Allergy and Immunology
Review Corner

Allergy and Immunology Review Corner: Chapter 92 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Questions prepared by Drs. Bret R. Haymore, Walter Reed Army Medical Center, and Jiun Yoon, Walter Reed Army Medical Center

Chapter 92: Drug Allergy

1. Which of the following is most associated with anaphylactic reactions in penicillin allergic patients:
A. Major determinant
B. Minor determinant
C. Penicilloyl epitope
D. Penicillenic acid

2. Which of the following are by themselves able to act as immunogens (complete allergens):
A. Beta-lactam antibiotics
B. Quinidine
C. Antithyroid drugs
D. Insulin

3. Which of the following require haptenization in order to be immunogenic:
A. Insulin
B. Protamine
C. Beta-lactam antibiotics
D. Succinylcholine

4. What percent of prior penicillin reactors, including those with a history of anaphylaxis and urticaria, become skin test negative:
A. 25 percent
B. 50 percent
C. 75 percent
D. 100 percent

5. Which of the following is most associated with hemolytic anemia due to G6PD deficiency:
A. Penicillin
B. Tetracycline
C. Chloramphenicol
D. Primaquine

6. Which of the following is effective and often recommended as pretreatment for aspirin desensitization:
A. Diphenhydramine
B. Cetirizine
C. Montelukast
D. Another NSAID

7. Which Gel-Coombs classes is associated with pencillin immunopathologic reactions:
A. Type I
B. Type II
C. Type III
D. All of the above

8. Which of the following is most likely to produce a lupus-like syndrome:
A. Penicillin
B. Halothane
C. Isoniazid
D. Quinine

9. Which of the following is true concerning reactions to radiocontrast media:
A. Premedication with corticosteroids and antihistamines reduces risk of anaphylactoid reactions
B. Premedication reliably prevents IgE mediated reactions
C. Hypertonic media is preferred over isotonic media
D. Patients should refrain from ingesting seafood rich in iodine

10. What percentage of history-positive patients have a negative skin test to penicillin:
A. 5 percent
B. 20 percent
C. 50 percent
D. 80 percent

Answers
1. B, page1679
2. D, page 1681
3. C, page 1681
4. C, page 1684
5. D, page 1685
6. C, page 1689
7. D, page 1684
8. C, page 1683
9. A, page 1684
10. D, page 1687