医、技学院华盛顿医疗手册培训过敏和免疫学.pptVIP

Clinical Presentation The hallmark of PID is recurrent infections. Immunoglobulin A (IgA) deficiency is the most common immune deficiency, with a prevalence of 1 in 500 people. In 15% of cases, an associated immunoglobulin G (IgG) subclass deficiency is present. elevated levels of IgE. A marked increase in tissue and blood eosinophils may also be observed. Mutations in STAT3 have been linked to development of this disease (N Engl J Med 2007;357(16):1608). Initial evaluation should focus on identifying possible secondary causes of recurrent infection such as allergy, medications, and anatomic abnormalities. CBC with differential/ HIV test/ quantitative immunoglobulin levels/ and complement levels/B and T cells B-cell function A patient with normal or low IgG and a poor response to immunization is classified as having CVID. Diagnostic Testing IgA deficiency: No specific treatment is available. CVID should be treated with IVIG. Replacement should be initiated with 400 mg/kgPatients, especially those with no detectable IgA, need to have vital signs monitored q15min initially because anaphylaxis from IgE anti-IgA antibodies can develop in these patients. For these patients, it is best to use IVIG preparations that have very low IgA. Adverse drug reactions (ADRs) are a very common problem. Only a subset of reactions are mediated immunologically Classification Type A drug reactions Type B drug reactions Many different mechanisms can account for immunologically mediated drug reactions occur with relatively low doses of the drug, usually on reexposure after an initial sensitization to the drug. Pseudoallergic reactions (formerly called anaphylactoid reactions) β-Lactam sensitivity. Penicillins and other β-lactam antibiotics are commonly associated with immunologically mediated drug reactions. consists of three non-cross-reactive metabolites, termed the minor determinants. Immediate allergic reactions are most often related to the major determinant. In addition,