Immunology Review Corner

Immunology Review Corner: Chapter 73 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Dr. Karla R. Davis, Walter Reed Medical Center

Chapter 73: Occupational Asthma

1. Which of the following agents is (are) most commonly associated with Irritant-Induced Asthma (IrIA)?
A. Acrylate
B. Amines
C. Ammonia
D. Anhydrides

2. Which of the following agents, associated with occupational asthma (OA), is a high molecular weight agent?
A. Choramine-T
B. Formaldehyde
C. Latex
D. Wood dust

3. Which of the following low molecular weight agents induces specific IgE antibodies, probably by acting as a hapten and binding with proteins to form a functional antigen?
A. Gum
B. Latex
C. Seafood
D. Trimellitic anhydride

4. Which of the following agents can act as a complete antigen?
A. Flour
B. Persulfate
C. Platinum Salt
D. Trimellitic anhydride

5. Which of the following cell types plays a central role in occupational asthma without the production of IgE antibodies?
A. CD4+ T cells
B. CD8+ T cells
C. Gamma-delta T cells
D. Double-negative T cells

6. Which of the following agents associated with occupational asthma can activate complement in high concentrations?
A. Anhydrides
B. Diisocyanates
C. Persulfate
D. Plicatic acid

7. Cigarette smoking influences sensitization and asthma resulting from exposure to which of the following compounds?
A. Colophony
B. Diisocyanates
C. Platinum
D. Western Red Cedar

8. The presence of which of the following alleles is thought to be protective in both Western red cedar and diisocyanate-induced occupational asthma?
A. DQB1*0104
B. DQB1*0301
C. DQB1*0302
D. DQB1*0501

9. Which of the following statements regarding the diagnosis of occupational asthma is the most accurate?
A. A negative methacholine challenge test when the patient is off work and symptom-free excludes the diagnosis of occupational asthma.
B. Specific challenge testing for occupational asthma has not been demonstrated to yield either false-positive or false-negative results.
C. Serial peak expiratory flow (PEF) monitoring should be conducted every 2 hours for at least 2 weeks while at work and 2 weeks away from work in order to achieve the greatest sensitivity and specificity for the diagnosis of occupational asthma.
D. Patients with occupational asthma demonstrate an increase in sputum eosinophils and eosinophil cationic proteins during periods of work exposure, as compared to periods away from work.

10. Which of the following statements regarding occupational asthma and diisocyanates is the most accurate?
A. Atopy and smoking are risk factors for the development of Toluene diisocyanate (TDI)-induced occupational asthma.
B. Approximately 5 to 10 percent of workers exposed to diisocyanates develop occupational asthma.
C. Specific IgE antibodies to Toluene diisocyanate (TDI) are found in the majority of patients with documented disease by specific challenge tests.
D. Patients with occupational asthma due to Methylene diphenyl diisocyanate (MDI) have a better prognosis than those with occupational asthma due to either Hexamethylene diisocyanate (HDI) or Toluene diisocyanate (TDI).

Answers:
1. C, Pages 1333-1334
2. C, Page 1334
3. D, Pages 1334-1335
4. A, Page 1335
5. B, Page 1335
6. D, Page 1335
7. C, Page 1342
8. D, Page 1342
9. D, Page 1345
10. B, Pages 1347-1348