Immunology Review Corner

Chapter 85 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Drs. Bret Haymore, Walter Reed Army Medical Center; Soo Kim-Delio, Walter Reed Army Medical Center; and Nana Mireku, Children’s Hospital of Michigan.

Chapter 85: Urticaria & Angioedema

1. Which of the following is thought to be non-IgE mediated cause of urticaria?
A) Penicillin
B) Aspirin
C) Dog sensitivity
D) Hymenoptera sting

2. Sensitivity to this dye is reported in up to 15 percent of patients with urticaria related to asthma
A) Yellow no. 40
B) Red no. 40
C) Red no. 5
D) Yellow no. 5

3. The antihistamine most effective for cold-induced urticaria
A) Diphenhydramine
B) Fexofenadine
C) Cyproheptadine
D) Hydroxyzine

4. Which of the following statements best describes a component of exercise-induced anaphylaxis from cholinergic urticaria?
A) Lesions in exercise-induced urticaria are characterized by small punctuate lesions.
B) Anxiety is a major component and trigger of exercise-induced anaphylaxis.
C) Patients with exercise-induced anaphylaxis have a low incidence of atopy compared to other physical urticarias.
D) Exercise is the precipitating stimulus in cholinergic urticaria and exercise-induced anaphylaxis

5. The drug of choice for the management of cholinergic urticaria
A) Diphenhydramine
B) Fexofenadine
C) Cyproheptadine
D) Hydroxyzine

6. Low levels of this complement component most help distinguish between hereditary and acquired angioedema
A) C1
B) C2
C) C3
D) C4

7. Which 3 fragments of complement components act as anaphylotoxins?
A) C3a, C4a, C5a
B) C3, C4, C5
C) C6, C7, C8
D) C2b, C4b, C5b

8. What form of urticaria occurs mainly in children, generally on extremities at the site of insect bites?
A) Urticaria pigmentosa
B) Papular urticaria
C) Erythema multiforme
D) Solar urticaria

9. Which of these statements best characterizes chronic urticaria?
A) Biopsy of lesions reveal evidence of increased vascular permeability, edematous tissue and little or no cellular infiltrate.
B) Lesions appear quickly and usually disappear in 2 to 3 hours.
C) Biopsy typically reveals a non-necrotizing perivascular mononuclear cell infiltrate.
D) Steroids are first-line treatment for chronic urticaria.

10. What is the test for the characteristic lesions of cholinergic urticaria?
A) Apply a test tube of warm water at 44 degrees Centigrade to the arm for 4-5 minutes.
B) Immersion in a hot bath
C) Exercise while wearing an occlusive body suit
D) Intradermal injestion of 0.01 mg if methacholine in 0.1 ml saline

Answers:
1. B, page 1540
2. D, page 1540
3. C, page 1543
4. D, page 1544
5. D, page 1545
6. A, page 1549
7. A, page 1537
8. B, page 1542
9. C, page 1541
10. D, page 1545