/activation
  3. Type III?
    What causes? Mediated by?
    • IgG or IgM immune complex mediated
    • tissue damage
  4. Type IV?
    What causes? Mediated by?
    • T-cell mediated
    • Delayed sensitivity
  5. Type I typical Sx
    angioedema, urticaria, rhinoconjuntivitis, wheeze, diarrhea, vomitting, ANAPHYLAXIS
  6. Syndrome of type I (x6)
    - Atopic Dermatitis (infantile eczema)

    • - Food allergy
    • - Oral allergy syndrome (OAS)
    • - Latex food syndrome

    • - Allergic rhinitis
    • - Acute urticaria
  7. Syndromes of type II
    • Haem
    •   Haemolytic anaemia + anaemia
    • - Haemolytic disease of newborn (HDN)
    • - Autoimmune haemolytic anaemia (ITP = Evan's syndrome)
    • - Pernicious anaemia
    •  Bleeding
    • - Autoimmune Thrombocytopenic Purpura

    • Eponymous
    • - Goodpasture's syndrome
    • - Graves disease

    • - Acute rheumatic fever
    • - Pemphigus Vulgaris
    • - Myasthenia Gravis

    • vasculitis
    • - Churg-Strauss syndrome
    • - Wegener Granulomatosis (GPA)
    • - Microscopic polyangiitis (MPA)

    - Chronic urticaria
  8. Syndromes of type III
    - SLE

    - Serum sickness

    • - Mixed Essential Cryoglobulinaemia
    • - Polyarteritis Nodosa (PAN)

    • - Farmer's lung
    • - Chlamydia trachomatis - reactive arthritis
  9. Syndromes of type IV
    - Type I DM

    • - Rheumatoid arthritis
    • - Multiple Sclerosis

    - Crohn's

    • - Contact Dermatisis e.g. Nickle, poison ivy
    • - Mantoux Test
  10. Syndrome of type I (x6) + antigen, antibodies
    - Atopic Dermatitis (infantile eczema)

    • - Food allergy
    • - Oral allergy syndrome (OAS)
    • - Latex food syndrome

    • - Allergic rhinitis
    • - Acute urticaria
  11. Syndromes of type II + antigen, antibodies/diagnosis
    • Haem
    •   Haemolytic anaemia + anaemia
    • - Haemolytic disease of newborn (HDN)
    •    + ag on neonatal erythrocytes
    •    + +ve direct coombs test
    • - Autoimmune haemolytic anaemia (ITP = Evan's syndrome??)
    •   + numerous autoantigen e.g Rh blood group Ag
    •   + +ve Direct Coombs test, anti red cell ab
    • - Pernicious anaemia
    •  + intrinsic factor and gastric parietal cell
    •  + anti gastric parietal cell Ab, anti-IF ab, Schilling test
    •  Bleeding
    • - Autoimmune Thrombocytopenic Purpura (AITP)
    •   + glycoprotein IIb/IIa on platelets
    •   + anti platelet ab

    • Eponymous
    • - Goodpasture's syndrome
    •   + non-collagenous domain of basement membrane collagen type IV
    •   + anti GBM ab, linear smooth IF staining of IgG deposits on BM
    • - Graves disease
    •   + TSH receptor
    •   + anti TSH-R ab

    • - Acute rheumatic fever
    •   + M proteins on Group A strep
    •   + clinical, based on Jones criteria
    • - Pemphigus Vulgaris
    •    + epidermal cadherin
    •    + direct immuno-fluorescence showing IgG deposition
    • - Myasthenia Gravis 
    •    + Acetycholine receptor
    •    + anti Ach-R ab, abnormal EMG, Tensilon test

    • vasculitis
    • - Churg-Strauss syndrome
    •    + M and S vessel vasculitis
    •    + p-ANCA (against myeloperoxidase, granulomas, eosinophils, granulocytes
    • - Wegener Granulomatosis (GPA)
    •    + M and S ves vasculiti
    •    + c-ANCA (against proteinase 3), granulomas
    • - Microscopic polyangiitis (MPA)
    •    + Pauci-immune necrotizing, small ves vasculitis
    •    + p-ANCA

    • - Chronic urticaria
    •    + meds (NSAIDs), cold, food, pressure, sun, exercise, insect stings, bites
    •    + challenge test, ESR (raised in urticaria vasculitis), skin prick testing
  12. Syndromes of type III (x6)+ antigen, antibodies/diagnosis
    • - SLE
    • + intracellular components: DNA, histones, RNP
    • + path: ANA+ve (antinuclear), anti-dsDNA, anti-sm
    • + ab to dsDNA, histones (drug induced), Ro, La, smooth muscle, U1RNP
    • + drugs can induced SLE: hydralyzine, procainamide, Isoniazid

    • - Serum sickness
    • + reaction to proteins in antiserum (penicillin)
    • + decreased C3, blood shows immune complexes, signs of blood vessels inflammation

    • - Mixed Essential Cryoglobulinaemia
    • + IgM against IgG +/- hepC antigens
    • + clinical and biopsies
    • - Polyarteritis Nodosa (PAN)
    • + hep B,C virus antigen
    • + clinical, biopsy, 'Rosary sign'

    • - Allergic alveolitis Farmer's lung
    • + mouldy hay, actinomycetes
    • - Chlamydia trachomatis - reactive arthritis
    • (synovial fluid culture is negative as it is auto-immune)
  13. Syndromes of type IV (x6) + antigen, antibodies/diagnosis
    • - Type I DM
    • + Pancreatic beta cell proteins (GAD, glutamate decarboxylase)
    • +GAD ab, Islet cell ab, blood glucose, ketouria

    • - Rheumatoid arthritis
    • + antigen in synovial membrane
    • +anti-CCP, rheumatoid factor, X-ray, ESR, CPR
    • (cyclic citrullinated protein)
    • - Multiple Sclerosis
    • + oligodendrocyte
    • (myelin basic protein, proteolipid protein)
    • + CSF shows Oligoclonal bands of IgG on electrophoresis

    • - Crohn's
    • +biopsy of lesion

    • - Contact Dermatisis
    • + Nickle, poison ivy
    • + clinical or Patch test
    • - Mantoux Test
    • + Tuberculin
  14. Other important disease x5
    • - Limited Cutaneous Scleroderma (CREST syndrome)
    • - Diffuse Cutaneous Scleroderma

    • - Sjogren's syndrome
    • - IPEX syndrome

    - Coeliac disease
  15. Other important disease x5 + antigen, antibodies/diagnosis
    • - Limited Cutaneous Systemic Scleroderma (CREST syndrome)
    •   + calcinosis, Raynauld's, eosophageal dysmotility, sclerodactyly, telangectasia
    •    + + primary pulmonary hypertension
    •    + anti-centromere ab
    • - Diffuse Cutaneous Scleroderma
    •   + CREST + GIT + intertistial pulm disease + renal prob
    •   + anti-topoisomerase / SCL70 (RNA Pol I, II, III, Fibrillarin ab)

    • - Coeliac disease
    •   + failure of tolerance to gluten, villous atrophy and enteropathy
    •   + IgA EMA (anti-endomysal ab) disappears with exclusion diet; Ireland
    •   + IgA TGT (anti-transglutaminase ab); North Africa
    •   + IgG anti-gliadin ab
    •   + Dermatitis herpetiformis
    •   + 95% have DQ2 or DQ8 (two eight or not to eat)


    • - Sjogren's syndrome
    •    + dry mouth, eyes, nose and skin  
    •    + Anti-Ro, anti-La, Schimer test to measure production of tears
    • - IPEX syndrome
    •   + Immune dysregulation, Polyendocrynopathy, Enteropathy, X-linked inheritance syndrome + autoimmune disease + Eczematous dermatitis, nail dystrophy, autoim skin conditions e.g. alopecia universalis, bullous pemphigoid

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