Disorders in immunity

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1

Name the two major categories of immune dysfunction

-Hypersensitivity 
-Hyposensitivity

2

Identify the four types of overreaction to antigens.

-type I: immediate reactions - B cells (IgE)
-type II: antibody-mediated - B cells (IgG & IgM)
-type III: immune complex reactions - B cells (IgG & IgM)
-type IV: delayed/cell mediated - T cells & macrophages

3

Gives examples of disorders for each type of reaction.

Type 1: anaphylaxis, hay fever, asthma
type 2: hemolytic dz of newborn, myasthenia gravis
type 3: lupus, RA, arthus reaction, serum sickness
type 4: TB skin test, poison ivy, graft rejection

4

Define allergen and distinguish among inhalant, ingestant and contactant types. Give examples of each category.

Allergen – an antigen which allergic individuals are sensitive to 
-Inhalant: allergens which enter the respiratory tract (dust, dander, pollen) 
-Ingestant: allergens which enter the gastrointestinal tract (food, drug) 
-Injectant: allergens which enter via a shot or venom from stings (drugs injected, bee venom)  -Contactant: allergens which enter via the skin (chemicals, dyes, latex)

5

Describe the sequence of events after secondary exposures to allergens.

Primary exposure – also called the “Sensitizing Dose” 
-Allergen is phagocytized, processed, and presented to a T-helper cell. 
-T-cell is activated and presents allergen (or secretes cytokines) to activate a B-cell. 
-B-cell proliferates and differentiates in to Plasma cells (which produce IgE antibodies rather
than IgM or IgG antibodies) and Memory cells
-IgE antibodies attach via the Fc portion of the Ab to the cell membrane of a mast cell.
Secondary exposure – also called the “Shocking Dose” 
-Allergen is encountered for the second time and binds to Memory cells – which “re-sensitize” the body (see Sensitizing Dose) to the allergen
-Allergen also binds to the free Fab (antigen binding) region of IgE Ab on sensitized Mast cells. 
-When several adjacent Ab are bound with allergen, the cell degranulates. 
-Degranulation releases chemical mediators which cause allergic symptoms (hives, itchy, red, watery eyes, nasal congestion, puffiness around eyes, sneezing, headache, and sometimes difficulty breathing).

6

Explain why systemic anaphylaxis is so serious.

Systemic anaphylaxis involves a severe, systemic reaction which affects the respiratory and circulatory systems. Persons with a severe anaphylactic reaction can go into anaphylactic shock and stop breathing. Death can occur within 15 minutes if not treated.

7

Briefly describe two methods for diagnosing allergies.

-In vivo (in the living organism) - Skin test – small amounts of allergen are injected or scratched
into the skin and monitored for wheal response (bumps)
-In vitro (in the living tissue outside the body)
o Serological tests – for IgE levels (RAST, radioallergosorbent test)
o Leukocyte histamine release test
o Differential blood cell count
o Elevated blood levels of tryptase (released by mast cells during allergic response)

8

Discuss the mechanism of action of “allergy shots”.

-Desensitization - controlled injections of allergen (small but increasing doses every two
weeks)
o Produces IgG antibodies which block the allergen from binding IgE on mast cells
-Drugs which block allergies –
o Corticosteroids (inhibit lymphocytes)
o Antihistamines – block histamine
o Aspirin – blocks prostaglandin
o Cromolyn – prevents degranulation of mast cells o Epinephrine – opens airways in an asthma attack o Leukotriene inhibitors – ie., Advair

9

List the major immune system components involved in Type II hypersensitivity.

-IgG and IgM antibodies tag cells (or target cells) for destruction 
-Complement Activation – causes lysis of targeted cells

10

Explain the basis for the ABO blood groups, and what type of antibody to the ABO antigens different individuals might have

-“A” type blood cells have A antigens and B antibodies
-“B” type blood cells have B antigens and A antibodies
-“O” type blood cells have neither A nor B antigens and both A and B antibodies
-“AB” type blood cells have A and B antigens and no antibodies

11

Identify which blood types are considered universal donors and universal recipients.

-AB is considered the “Universal Recipient”
-O is considered the “Universal Donor”

12

Explain under what circumstance the Rh factor can be problematic for newborn babies.

If the mother is Rh- and the fetus is Rh+ and the mother has already been sensitized to the Rh+ antigen by a previous pregnancy

13

Specify how Type III hypersensitivity is similar to, and also differs from, Type II hypersensitivity.

-Type II targets cells using antibodies attached to the targeted cell – targets the cells for destruction
-Type III targets cells using antigen-antibody (Ag/Ab) complexes which are of intermediate size and which cause neutrophils to migrate to the area that they get caught in and degranulate – causing damage to tissues.

14

Provide highlights about the Arthus reaction and serum sickness.

-Arthus reaction: localized reaction at the site of injection due to inflamed blood vessels in the
vicinity of any injected antigen
-Serum sickness: systemic reaction throughout the blood and settle into various tissues causing destruction at the site (due to neutrophils degranulating)
-Similar, but different from anaphylaxis because
o Depend on IgG, IgM, IgA rather than IgE
o Require large doses of antigen
o Symptoms are delayed rather than immediate

15

Describe the pathogenesis of contact dermatitis.

First exposure
o Allergen enters the skin and is engulfed by macrophages just under the skin
o Macrophages engulf, process, and present antigen to T-helper cells which proliferate and differentiate into many T-helper1 cells (Sensitized)

Second exposure
o Allergen is processed and presented by macrophages to T-helper cells
o T-helper cells proliferate and differentiate into T-helper1 cells and memory cells
o T-helper 1 cells activate macrophages
o Macrophages secrete cytokines which cause the contact dermatitis (delayed hypersensitivity reaction on the skin)

16

Provide the names for four different sources of graft material.

-autograph: self
-isograft: identical twin
-allograft: close match from same species
-xenograft: different species

17

List the target cells for the following autoimmune diseases.
1.Graves disease
2.Myasthenia Gravis
3.Type I diabetes
4.Multiple sclerosis
5.RA and Ankylosing spondylitis
6.Lupus

1. Thyroid Stimulating Hormone (TSH) receptors
2.(ACh) receptors on postsynaptic membrane of synapse of the neuromuscular junction
3.T-cells attack insulin producing cells in the pancreas
4. T-cells and antibodies attack myelin sheath
5. Immune complexes collect in the joints
6. Immune complexes collect in various organs

18

Distinguish between primary and secondary immunodeficiencies.

-Primary Immunodeficiencies: present at birth (congenital) and usually stemming from genetic errors
-Secondary immunodeficiencies: acquired after birth caused by natural or artificial agents

19

Explain severe combined immunodeficiency. What type of cells are people with SCID lacking?

-Complete absence of lymphocyte stem cells in the bone marrow
-Loss of both B-cells and T-cells (not just immature, but all forms of lymphocytes)

20

Name four conditions that can cause secondary immunodeficiencies.

-Infection 
-Organic/Non-infectious Metabolic Disease (liver, diabetes, kidney disease) 
-Chemotherapy 
-Radiation


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