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126 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is the predominant T cell type in the Epithelial layer of the GI tract? Other cells?
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CD8+
Other: paneth, intraepithelial lymphs |
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What is the predominant T cell type in the lamina propria layer of the GI tract? Other cells?
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Activated CD4+
Other: Activated B cells and plasma cells (IgA), T cells, Macros, Mast cells, eosinophils |
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What is the predominant T cell type in the peyer's patches of the GI tract? Ohter cells?
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CD4+
Other: B cells, M cells (deliver antigens to Peyer's patches) |
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What chemokine + chemokine receptors bring T cells to the small intestine?
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alpha 4 beta 7
CCR9 |
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Where are paneth cells located?
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Crypts of Lieberkuhn in small intestine (epithelial layer)
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What role do intestinal epithelial cells play in mucosal immunity?
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Transport secretory IgA
Bind TLRs on bacteria/viruses Influence Treg cell expansion |
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What adhesion molecules allow IgA B cells to migrate from a LN to the gut lamina propria?
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alpha 4 beta 7
MAdCAM -1 ++gut homing integrins |
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How is IgA transported across the epithelium?
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poly Ig receptor
++transports dimerized IgA to the luminal surface and then the receptor is cleaved. The IgA molecule + the extracellular domain of the poly Ig receptor is released into the intestinal lumen. |
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Where doe the Poly Ig Receptor transport IgA? IgM?
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IgA:
++ intestinal lumen, milk, bile, saliva, sweat, sputum IgM: intestinal secretions |
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How much IgA does a normal adult secrete in one day?
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2 grams
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What ILs stimulate IgA isotype switching?
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IL-5, TGF- beta
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What specialized epithelial cells allow transport into peyer's patches?
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M cells
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What cells are responsible for EoE/eos gastritis?
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T cells and IgE B cells
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What chemokines/ ILs are thought to cause EoE?
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IL-5
Eotaxin-3 |
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In what layers to you find eosinophilic infiltrates in the gut?
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mucosal
vascular serosal |
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What do you see on endoscopoy int EoE?
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linear furrows, white plaques, concentric rings
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What do you see on endoscopy in Celiac disease?
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loss of intestinal villi
hyperplasia of crypts lymphocytic infiltrate |
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How do you screen for Celiac?
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IgA ab to TTG
Check IgA level |
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List 8 nontoxic adverse reactions to food.
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Lactase deficiency
Galactosemia Pancreatic Insufficiency Gallbladder/liver disease Hiatal hernia gustatory rhinitis anorexia nervosa auriculotemporal syndrome depression |
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What is Frey's syndrome?
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transient, unilateral and bilateral facial flushing or sweating after ingestion of spicy or flavored foods. Due to a damaged auriculotemporal nerve.
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What is scromboid fish poisening?
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ingestion of histamine in poorly handled fish causes allergic symptoms
**Usually Mahi Mahi |
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What is the prevelence of food allergies in adults? young kids?
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adults= 3-4%
young kids= 6% ++public perception is much higher (25%) |
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Where does sensitization occur in Class 1 allergens?
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GI tract-- occurs during a window of immunologic immaturity
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List examples of Class 1 allergens.
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Milk (casein, whey), Egg (ovalbumin, ovomucoid), Peanut (Vililin, conglutin, glycinin), Fish (parvalbumin), and shellfish (tropomyosin)
**Also, nonspecific lipid transfer proteins in apple and corn. **heat resistant, acid stable, water soluble |
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Where does sensitization occur in Class 2 allergens?
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respiratory tract-- IgE antibodies recognize homologous epitopes on food proteins from plants (pollen food allergy syndrome)
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What foods are the highest risk for anaphylaxis?
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peanut, tree nut, seafood
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What are the risk factors for fatal anaphylaxis?
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asthma
delayed epi young adult/teen no skin symptoms |
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Is tryptase elevated in food associated, exercise induced anaphylaxis?
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not always
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What is the antigen that is most common implicated in food associated, exercise induced anaphylaxis?
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omega- 5 gliadin
wheat and celery |
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What symptoms are associated with food induced proctocolitis?
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blood in stool
first few months of life no FTT |
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How do you make the diagnosis of food induced proctocolitis?
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SPTs
elimination diet Challenge results in symptoms in 72 hrs. |
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What symptoms are associated with food protein induced enterocolitis?
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emesis, diarrhea
FTT emesis 1-3 hrs after eating hypotension |
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How do you make the diagnosis of food protein-induced enerocolitis?
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SPTs NEG
challenge results in symptoms in 1-2 hrs. Need IV, resus equip --increased serum neutro ?TNF mediated Jejunal bx= flat vili increased lymph, eo's mast cells |
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What symptoms are associated with food protein induced enteropathy (celiac) ?
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diarrhea, steatorrhea, abdominal distention, flatulence, oral ulcers, weight loss
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How do you diagnose food protein induced enteropathy (celiac)?
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endoscopy/biopsy
IgA celiac abs elimination diet |
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What symptoms are associated with Heiner syn?
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recurrent pneumonia
hemosiderosis iron deficiency anemia FTT |
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How do you make the diagnosis of Heiner syn?
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milk precipitins
lung biopsy peripheral eosinophilia elimination diet |
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How often (what percentage) of patients with a negative serum specific IgE have clinical reactions?
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10-25%
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How often do patients with peanut allergy outgrow it? with tree nut allergy?
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PN 20%
TN 9% |
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How frequently do patients who outgrow PN/TN redevelop it?
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7-9%
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What causes pernicious anemia?
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autoantibodies to intrinsic factor and parietal cells
**mediated by CD4+, recognize a subunit of the H+/K+ ATPase |
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What is the genetic association with pernicious anemia?
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HLA- DR3
HLA-B8 |
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How do you treat penicious anemia?
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lifelong B12 supplement
*causes neurologic damage if not treated. |
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What foods have gluten?
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Wheat, barley, rye
some oats |
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What is the genetic association with celiac?
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HLA-DQ8
HLA-DQ2 |
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What test should be sent for celiac?
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anti IgA gTG (higher sensitivity and specificity than IgG tTG); also send total IgA to interpret
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What symptoms are associated with eosinophilic esophagitis?
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FTT, abd pain, gastric dysmotility, emesis, diarrhea, dysphagia, food impaction
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Type I Autoimmune Hepatitis affects what age group? What antibodies are positive?
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ANY age
ANA ss/ds DNA pANCA smooth muscle actin soluble liver or pancreas antigen |
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Type II Autoimmune Hepatitis affects what age group? What antibodies are positive?
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CHILDREN
Type I DM Arthritis Autoimmune Thyroiditis Sjogren Syndrome Vitiligo Autoantibody to cytochrome P450D6 (CYP2D6) |
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Type III Autoimmune Hepatitis affects what age group? What antibodies are positive?
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ANY age
anti-liver-kidney-microsomes 1 liver-cytosol antigen Soluble liver or pancreas Ag some overlap with primary biliary chirrhosis |
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What clinical features are associated with autoimmune hepatitis?
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jaundice, dark urine, abdominal pain, anorexia, amenorrhea, delayed menarche, HSM, spider nevi, cushingoid features
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What abnl labs are associated with autoimmune hepatitis?
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increased LFTs, bili, hypergammaglobulinemia
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What happens in primary biliary cirrhosis?
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chronic inflammation of the INTRAHEPATIC bile ducts, leads to the disappearance of the ducts, chronic cholestasis, hepatic fibrosis, cirrhosis, liver failure
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What is the genetic association with primary biliary cirrhosis?
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HLA-A0201
HLA-DR8 HLA-DR |
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What lab is diagnostic for primary biliary cirrhosis?
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anti mitochondrial antibody
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What is primary sclerosing cholangitis?
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intrahepatic AND extrahepatic bile duct inflammation, fibrosis, and stricture
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What are risk factors for the development of primary sclerosing cholangitis?
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almost 90% have UC
men > women (2:1) |
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What is the genetic association seen with primary sclerosing cholangitis?
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HLA-B8
HLA-DR3 HLA-DRw52 |
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What immune cells are present in the bile ducts in patients with primary sclerosing cholangitis?
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CD8 >CD4. CD4s have abberant MHC Class II and ICAM1
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What antibody is positive in patients with primary sclerosing cholangitis?
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ANA
anti-smooth muscle anitbody |
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What symptoms are seen in patients with primary sclerosing cholangitis?
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pruritus
hyperpigmentation xanthelasma jaundice recurrent fever pain |
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What sequelae are often seen in patients with primary sclerosing cholangitis?
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cirrhosis
increased risk of cholangiocarcinoma |
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How does smoking affect patients with UC? Chrons?
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smoking is advantageous for pts with UC, not Crohns
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What genetic mutation is seen in pts with Crohns?
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NOD2/CARD15
*20-25% |
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What disease other than Crohn's has a defect in NOD2/CARD15?
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Blau syndrome:
What is Blau syndrome? |
Blau syndrome is a rare autosomal dominant disorder characterized by granulomatous polyarthritis, panuveitis, cranial neuropathies, and exanthema
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What ethnic groups have an increased frequency in Crohns?
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Ashkenazi Jews
African Americans |
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What features (other than GI) are seen in patients with UC?
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arthralgia
arthritis sacroiliitis |
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How do you performe a food challenge? What #mg do you start with? end with?
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Start with 125-500mg (fasting state)
Increase every 15-60 mins Clinical reactivity ruled out at 10 grams |
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In a patient >2yrs, what is the value (kUa/L) where there is a >95% chance of reaction to EGG upon food challenge?
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Egg (>2yrs) = 7 kUa/L
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In a patient <2yrs, what is the value (kUa/L) where there is a >95% chance of reaction to EGG upon food challenge?
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Egg (<2yrs) = 2 kUa/L
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In a patient >2yrs, what is the value (kUa/L) where there is a >95% chance of reaction to MILK upon food challenge?
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MILK (>2yrs) = 15 kUa/L
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In a patient <2yrs, what is the value (kUa/L) where there is a >95% chance of reaction to MILK upon food challenge?
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MILK (<2yrs) = 5 kUa/L
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In a patient with history of peanut allergy, what is the value (kUa/L) where there is a >95% chance of reaction to PEANUT upon food challenge?
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PEANUT= >14 kUa/L
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In a patient with history of fish allergy, what is the value (kUa/L) where there is a >95% chance of reaction to FISH upon food challenge?
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FISH= >20 kUa/L
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In a patient with history of soy allergy, what is the value (kUa/L) where there is a >75% chance of reaction to SOY upon food challenge?
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SOY= >30 kUa/L
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In a patient with a history of wheat allergy, what is the value (kUa/L) where there is a >75% chance of reaction to WHEAT upon food challenge?
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WHEAT= >26 kUa/L
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In a patient with history of reaction to tree nuts, what is the value (kUa/L) where there is a >95% chance of reaction to TREE NUTS upon food challenge?
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TREE NUTS= >15 kUa/L
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What is the most common food allergy in children?
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Cow's MILK (casein and whey-- not denatured by pasteurization)
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Is there cross reactivity amond various types of milk?
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10% with beef
92% with goat's milk 4% with mare's milk |
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What is more allergenic, egg's white or egg yolk?
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Egg WHITE
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What are the proteins in egg white that kids are most allergic too?
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Gammaglobulin
Apovitellin Other= ovomucoid, ovalbumin, and ovotransferrin |
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How prevelant is wheat allergy in children?
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0.4%
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What proteins are the major allergens in IgE mediated reactions to WHEAT?
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Globulin
Glutenin |
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What WHEAT protein is the major allergens in a Celiac disease?
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Gliadin
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What protein in WHEAT is the major allergen in a patient with Baker's Asthma?
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Albumin
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What are the major allergens that cause allergy to PEANUT?
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Ara h1
Ara h2 Ara h3 What allergen mediates Oral Allergy Syndrome to peanut? |
Ara h8
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What is the % crossreactivity between PEANUT and other legumes (PEA)?
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5%
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What is the estimated prevelence of SOY allergy in kids?
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0.4%
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What is the % crossreactivity between PEANUT and other legumes (SOY)?
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5%
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What is the estimated prevelence of TREE NUT allergy in kids?
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0.6%
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Within the TREE NUT family, what nuts have the highest cross reactivity?
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PISTACHIO and CASHEW
WALNUT and PECAN |
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What is the major food allergen in CODFISH that causes allergy?
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CODFISH= Gal c1
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What is the major food allergen in SALMON that causes allergy?
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SALMON= Sal s1
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What 2 families are shellfish divided into?
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Crustaceans
Mollusks |
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What is the dominant allergen in FINNED FISH?
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FINNED FISH= Parvalbumin
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What is the dominant allergen in SHELLFISH?
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SHELLFISH= Tropomyosin
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What invertebrates have tropomysin as their dominant allergen? What other species also shares this?
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COCKROACH
DUSTMITE **SHELLFISH shares |
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How often do shellfish allergens cross react?
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75%
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What is included in the CRUSTACEAN family?
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SHRIMP
CRAB LOBSTER |
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What is included in the MOLLUSK family?
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CLAM
OYSTER MUSSELS |
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What is the % cross reactivity between crustaceans and mollusks?
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not well defined
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List the 4 Casein allergenic proteins.
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alpalpha s1- Casein
alpalpha s2- Casein beta Casein kappa Casein |
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What is the major food allergen associated with all the CASEINS?
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Bos d 8
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List the 3 whey allergenic proteins.
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Beta Lactoglobulin
Alpha Lactalbumin Serum Albumin |
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What is the major food allergen associated with all the WHEYS?
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Beta Lactoglobulin= Bos d 5
Alpha Lactalbumin= Bos d 4 Serum Albumin= Bos d 6 |
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List the 3 chicken egg white allergenic proteins.
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Ovalbumin
Ovomucoid Ovotransferrin |
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What is the major allergenic determinant associated with each chicken egg white allergen?
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Ovalbumin= Gal d 1
Ovomucoid= Gal d 2 Ovotransferrin= Gal d 3 |
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What are the major allergenic proteins in PEANUT?
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VICILLIN
CONGLUTIN GLYCININ |
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What is the major allergenic determinant for each allergenic protein in PEANUT?
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VICILLIN= Ara h1
CONGLUTIN= Ara h2 GLYCININ= Ara h3 |
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What are the major allergenic proteins in SOY?
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GLYCININ G1 acidic chain
PROFILLIN |
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What is the major allergenic determinant for each allergenic protein in SOY?
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GLYCININ G1 acidic chain
PROFILLIN= Gly m3 |
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What are the foods associated with Major Class I Food Allergen Lipid Transfer Proteins and what is the major determinant associated with each?
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APPLE = Mal d3
APRICOT= Pru ar3 PEACH= Pru p3 PLUM= Pru d1 CORN= Zea m14 |
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What is the mneumonic to recall the common food allergens and major determinants?
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MILK proteins are the BOSs
The CHICKEN GALlantly defends his EGGS. CODFISH GADda swim upstreasm SOY GLYdes into many recipes. A bad APPLE is MAL. JUGhead hits his head on WALNUTS. Most people are PRUdent about their fruit (Plum, Peaches, Apricot, Cherries). Bella eats CORN with ZEAl. |
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What are the 2 major protein groups in LATEX allergy, the foods associated with each group, and and major anitgenic determinants specific to each food in LATEX allergy?
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Group1= Class I Chitinases
--avacado, chestnut, banana --?? major determinants Group 2= Thaumatin-like -Cherry: Pru a2 -Apple: Mal d2 |
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What is the major protein group in BIRCH allergy, the foods associated with it, and the major antigenic determinants on each food associated with BIRCH Class II allergy?
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Group= Bet V1
**Pathogen related proteins 10 APPLE= Mal d1 CHERRY= Pru a1 PEAR= Pyr a1 CELERY= Api g1 CARROT= Dau c1 POTATO= ? |
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What is the major protein group in CELERY-MUGWORT SPICE allergy, the foods associated with it, and the major antigenic determinants on each food associated with CELERY MUGWORT SPICE Class II allergy?
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Bet V2= Profillins
LATEX= Hev b8 CELERY= Api g4 POTATO= ? CHERRY= Pru av4 PEAR= Pyr c4 PEANUT= Ara h5 SOY= Gly m3 APPLE= ? TOMATO= ? CARROT= ? |
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What are the 5 plant protein groups associated with SEED STORAGE PROTEIN allergy? What foods are associated with each group and what are the major antigenic determinants on each food?
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Group 1: 2S Albumin
- Mustard: Sin a1 - English Walnut: Jug r1 - Rapeseed: ? - Brazil Nut: ? Group 2:Vicilin - Peanut: Ara h1 - Walnut: Jug r1 Group 3: Conglutin - Peanut: Ara h2 Group 4: Glycinin - Peanut: Ara h3 - Soy: ? Group 5: Beta- Glycinin - Soy: ? |
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What are the cross reacting foods with BIRCH- Bet V1 pollen?
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apple,apricot,cherries,plums, kiwi,
potato, celery, carrot hazelnut, almond, walnut |
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What are the cross reacting foods with RAGWEED- Amb A1 pollen?
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Banana,Cucumber, Watermelon, Canteloupe, Honeydew, Zucchini, Dandelions, Chamomile Tea
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What are the cross reacting foods with GRASS pollen?
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Peaches
Orange Melon Celery Tomato |
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What are the cross reacting foods with MUGWORT pollen?
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Apple
Kiwi Celery Carrots Sunflower |
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What are the cross reacting foods with ALDER pollen?
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Apples, Cherries, Pear, Peaches, Celery, Parsley, Almonds
Hazelnut |
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What are the cross reacting foods with LATEX allergen?
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Avocado
Banana Kiwi Papaya Potato Tomato Chestnut |
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What are the foods with lipid transfer proteins?
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Fruits (peach, apple)
Veggies Peanut Treenut |
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What are the foods with profillins?
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Fruits
Veggies (Carrots) Birch Tree Latex Grasses |
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