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37 Cards in this Set

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1. Describe the role of IgE antibody in atopic disease.

1. Atopic individuals produce large amounts of IgE antibody in response to antigens that do not elicit IgE responses in other people
2. In an atopic individual, mast cells are coated with IgE antibody specific for the antigen(s) to which the individual is allergic.
3. This process of coating mast cells with IgE is called sensitization, because coating with IgE specific for an antigen makes the mast cells sensitive to activation by subsequent encounter with that antigen.
1. Briefly outline the steps involved in IgE production (include the role of T cells and cytokines).
1. In individuals who are prone to allergies, exposure to some antigens results in the activation of Th2 cells and the production of IgE antibody
2. Two of the cytokines secreted by Th2 cells, interleukin-4, and IL-13, stimulate B lymphocytes specific for the foreign antigens to switch to IgE-producing plasma cells.
1. List the most important mast cell mediators of allergic reactions and their actions.
1. The most important mediators produced by mast cells are vasoactive amines and proteases
2. They are responsible for acute vascular and smooth muscle reactions and inflammation, the hallmarks of immediate hypersensitivity
1. Distinguish the “early phase” and “late phase” allergic reactions and the mediators involved.
1. Early phase – Histamines produced by the activation of mast cells by the IgE
2. Late phase – cytokines produced by mast cells stimulate the recruitment of leukocytes, which cause the late-phase reaction.

Explain the pathogenesis of allergic rhinitis.

1. It affects 10-30 percent of children and adults in the U.S. while creating a significant economic impact in terms of clinician visits, lost school and work days, and medications

Briefly summarize the epidemiology and impact of allergic rhinitis in the United States.

1. It affects 10-30 percent of children and adults in the U.S. while creating a significant economic impact in terms of clinician visits, lost school and work days, and medications

Describe the primary symptoms associated with allergic rhinitis.

1. Sneezing, rhinorrhea, nasal obstruction and nasal itching

List the major additional conditions associated with allergic rhinitis

1. Postnasal drip, cough, and irritability

Explain the mechanisms of skin tests and in vitro tests used for atopic diseases and describe the positive results

1. A needle is used to inject an allergen and watch for a wheal and flare reaction
2. Blood draw to check for IgE

What is an allergy

1. IgE-mediated immediate hypersensitivity reaction


What is an allergen

A substance that causes a hypersensitivity reaction

What is atopy

Genetically predisposed for an allergy

What is hypersensitiviity

An excessive immune response

Describe Reoviridae

1. Non-enveloped, icosahedral capsid
2. dsRNA (10-12 segments, ~18-20 kbp total size)
3. Some serotypes can cause mild URTI’s, common cold
4. Not a major etiology of URTI’s
5. No antivirals or vaccine, supportive care, hand washing

Describe Picornaviridae (Polio)

non-enveloped, icosahedral capsid
2. (+) ssRNA
3. Over 100 serotypes
4. Estimated to cause 50% of URTI’s
5. Optimal growth at 33 C
6. Spread by respiratory droplets, hand to face contact
7. Major cause of antibiotic misuse

What are the Entero viruses

1. Echovirus
2. Coxsackie Virus
3. Enterovirus

Describe Coronaviridae

1. Enveloped, helical capsid
2. (+) ssRNA
3. Usually infects GI or URT
4. Enveloped glycoproteins in EM image appear like a halo or ‘corona’
5. Spread by aerosol droplets contacting mucous membranes
6. Usually mild to moderate illness, short duration
7. Runny nose, cough, sore throat, fever
8. Sometimes can spread to LRT and cause pneumonia
9. No antivirals or vaccine available
10. ID by PCR and/or serology

Describe SARS

1. Rapid onset
2. Infects the lungs, GI tract, liver and kidneys
3. Disease is limited to the lungs
4. Average incubation period: 4-6 days
5. Natural reservoir is bats

Describe MERS-CoV

1. Most infections result in severe respiratory illness
2. Roughly 50% mortality rate

Describe Bunyaviridae

1. Enveloped, helical capsid
2. (-) ssRNA
3. Natural reservoir; mice
4. No person to person transmission

Describe Parvoviridae

1. Non-enveloped, icosahedral capsid
2. ss linear
3. commonly seen in dogs and cats
4. typically associated with childhood infections
5. most commonly found in association with other viruses

Describe Adenoviridae

1. non-enveloped, icosahedral capsid
2. ds linear (associated with viral histone-like proteins)
3. transmission by direct contact, waterborne or fecal-oral route
4. genome divided into immediate-early, early and late genes
5. modulates cell cycle to gain access cellular DNA polymerase for genome replication
6. diseases include – common cold, keratoconjunctivitis, acute hemorrhagic cystitis, gastroenteritis, pharyngoconjunctival fever

Identify the most common etiologies of viral URTI’s

Picornaviruses ~ 50% of cases


Coronaviruses 10-20% of cases


Adenoviruses 5% or cases


Paramyxoviruses 10-15% of cases


Orthomyxoviruses 10-15% of cases


Parvoviruses, Reoviruses, and Bunyaviruses are rare

1. Discern fact from fiction in regard to myths about the common cold

1. Usually 5-14 days


2. Nasal congestion, sore throat, malaise, fever


3. Encompasses diseases of larynx, pharynx, sinuses


4. Most caused by viruses, fall and winter prevalence


5. Treatment aimed at managing symptoms

1. Recognize the diagnostic tests available for virus identification

ID by PCR, serology, sequencing, virus isolation, microscopy

1. Recognize the importance of global travel and epidemiology in tracking new emerging viral causes of URTI’s

1. Understanding where the individuals have traveled and how the virus spreads will help to determine the initial location of the virus

1. Explain the use of first and second generation antihistamines in allergic rhinitis.

1. Antihistamines compete with histamine for the H1 receptor sites that contribute to sneezing, itching, rhinorrhea, and conjunctivitis.
2. They also inhibit mast cell activation but generally do not improve nasal congestion

1. Compare the first generation antihistamine diphenhydramine, the second generation agents loratadine and fexofenadine and the intranasal antihistamine azelastine in terms of sedative effects and ability to cross the blood-brain barrier

1. First generation cross the blood-brain barrier and have significant sedative and anticholinergic effects
2. Second generation do not cross the blood-brain barrier and are nonsedating

1. Compare the first generation antihistamine diphenhydramine, the second generation agents loratadine and fexofenadine and the intranasal antihistamine azelastine in terms of anticholinergic effects

1. first generation demonstrate decreased motor skills, diminished driving ability, and reduced cognition

1. Compare the first generation antihistamine diphenhydramine, the second generation agents loratadine and fexofenadine and the intranasal antihistamine azelastine in terms of duration of action

1. second generation have a longer duration

1. Discuss the use of intranasal corticosteroids (a.k.a. topical intranasal glucocorticoids) versus systemic oral corticosteroids for the treatment of allergic rhinitis.

1. Intranasal corticosteroids provide a 50 to 90% reduction in symptoms. In contrast to antihistamines, topical corticosteroids reduce nasal congestion in addition to relieving itching, rhinorrhea, sneezing, and allergic conjunctivitis.

Explain the mechanism of action and role of fluticasone, triamcinolone, beclomethasone, and mometasone (corticosteroids) in treating allergic rhinitis

1. Corticosteroids inhibit T-lymphocyte mucous secretion, vascular permeability, and mast cell proliferation.
2. The efficacy of intranasal corticosteroids emphasizes the importance of non-histamine mechanisms to the pathophysiology of AR

Explain the mechanism of action and role of cromolyn ( a mast cell stabilizer) in treating allergic rhinitis

1. cromolyn stabilizes mast cells and mediates additional anti-inflammatory activities toward macrophages and T lymphocytes.
2. Provides relief in patients with mild to moderate symptoms and controls nasal congestion

Explain the mechanism of action and role of montelukast (a leukotriene modifier)


in treating allergic rhinitis

1. a pro-inflammatory vasoactive mediator
2. reduces sneezing, rhinorrhea, and nasal congestion in patients with SAR
3. improves nasal and ocular symptoms as well as quality of life in patients with SAR and PAR

Explain the mechanism of action and role of ipratropium (an anticholinergic)


in treating allergic rhinitis

Block M receptors allowing the sympathetic nervous system to take over

Explain the mechanism of action and role of


phenylephrine and pseudoephedrine (decongestants)


in treating allergic rhinitis

1. treat nasal stuffiness but are mild stimulants
2. usually used in combination with antihistamines to control the full spectrum of AR symptoms

1. Indicate the most common side effect(s) associated with antihistamines, decongestants, corticosteroids, mast cell stabilizers and leukotriene modifiers used in the treatment of allergic rhinitis.

1. Antihistamines – decreased motor skills, diminished driving ability, and reduced cognition
2. Decongestants -
3. Corticosteroids – topical side effects, include local irritation, dryness, and epistaxis
4. Mast cell stabilizers – no significant side effects