Immunology Review Corner

Chapter 80 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 in Germany, and Soo Kim-Delio, Walter Reed Army Medical Center.

Chapter 80: Immunotherapy for Inhalant Allergens

1. Allergen immunotherapy results in a prompt increase in allergen-specific IgG antibodies. Which IgG subclass initially predominates?
A. IgG1
B. IgG2
C. IgG3
D. IgG4

2. Allergen immunotherapy results in a prompt increase in allergen-specific IgG antibodies. Which IgG subclass has a pronounced increase by the second year of immunotherapy?
A. IgG1
B. IgG2
C. IgG3
D. IgG4

3. Which of the following is increased in patients receiving allergen immunotherapy?
A. Basophil responsiveness to histamine
B. Percentage of B lymphocytes expressing CD23
C. Percentage of CD8+ T lymphocytes
D. Serum levels of soluble IL-2R

4. In subjects treated with specific immunotherapy, nasal biopsy specimens taken 24 hours after exposure to allergen demonstrate increases in which of the following?
A. Activated eosinophils
B. Infiltrating CD4 + T lymphocytes
C. mRNA for interferon gamma
D. Total eosinophils

5. What are the general guidelines for the duration of inhalant allergen immunotherapy?
A. Continue for 3-5 years, regardless of patient symptoms
B. If successful, continue for 3-5 years, in most cases
C. If successful, continue for 3-5 months, in most cases
D. Continue indefinitely

6. Patients with asthma are at greater relative risk to have a fatal reaction to allergen immunotherapy than patients who only have rhinitis. At which percentage of FEV1 should patients not receive immunotherapy?
A. FEV1 less than 80 percent of predicted before medication
B. FEV1 less than 80 percent of predicted after medication
C. FEV1 less than 70 percent of predicted before medication
D. FEV1 less than 70 percent of predicted after medication

7. What is the target effective maintenance dose for ragweed in allergen immunotherapy?
A. 7 micrograms per injection at maintenance
B. 12 micrograms per injection at maintenance
C. 15 micrograms per injection at maintenance
D. 18 micrograms per injection at maintenance

8. What is the target effective maintenance dose for cat in allergen immunotherapy?
A. 7 micrograms per injection at maintenance
B. 12 micrograms per injection at maintenance
C. 15 micrograms per injection at maintenance
D. 18 micrograms per injection at maintenance

9. What is an absolute indication for specific immunotherapy with inhalant allergens?
A. Cases of IgE-mediated allergic asthma
B. Sensitivities to allergens that cannot be avoided
C. Need for daily pharmacotherapy
D. There are no absolute indications

10. Which method of immunotherapy produces a local immunologic reaction without evidence of a systemic response?
A. Intranasal immunotherapy
B. Oral immunotherapy
C. Subcutaneous immunotherapy
D. Sublingual immunotherapy

Answers:
1. A, page 1460
2. D, page 1460
3. C, pages 1458, 1460
4. C, page 1461
5. B, page 1465
6. D, page 1466
7. B, pages 1463-1464
8. C, pages 1463-1464
9. D, page 1462
10. A, page 1469