Immunology Review Corner

Chapter 83 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Drs. Karla R. Davis, Landstuhl Regional Medical Center, Germany, and Soo Kim-Delio, Walter Reed Army Medical Center.

Chapter 83: Anaphylaxis and Anaphylactoid Reactions

1. Anaphylaxis associated with which of the following agents occurs more frequently in men than in women?
A. Aspirin
B. Intravenous muscle relaxants
C. Latex
D. Stinging insects

2. Atopic individuals have an increased incidence of anaphylaxis to which of the following?
A. Hymenoptera stings
B. Insulin
C. Latex
D. Muscle relaxants

3. Which of the following statements regarding factors affecting the incidence or severity of anaphylaxis and anaphylactoid reactions is the most accurate?
A. Females are affected more frequently than males in all age groups.
B. The incidence of anaphylaxis is increased in urban, as compared with rural, environments.
C. The likelihood of a second episode of anaphylaxis decreases as the time between the original event and readministration of the antigen increases.
D. Anaphylactic reactions to penicillin are more common in atopic individuals.

4. Which mediator is capable of converting angiotensin I to angiotensin II?
A. Carboxypeptidase
B. Cathepsin G
C. Chymase
D. Tryptase

5. Cardiac effects of histamine are mediated through H1 and H2 receptors. Which of the following effects is produced by H1 receptor stimulation?
A. Increased force of ventricular contraction
B. Increased force of atrial contraction
C. Increased rate of atrial contraction
D. Hastened diastolic depolarization at the sinoatrial node

6. Multiple mediators are recruited during anaphylaxis and anaphylactic events, activating multiple inflammatory pathways. Which of the following has been demonstrated to be increased in patients with severe anaphylactic reactions?
A. C3
B. C3a
C. Factor V
D. Fibrinogen

7. Nitric oxide is synthesized from L-arginine through the activity of nitric oxide synthase (NOS). Of the options listed below, where is inducible nitric oxide synthase (iNOS) found?
A. Endothelium
B. Platelets
C. Smooth muscle
D. Skeletal muscle

8. Signs and symptoms of anaphylaxis may vary in individual patients. Overall, the most frequent manifestations of anaphylaxis ranked from most common to least common are which of the following?
A. Cutaneous, Gastrointestinal, Respiratory, Hypotension
B. Cutaneous, Respiratory, Hypotension, Gastrointestinal
C. Cutaneous, Respiratory, Gastrointestinal, Hypotension
D. Respiratory, Cutaneous, Hypotension, Gastrointestinal

9. Which of the following best describes the time course of histamine elevation in association with an anaphylactic episode?
A. Begins to rise in 5-10 minutes, remains elevated for 30-60 minutes
B. Begins to rise in 5-10 minutes, peaks in 60-90 minutes
C. Begins to rise in 5-10 minutes, remains elevated for as long as 5 hours
D. Begins to rise in 30-60 minutes, remains elevated for 60-90 minutes

10. What is the appropriate dose and route of administration for Epinephrine for initial management of an adult with anaphylaxis?
A. 0.01 mg/kg of a 1:1000 solution IM in the deltoid
B. 0.1 mg of 1:1000 aqueous solution diluted in 10mL Normal Saline IV
C. 0.1-0.3 mL of a 1:1000 solution IM in the lateral thigh
D. 0.3-0.5 mL of a 1:1000 solution IM in the lateral thigh

Answers:
1. D, page 1499
2. C, page 1500
3. C, pages 1500-1501
4. C, page 1504
5. D, page 1505
6. B, page 1505
7. C, page 1506
8. B, page 1508
9. A, page 1512
10. D, pages 1514-1516