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TAO LE BRET HAYMORE VIVIAN HERNANDEZ-TRUJILLO GERALD LEE ACAAI REVIEW FOR ALLERGY & S E C THE O N D E IMMUNOLOGY D I T I O N BOARDS Concise topic summaries ideal for quick review Hundreds of color images and tables that enhance study Key facts and mnemonics for easy memorization Embedded flashcards to test critical concepts ACAAI REVIEW FOR ALLERGY & THE IMMUNOLOGY BOARDS SECOND EDITION Tao Le, MD, MHS Associate Clinical Professor of Medicine and Pediatrics Chief, Section of Allergy and Immunology Department of Medicine University of Louisville School of Medicine, Kentucky Bret Haymore, MD Assistant Professor University of Oklahoma Health Science Center Medical Director, BreatheAmerica Tulsa, Oklahoma Vivian Hernandez-Trujillo, MD Director, Division of Allergy and Immunology Miami Children's Hospital Clinical Assistant Professor Herbert Wertheim College of Medicine Miami, Florida Gerald Lee, MD Assistant Professor Section of Allergy and Immunology Department of Pediatrics University of Louisville School of Medicine, Kentucky American College of Allergy, Asthma & Immunology ACAAI Review for the Allergy and Immunology Boards, Second Edition Copyright © 2013 by American College of Allergy, Asthma & Immunology. All rights reserved. Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. DEDICATION To our families, friends, and loved ones, who encouraged and assisted us in the task of assembling this guide. v CONTENTS Contributing Authors ix Senior Reviewers xi Preface xiii Acknowledgements xv How to Contribute xvii SECTION I. BASIC SCIENCE Chapter 1. Immune Mechanisms 1 Yong Luo MD, PhD & Joon H. Park, MD Antigens Major Histocompatibility Complex Cytokines, Chemokines, and Their Receptors Immunologic Tolerance Cell Adhesion Molecules Immunogenetics Complements and Kinins Immunoglobulins Mucosal Immunity T-Cell Receptors and Signaling Transplantation and Tumor Immunology B-Cell Receptor Signaling Innate Immunity and Toll-Like Receptors Chapter 2. Cells Involved in Immune Responses 67 Cindy Salm Bauer, MD & Michelle A Halbrich, MD Lymphocytes Platelets Monocytes, Macrophages, and Dendritic Cells Epithelial Cells Mast Cells Endothelial Cells Basophils Smooth Muscle Eosinophils Fibroblasts Neutrophils Chapter 3. Specific Immune Responses 93 Cindy Salm Bauer, MD Immediate Hypersensitivity Reactions Type III Hypersensitivity Reactions Type I Hypersensitivity Reactions Type IV Hypersensitivity Reactions Type II Hypersensitivity Reactions vi Chapter 4. Laboratory Tests 105 Michelle A Halbrich, MD, Hillary Hernandez-Trujillo, MD, & Ahila Subramanian, MD, MPH Immunoglobulin Measurement Phagocytosis and Cell Killing Mediator Detection Hybridoma and Monoclonal Antibodies Cell Surface Markers and Receptors Immune Complexes Lymphocyte Function: Cell Proliferation, Complement Cytokine Production, and Cytotoxicity Molecular Biology Technology Chemotaxis Chapter 5. Anatomy, Physiology and Pathology 157 Kusum Ahila Subramanian, MD, MPH Lymphoid System and Organs Skin Upper Airway (Nose, Sinuses, and Middle Ear) Gastrointestinal Remodeling of the Lower Airway Chapter 6. Research Principles 183 Hillary Hernandez-Trujillo, MD Experimental Design Informed Consent Data Analysis and Biostatistics Adverse Event Reporting Epidemiology SECTION II. CLINICAL SCIENCE Chapter 7. Hypersensitivity Disorders 193 Justin C. Greiwe, MD, Michelle A Halbrich, MD, Fatima S. Khan, MD, & Mariam Rasheed, MD Rhinitis Interstitial Lung Disease Sinusitis Chronic Obstructive Pulmonary Disease Otitis Media Food Allergy Conjunctivitis Anaphylaxis Atopic Dermatitis (Eczema) Stinging Insect Allergy Asthma Drug Reactions Occupational Disease Urticaria Lung Diseases Contact Hypersensitivity Allergic Bronchopulmonary Aspergillosis and Vaccine, Principles and Reactions Allergic Fungal Sinusitis Bronchiolitis Hypersensitivity Pneumonitis Croup Chapter 8. Immunological Disorders 297 Neeti Bhardwaj MD, MS, Timothy J. Campbell, MD, Michelle A Halbrich, MD, Fatima S. Khan, MD, & Pavadee Poowuttikul, MD Hereditary and Acquired Angioedema Immunologic Rejection and Organ Congenital (Primary) Immunodeficiencies Transplantation Acquired (Secondary) Immunodeficiencies Stem Cell Transplantation Systemic Autoimmune Disease Graft-Versus-Host Reaction vii Immune Endocrinopathies (Thyroid, Diabetes, Leukemias, Lymphomas, Myelomas and Adrenal) Granulomatous Diseases Immunologic Renal Diseases Amyloidosis Immunologic Skin Diseases Mastocytosis Immunologic Eye Diseases Immunohematologic Diseases Inflammatory Gastrointestinal Diseases Cystic Fibrosis Immunologic Neuropathies Reproduction and the Immune System Hypereosinophilic Syndromes Immunologic Aspects of Infectious Diseases Chapter 9. Pharmacology and Therapeutics 421 Ahmed Butt, MD & Jonathan Romeo, DO Allergen Avoidance Cytokine and Cytokine Receptor-Mediated Immunotherapy Therapy Histamine Antagonists Cellular Immune Reconstitution Theophylline Immunoprophylaxis Vaccine β Agonists and Blockers Apheresis Leukotriene Pathway Modulators Anti-inflammatory Agents Mast Cell Stabilizers Surgical Intervention With Sinuses and Middle Anticholinergics Ear Corticosteroids Controversial Treatments Immunomodulators and Immunosuppressives Cardiopulmonary Resuscitation Immunoglobulin Replacement Therapy Dermatologic and Ophthalmic Treatments Gene Therapy Chapter 10. Specific Diagnostic Modalities 485 Lisanne P. Newton, MD & Jonathan S. Tam MD Skin Tests (Immunoassay for Total and Specific Serologic Tests for Autoimmunity IgE) Molecular Diagnostics and Tissue Typing Nasal Provocation Imaging Pulmonary Function Tests Flow Cytometry and Cell Surface Markers Bronchial Provocation Controversial Tests Nasal and Sputum Smears Delayed Type Hypersensitivity Tests Mucociliary Function Food Challenge Serologic Tests Chapter 11. Allergens and Antigens 533 Howard C. Crisp, MD & Jonathan S. Tam MD Aerobiology Standardization & Stability of Antigens Pollens Autoantigens Molds and Fungi Infectious Agents Indoor Allergens Foods Pollutants Venom Allergen and Antigens About the Editors 577 ix CONTRIBUTING AUTHORS Cindy Salm Bauer, MD Hillary S. Hernandez-Trujillo, MD Physician, Division of Allergy and Immunology, Attending Physician, Connecticut Asthma & Department of Pediatric Pulmonology, Phoenix Allergy Center; Clinical Assistant Professor, Children's Hospital; Clinical Assistant Professor, Department of Pediatrics, University of Department of Child Health, University of Connecticut School of Medicine, Division of Arizona College of Medicine, Phoenix, Arizona Infectious Diseases and Immunology, Connecticut Children's Medical Center, West Neeti Bhardwaj MD, MS Harford, Connecticut Assistant Professor of Pediatrics, Division of Pediatric Allergy and Immunology, Department Fatima S. Khan, MD of Pediatrics, Penn State Milton S. Hershey Physician, Allergy/Immunology, Grand Forks, Medical Center, Penn State College of North Dakota Medicine, Hershey, Pennsylvania Yong Luo MD, PhD Ahmed Butt, MD Fellow, Division of Allergy and Immunology, Allergist/Immunologist, Allergy and Asthma Departments of Medicine and Pediatrics, North Centers of Fredericksburg and Fairfax, Shore-LIJ Health System, Great Neck, New Fredericksburg, Virginia York Timothy J. Campbell, MD Lisanne P. Newton, MD Fellow, Division of Allergy and Immunology, Fellow, Division of Allergy and Immunology, Department of Pulmonology, Allergy and Department of Pulmonology, Allergy and Critical Care Medicine. Respiratory Institute, Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Ohio Cleveland Clinic, Ohio Howard C. Crisp, MD Joon H. Park, MD Fellow-in-Training, Department of Allergy and Allergist and Immunologist, Clinical Allergy Immunology, Wilford Hall Ambulatory Surgical Center, Fairfax, Virginia Center, San Antonio, Texas Pavadee Poowuttikul, MD Assistant Professor, Assistant Program Director, Justin C. Greiwe, MD Allergy/Immunology, Children's Hospital of Fellow, Division of Allergy and Immunology, Michigan, Wayne State University, Detroit, Department of Pulmonology, Allergy and Michigan Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Ohio Mariam Rasheed, MD Assistant Professor of Pediatrics, Albert Einstein Michelle A Halbrich, MD College of Medicine, Division of Allergy and Fellow, Paediatric Clinical Immunology and Immunology, Department of Pediatrics; Allergy, McGill University, Montreal Children’s Attending Physician, The Children's Hospital at Hospital, Quebec, Canada Montefiore, New York, New York

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Fibroblasts. Chapter 3. Specific Immune Responses. 93. Cindy Salm Bauer, MD. Immediate Hypersensitivity Reactions. Type I Hypersensitivity Reactions . David Lang, MD. Chairman, Department of Allergy and. Immunology; Co-Director, Asthma Center;. Director, Allergy and Immunology Fellowship.