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43 Cards in this Set
- Front
- Back
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Grass is monoporate ("grasshole")
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Northern grasses include Timothy (Phl p), orchard, rye (Lol p), fescue, and bluegrass (Poa p); Southern grasses include Bermuda (Cyn d), Bahia and Johnson (Sor h)
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Bahia and Johnson (southern grasses) are cross-reactive; Timothy and sweet vernal (northern grasses) are cross-reactive; if in doubt, pick north-north or south-south for cross-reactivity
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Ragweed (Amb a) - profilin, cystatin; Mugwort (Art v) - profilin; Urticaceae/pellitory (Par o)
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The Chenopods/Amaranths: Pigweed (Amaranthus), Lambsquarter (Chenopodium), Wingscale/saltbush (Atriplex), Burning bush (Kochia scoparia), Russian thistle (Salsola)
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Most important cause of hay fever of the chenopods is russian thistle (salsola)
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Ragweed pollen-food associations include banana, cantaloupe, watermelon
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Ragweed may account for 75-90% of all pollen between August and October; season ends with first frost
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Sage/mugwort pollen-food associations include mugwort-celery spice, mugwort-peach, mugwort-mustard
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Plantain looks like a "doughnut"
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Dock/Sorrel (Rumex) has characteristic starch inclusion granules
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All trees pollinate in the spring, except Elm species, which pollinate in the fall, and Mountain Cedar, which pollinates in the winter
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Tree pollens: birch (Bet v), Oak (Que a), Ash (Fra a), Olive (Ole e), Mountain cedar (Jun a), Sycamore (Pla a)
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Pine looks like a mickey mouse hat; large size (50-100um) so rarely allergic
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Cypress/Juniper/Cedar all look like PacMan; Jun ashei is mountain cedar; Jun virginiana is Eastern red cedar (pollinates in spring in Eastern US); all have strong cross-reactivity within this family
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Oak is triangular shaped and cross-reacts with beech, chestnut, birch and other Betula species
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Betula family (birch, alder, hazelnut, hornbeam) may appear like lemons if only 2/3 pores visible
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Birch/Hazelnut food-pollen allergy associations: apple, almond, apricot, carrot, celery, cherry, coriander, fennel, kiwi, nectarine, parsley, parsnip, pear, pepper, plum, potato and walnut
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Strong cross-reactivity between Betula family (birch, alder, hazelnut) and Fagaceae (oak, beech, chestnut)
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Maple/box elder may appear as beach ball; box elder is wind-pollinated, and maple is primarily insect-pollinated
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Elm (Ulmaceae) may appear pentagonal
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Ash often appears like a square
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Olive, ash, privet and russian olive all cross-react
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Poplar and cottonwood appear like cufflinks with a thin outer rim; willow is not allergenically important, but aspirin is made from their bark
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Sweetgum (Hamamelidaceae) resembles a soccer ball
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Acacia looks like squares stuck together to form circle or square (16 or 4 in clump)
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Alternaria is club-shaped; prevalent outdoors as dry day mold spore; associated with severe asthma, hay fever
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Cladosporium is cigar-shaped, may be in chains; outdoors as dry day spore; also prevalent indoors
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Aspergillus is dandelion-shaped; common indoor spore; causes ABPA
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Penicillium is broom/paintbrush-shaped; common indoor spore; causes HP in cheese workers
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Helminthosporium looks like caterpillar (large cladosporium shape with inner walls); implicated in AFS
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Epicoccum is round; dry-day spores; warty surface
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Fusarium is slender sickle-shaped; transverse septa
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Ascomycetes is rainy-day spore; eight/ascus
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Stachybotrys is "black mold", often present indoors after water damage
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Common indoor spores: Aspergillus, Penicillium, Cladosporium, Rhizopus, Mucor
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Common outdoor spores:
- Dry day: Alternaria, Cladosporium, Epicoccum (ACE) - Rainy day: Ascospores, Basidiospores, Fusarium - At night/humid: Ascospores, Basidiospores - Outdoor molds usually present year-round, except with snow cover |
How to decrease mold: Dehumidify (<50%), limit house plants avoid raking/mowing/mulching, remove spoiled food from refrigerator, disinfect bathrooms with fungicide, use soapy water/bleach for cleaning
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US Dust mites: .pteronyssinus, D. farinae; Tropics: B. tropicalis; Storage mites: L.destructor, T.putrescentiae
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Dust mites depend on increased relative humidity for survival, grow best between 65-80F
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Dust mite allergens: Group 1 - Der p1, Der f1, cysteine protease homology; highly cross-reactive; present on small fecal particles; Group 2 - Der p2, Der f2, highly cross-reactive
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Der p10 is a tropomyosin; cross-reactive with other invertebrate tropomyosins (eg, shrimp, limpet)
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If predisposed to atopy, can be sensitized at mite levels of 2-10ug/g of dust; higher levels (>20ug/g) required for non-atopic children
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Fel d1 is major cat allergen (80% of cat-allergic persons react to Fel d1), made in skin, homologous to uteroglobin
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Fel d1 level >2ug/g a/w risk of sensitization; >10ug/g is risk factor for asthma in sensitive persons; minor allergens are Fel d2, d3
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Cat allergen found in 90% of US homes; remains airborne in undisturbed conditions; reducing levels takes 12-16 weeks after cat removal
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Dog allergens: Can f1 (lipocalin, major Ag - found in saliva), Can f2 (lipocalin), Can f3 (dog serum albumin, cross-reacts with mammalian albumins), Can f4 (lipocalin), Can f5 (kallikrein, major Ag; cross-reacts with human PSA - eg, sensitization could increase seminal fluid rxn risk)
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Lipocalins: Can f1,2,4; Rat n1; Mus m1; Equ C1,2; Bos (Cow) d2,5; beta lactoglobulin; Ory (Rabbit) c1; Bla g4; NOT CAT
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Cockroach: Bla g most common in crowded north american cities; P americana; B orientalis (a/w leaking water)
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Cockroach Ag from feces, saliva, frass (debris); Bla g1,2 - aspartic proteases; Bla g4 - lipocalin; Per a1 cross-reacts with Bla g1; Per a7 is tropomyosin
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Bla g2 levels >10ug/g a/w sensitization and disease; Ag carried on large particles (ex: dog, dust mites)
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Rat, mouse Ag are lipocalins, found mainly in urine; carried on small particles (eg, cat Ag) so remain airborne; significant cause of asthma in large cities
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IgG response to avian serum gamma globulin causes HP (pigeon breeder's lung, bird fancier's lung)
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Horses, cows and rabbits all have major allergens in lipocalin family
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Guinea pig - Cav p; Cat flea - Cen f; Silverfish - Lep s
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Air quality index: 0-50 = good (green); 51-100 = Moderate (yellow); 101-150 = Unhealthy for sensitive groups (orange); 151-200= Unhealthy (red); 201-300 = Very unhealthy (purple)
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NO2 - precursor to smog; fossil fuels + natural gas; a/w decreased lung function, increased airway pmn's, proinflammatory cytokines; increased Ag resonse at 0.4ppm
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O3 - Byproduct of reactions with NO, VOCs, UV light; increased in summer afternoons; INCREASES ASTHMA sx, hospitalizations and beta-agonist use; MAJOR outdoor pollutant in asthma exacerbations; unhealthy AQI at 0.065ppm
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So2 - decreases lung function in kids, causes bronchospasm at 0.5ppm; reverses with beta-2 agonists
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Particulate matter (PM) - mineral dust, organic matter, aerosolized fossil fuel combustion byproducts; small - <10um each; unhealthy AQI at 15.5ug/m3
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ETS increases indoor particulate matter, is associated with RECURRENT OM, URI, LRI, WHEEZING, CA; increases Th2 cytokines and eosinophils, and allergen sensitization
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Endotoxin originates from Gram + bacteria, molds, domestic animals; increased in homes with ETS
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NO2 comes from indoor gas appliances
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Other indoor irritants - biomass burning (eg, wood, plant fuels), household chemicals, dirty ventilation systems
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Asthmatics have decreased antioxidant levels at baseline
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ROS activate NFkB, AP1 and promote proinflammatory cytokine production
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AU/ml = allergy unit/mL; BAU = bioequivalent allergy unit/mL; standardization allows comparison to an FDA reference range
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ID50EAL is the method that determines standardized allergenicity unit (can also be done with ELISA/RAST using FDA standard for comparison)
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Venom allergen is standardized based on the content of venom proteins (hyaluronidase, phospholipase); 100ug/mL for individual species; 300ug/mL for mixed vespids
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Only 5 standardized extracts available in US: hymenoptera (hyal/phospholipase content); dust mite (AU); cat (BAU); grass (BAU); short RW (Amb a 1 major allergen content)
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Aqueous extracts - raw allergen added to saline, buffer; <50% glycerin; 0.4% phenol added as antimicrobial
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Glycerinated extracts - raw allergen extracted in 50% glycerin (or glycerin added after extraction); 50% glycerin is antimicrobial, more STABLE than aqueous extracts; 0.4% phenol added as antimicrobial
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Alum precipitated extracts - raw allergen precipitated with ALOH, forms complex that results in slower allergen release; used for rx but not SPT due to slow release; pros: LARGE doses can be given at less frequent intervals, LOWER incidence of systemic rxns
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Lyophilized extracts - freeze-dried allergen preps that need reconstitution; recommended to dilute with HSA; example of lyophilized extract: VENOM
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Acetone-precipitated extracts - technique precipitates proteins in concentrated form, removes LMW non-specific irritants; requires up to 50x more raw allergen as other extracts; used by Hollister-Stier (eg, cat, dog, cattle, horse, dust)
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To maintain stability of allergen extracts: LOW temps (36-46F); HIGHER glycerin content (50%); AVOID freeze/thaw cycles; INCREASED concentration of allergen in extract; LARGE vial volume (avoid sticking to wall of vial); AVOID mixing proteolytic enzymes (eg, COCKROACH, MOLDS, dust mite - although mite doesn't really affect pollens) - grass most susceptible to enzymes
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50% glycerin results in best allergen extract stability; also inhibits bacterial growth; may inhibit proteolytic enzymes; may cause PAIN with higher percentages of glycerin
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HSA as diluent (stabilizer/preservative) for allergen extracts - reduces sticking to wall of vial; more effective than glycerin in preventing phenol-mediated allergen degradation
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Phenol as diluent (stabilizer/preservative) - 0.4% is effective antimicrobial, but can break down allergen proteins in 50% glycerin diluents
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Thommen's Postulates of Allergenicity: 1) Must be allergenic (proteins, glycoproteins), 2) Must be anemophilous and sufficiently buoyant, 3) Must be abundant, with source widely distributed
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Most aeroallergens are 10-60um in diameter
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Mold spores can be very tiny (1-2um) or very large (100um)
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"Flashy" flowers usually insect-pollinated; "Puny" flowers usually wind-pollinated
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Monoecious - plant with male/female parts (Monoclinous - both parts within same flower; Diclinous - both parts on same plant, but not same flower);
Dioecious - male/female flowers present on different plants entirely (male plants, female plants) |
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Sampling methods: 1) Durham - uses gravity and microslides coated with jelly for 24h exposure, cheap but not very scientific; 2) Settle plates - indoor sampling with agar plates that are later incubated, cultured; 3) Rotorod - volumetric sampling with grease-coated rods, not great for small particles (float around rods), not affected by wind direction or speed; 4) Burkhard - suctions air at specific flow rate, "tail" keeps device oriented to wind, more efficient than Rotorod for small samples, consistent flow rate, can take samples over 7d, much more expensive than other samplers
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5) Adnerson - series of sieves with air drawn in, results in pollen separation by size, good for airborne fungi, good for short sampling times, expensive; 6) Allergenco - "grab type" non-wind-oriented sampling, can sample for 72h; 7) Liquid impingers - draw air into liquid, suspend allergens in liquid, good for bioaerosols; 8) Cyclonic collectors - good for dust, culturing fungi; 9) Filtration samplers - suck particles through a filter - good for dust levels, endotoxin, fungi, microorganisms (variety of sampling flow rates)
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